The Impact of COVID-19 on Radiotherapy Services in Scotland, UK: A Population-based Study

AIMS

The effect of the COVID-19 pandemic on cancer radiotherapy services is largely unknown. The aim of the present study was to investigate the impact of the resultant contingency plans on radiotherapy cancer services in Scotland.

MATERIALS AND METHODS

Detailed data of radiotherapy activity at our centre were collected from 1 April 2019 to 31 March 2021. Differences in mean weekly radiotherapy courses, dose and fractionation patterns and treatment intent were compared with corresponding pre-pandemic months for all treatment sites. Qualitative data were collected for a subgroup of radical radiotherapy patients.

RESULTS

Total radiotherapy courses decreased from 6968 to 6240 (-10%) compared with the previous year, prior to the pandemic. Average weekly radiotherapy courses delivered were 134 (standard deviation ±13), decreasing by 10% to 120 (standard deviation 15) (Welch's t-test, P < 0.001). The greatest decrease in new start treatment courses was observed from May to August 2020 (-7.7%, -24.0%, -16.7% and -18.7%) compared with the corresponding months in 2019. A significant reduction was seen for female patients <70 years (-16%) compared with females >70 years (-8%) or their male counterparts (-7% and -6%, respectively). By diagnosis, the largest reductions between pre- and post-pandemic levels were for anal (-26%), breast (-18%) and prostate (-14%) cancer. Contrarily, a significant increase was found for bladder (28%) and oesophageal (11%) cancers.

CONCLUSIONS

Over the first 12 months of the COVID-19 pandemic, radiotherapy activity significantly decreased compared with the 12 months prior. Due to issued guidance, the use of hypofractionated regimens increased, contributing to the reduction in treatments for some tumour sites. An increase in other tumour sites can probably be attributed to the reduction or cancellation of surgical interventions. These results will inform our understanding of the indirect consequences of the pandemic on radiotherapy services.

A statistical alternative to current measures of image quality in digital mammography

Objective. Mammogram image quality in European breast screening systems is defined by threshold gold thickness (T) assessment of the CDMAM contrast-detail phantom. Previous studies have outlined several limitations of the phantom including expense, number of images required and inter-phantom manufacturing variability. Two alternative approaches to image quality assessment for routine quality control are examined and compared to the CDMAM technique: (i) A detectability index (d′) based on a non-prewhitened model observer with an eye filter (NPWE) and (ii) A statistical estimate of contrast based on image noise levels (CSTAT ). Approach. The d′ calculation follows a previously published methodology based on the NNPS and contrast, both measured from an image of 5 cm of PMMA containing a 0.2 mm Al target, as well as the MTF measured under standard conditions. For the proposed statistical method, pixels in the centre of the same NNPS image were re-binned into a range of equivalent CDMAM target areas. For any area, the minimum contrast necessary to distinguish a signal from the background, CSTAT , is 3.29σ at a 95% level of confidence, where σ is the standard deviation of the background pixels. Theoretical analysis predicts a simple relationships between CSTAT , T and d′. Measured values of CSTAT were compared to T and d′ as a function of air kerma at the detector for ten digital mammography systems from three different manufacturers. Main Results. Theoretical relationships between CSTAT , d′ and T were demonstrated. Minimum acceptable image quality performance for 0.10 and 0.25 mm diameter discs, defined by the European Guidelines in terms of T, are equivalent to d′ values of 0.85 and 5.36 and threshold CSTAT values of 0.055 and 0.022. Significance. Strong correlations between log(T), log(d′) and log(CSTAT ) suggest that either alternative approach produces information corresponding to that obtained using the CDMAM. CSTAT should be considered as a simple, objective and cost-effective alternative to routine image quality assessment in mammography.

A one-generation reproductive toxicity study of the mycotoxin ochratoxin A in Fischer rats

Ochratoxin A (OTA) is a mycotoxin produced by Aspergillus and Penicillium molds. Grain-based foods account for most human dietary exposures to OTA. OTA is a teratogen, but its reproductive and developmental effects are poorly understood. A one-generation reproductive toxicity study was conducted with groups of 16 male and 16 female Fischer rats exposed to 0, 0.026, 0.064, 0.16, 0.4 or 1.0 mg OTA/kg in diet. Dams exposed to 1.0 mg OTA/kg diet had statistically significant F1 pup losses between implantation and postnatal day (PND 4). Delays in preputial separation (PPS) and vaginal opening (VO) were indicative of delayed puberty in F1 rats. Mild renal lesions in nursing pups indicated that exposure prior to weaning impacted the kidneys. The developing kidney was more susceptible to OTA than the adult kidney. Significant increases in multi-oocyte follicles (MOFs) and proportional changes in resting and growing follicles were observed in F1 female ovaries. Plasma testosterone was reduced in F0 males, and there were negative effects on sperm quality in F0 and F1 male rats. The results confirm that continuous dietary exposure to OTA causes post-implantation fetotoxicity in dams, and renal and reproductive toxicity in their male and female offspring.

Multiple risk behaviour and socioeconomic status during the transition from adolescence to adulthood

Background

Multiple risk behaviour (MRB) means the occurrence of two or more risk behaviours and is associated with a range of negative outcomes. What is unknown is whether MRB is associated with socioeconomic status (SES) in adulthood. This study aimed to examine the association between adolescent MRB and young adult SES and whether those who experienced early life socioeconomic disadvantage also faced greater negative impact of adolescent MRB.

Methods

Two prospective birth cohort studies; British Cohort Study 1970 (BCS70) and Avon Longitudinal Study of Parents and Children (ALSPAC), born in 1991-1992, were used. Logistic regression assessed the association between MRB and young adult SES. Three early life SES variables were examined for their moderating effect on the association using models with and without interaction parameters. Likelihood ratio tests ≤p=0.05 indicated evidence to support moderation. Multiple imputation was used to account for missing data.

Results

Adolescent MRB was negatively associated with young adult SES (university degree attainment) in BCS70 (OR 0.81, 95% CI: 0.76, 0.86) and ALSPAC (OR 0.85, 95% CI: 0.82, 0.88). There was a dose response, with each additional risk behaviour resulting in reduced odds of university degree attainment. In BCS70, maternal education (p = 0.03), parental occupation (p = 0.009) and household income (p = 0.03) moderated the effect of adolescent MRB on young adult SES. The effect of MRB on university degree attainment was stronger for those from poorer socioeconomic backgrounds. No evidence of moderation was found in ALSPAC.

Conclusions

Adolescence is a critical time to address MRB as behaviours established here may have effects in adulthood. Intervening on adolescent MRB may improve later SES and thus health outcomes later in life. Evidence for a moderation effect in the BCS70 but not ALSPAC suggests that measures should be investigated for their ability to capture the nuance of contemporary young adult SES.

Key messages

Intervening on adolescent multiple risk behaviour could improve socioeconomic life chances in young adulthood. Variables that capture the nuance of contemporary young adult socioeconomic status should be explored.

Effectiveness of school-based interventions to prevent anxiety & depression in young people

Background

The prevalence of anxiety and depression is increasing among children and young people (CYP). Evidence suggests 1/2 of mental illness is apparent by age 14 and 3/4 by early adulthood. Globally, there is growing interest in prevention of anxiety and depression in CYP.

Methods

We report the findings from a systematic review and network meta-analysis (NMA) of school-based interventions to prevent anxiety and depression in CYP. NMA enables the simultaneous comparison of multiple interventions in a single evidence synthesis, retaining the identity of each intervention analysed and ranking of interventions according to the probability that each is best for a given outcome. Bayesian analyses were conducted in OpenBUGS, & random effects NMA were conducted for the primary outcomes of post-intervention self-report anxiety and depression.

Results

NMA were conducted for universal and targeted populations, in primary, secondary & tertiary educational settings. In universal primary settings, there is no evidence that any intervention reduced depression or anxiety. In universal secondary settings, CBT & mindfulness-based interventions suggest a reduction in anxiety symptoms relative to usual curriculum but was not observed for depression symptoms. In targeted secondary settings, exercise appears effective for reducing anxiety symptoms relative to no intervention. For prevention of depression symptoms, CBT appears effective. In targeted primary settings, there is no evidence that any intervention is effective. Few tertiary institution-based interventions met our inclusion criteria.

Conclusions

standard meta-analyses require lumping over interventions such that intervention specific effects may be masked (e.g. psychological intervention vs control). This NMA has identified the specific interventions which may prevent anxiety and depression in CYP. However, we observed considerable uncertainty and no intervention appears effective across every population and setting.

Key messages

Network meta-analysis enables the simultaneous comparison of multiple interventions in a single evidence synthesis, retaining the distinct identity of each intervention analysed. We observed considerable uncertainty for effectiveness of school-based interventions to prevent anxiety and depression. No single intervention appears effective across every population and setting.

Deoxynivalenol-3-sulphate is the major metabolite of dietary deoxynivalenol in eggs of laying hens

Previous studies reported very low carry-over of dietary deoxynivalenol (DON) into eggs of laying hens. However, recent studies showed that DON is extensively metabolised to DON-3-sulphate (DON-3S) in chickens. We therefore hypothesised that DON-3S might also be a major DON metabolite in eggs of laying hens fed with DON contaminated diet. The aim of the work was to develop, validate and apply an LC-MS/MS based method for determination of DON, deepoxy-DON (DOM), DON-3S, and DOM-3-sulphate (DOM-3S) in freeze-dried eggs of laying hens. Laying hens were allocated to three treatment groups (negative control (NC); DON low (3.8 mg/kg DON in feed); DON high (7.5 mg/kg DON in feed)) and eggs were collected in the 5th, 7th and 10th week of the trial. DON-3S was identified as the major DON metabolite in eggs for the first time with average concentrations in fresh eggs <0.74 ng/g in the NC, 4.4-6.4 ng/g in the DON low group and 7.9-9.7 ng/g in the DON high group. DON-3S was also the major DON metabolite in chicken plasma, with average concentrations of 6.8±4.1 and 10±7 ng/ml in the DON low and DON high group, respectively. Experiments with intestinal explants indicated that DON-3S is in part already formed in intestinal mucosa cells. Considering the carry-over factor of 0.001, the European guidance value of DON in poultry feed (5 mg/kg), the tolerable daily intake of DON (1 μg/kg body weight and day) and the average egg consumption in Europe (0.5 egg/day/person), there is no significant health risk due to carry-over of DON or DON-3S into eggs, even if the per se non-toxic metabolite DON-3S might be hydrolysed back to free DON in the gut of the egg consumer.

Abstract P5-08-17: Breast cancer in octagenerians: A community hospital experience

Background : Breast cancer incidence increases with age. However Elderly patients are undertreated and underdiagnosed affecting their overall survival with limited availabilty of clinical trial data

Patients and Methods : We used the data from our cancer registry to evaluate the cases of breast cancer diagnosed between the years 2005-2010 with follow up data available to date to examine the method of diagnosis(mammogram vs palpable abnormality ), Age at diagnosis, Stage at diagnosis, Type of surgery (BCT Vs Mastectomy ), Receptor status(ER/PR/Her 2 neu) and treatment's received ( Hormonal therapy , Radiation therapy and chemotherapy) and average survival after the diagnosis of breast cancer. Data regarding the causality of death was not readily available as part of the registry data.

Results : A total of 495 breast cancer cases diagnosed in the years between 2005-2010 wee identified ., Median age at diagnosis was 85 with ages ranging from 81-102 .Out of the 495 patients 55 % were diagnosed with a mammogramand 41 % by palpable abnormality. Patients were diagnosed at Stage 0,1,2,3,4 (12%,45 %,7% ,3 %. 55% underwent Lumpectomy and 31 % underwent Mastectomy .82 % and 18 % ER negative. Her 2 data was only available in 59 patients, out of those tested only 4 Her 2 positive. , Radiation(34 %) /Chemo(6 %)/ Hormone(34%) ,Radiation/Chemo 2 % ,Radiation/Hormone 18%, Chemo/Hormon 2% , 41 % didn't proceed with any treatments.Median survival was 54 months and Average survival was 56 months. Median survival 54 months and average survival was 56 months, With 203 patients alive at the end of 5 years with mortality of about 62 %. However we do not have the data of causality of death in these patient .

Comparison between Age Groups : See table below

Comparision of data b/n Age groupsAge at Diagnosis80-8485-8990 +No of patients24419256Mammogram13810532Palpable Lump947924Lumpectomy1576724Mastectomy803026Average Survival in months84.54848.5

Conclusion: Even though Surgery was performed in most the patients , Only 50 % or lesser number of patients had Adjuvant treatment with Endocrine , Radiation and chemotherapy. Based on the data even though most patient were diagnosed with early stage breast cancer , had significantly poor survival with median survival of about 54 months . With Survival dramatically dropped from 84 months to 48 months in patient 85 + years of age.

Citation Format: Gadiyaram V, Caldwell D. Breast cancer in octagenerians: A community hospital experience [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-08-17.

Concurrent supplementation of arginine and antioxidant vitamins E and C reduces oxidative stress in broiler chickens after a challenge withEimeriaspp

Dominguez P.A., Pro-Martinez, A., Narciso-Gaytán, C., Hernández-Cázares, A., Sosa-Montes, E., Perez-Hernandez, P., Caldwell, D. and Ruiz-Feria, C. A. 2015. Concurrent supplementation of arginine and antioxidant vitamins E and C reduces oxidative stress in broiler chickens after a challenge with Eimeria spp. Can. J. Anim. Sci. 95: 143–153. Oxidation is a major problem associated with pathogen damage in animals. One-day-old mixed-sex broiler chicks (Cobb 500; n=624) were randomly assigned to one of six treatments: a basal diet [CTL; 40 mg of vitamin E (VE) kg−1of feed and 1.5% Arginine (Arg)] or the basal diet plus Arg (ARG; 0.3%), Arg+VE (AVE; 0.3% and 40 mg kg−1respectively), Arg+vitamin C (VC) (AVC; 0.3% and 1 g kg−1respectively), VE+VC (VEC; 40 mg+1 g kg−1respectively), or Arg+VE+VC (AVEC; 0.3%+40 mg+1 g kg−1respectively). At day 14, all birds were orally challenged with 100× the normal dose of Advent®coccidiosis vaccine (450 000 oocysts). Intestinal lesion scores (LS) in duodenum, jejunum and ceca were recorded, along with relative immune system organ weights at day 23. Plasma samples were taken before (2 h) and after challenge (12, 24 and 48 h) to determine malondialdehyde (MDA), nitric oxide (NO) and glutathione peroxidase activity (GPx). Birds fed the VEC diet were heavier at 7 d (P<0.05) than birds fed the AVE diet. CTL birds had heavier (P<0.05) bursas than AVC birds; no differences among treatments for spleen and thymus were found. The jejunum LS was lower in the AVC and VEC birds than in CTL birds, whereas ceca LS was highest in AVE birds, and the duodenum LS was not affected by treatment. Birds fed the AVEC diet had the lowest MDA levels before challenge, but higher levels of MDA than birds fed the CTL, ARG or AVE 12 h after challenge. Before challenge ARG birds had higher (P<0.05) NO levels than AVEC-fed birds, but 12 h after challenge birds fed the CTL, ARG or AVE diet had lower NO levels than birds fed the AVC, VEC or AVEC diet. Before challenge AVEC-fed birds had higher (P<0.001) GPx activity than CTL, ARG and AVE birds, but after 12, 24 and 48 h VEC birds showed higher GPx activity than CTL, ARG- and AVE-fed birds. Although Arg, VE and VC, modulated oxidative stress during coccidiosis challenge, the effects were not sufficient to affect performance relative to the control diet.

Pasteurization of chicken litter with steam and quicklime to reduce Salmonella Typhimurium

The nursery industry pasteurizes soil with steam and quicklime to reduce plant pathogens. The mechanism of action for quicklime is the resulting exothermic reaction that occurs when the chemical interacts with water and its ability to increase pH levels. These treatments may also reduce pathogens in a commercial poultry house. In this study, a steam sterilization cart simulated conditions used by the nursery industry to treat litter inoculated with Salmonella enterica serovar Typhimurium. A homogenized sample of litter was exposed to steam for 0, 5, 30, or 120 min. Quicklime was used at concentrations of 0 (control), 2.5, 5.0, or 10.0%. All steam treatments, with or without quicklime, significantly reduced Salmonella Typhimurium colonization by at least 3 orders of magnitude. Significant reductions were also observed in the treatments with quicklime alone. Both the steam and the quicklime treatments often reduced colonization to undetectable levels, even when samples were enriched. Therefore, we demonstrated 2 novel techniques for reducing Salmonella Typhimurium in poultry litter. Soil pasteurization potentially offers an environmentally sound means of reducing the pathogens present in used poultry litter.

Immune response of broiler chickens fed different levels of arginine and vitamin E to a coccidiosis vaccine and Eimeria challenge

One-day-old broiler chicks (n = 300) were orally vaccinated (Coccivac-B) and divided into 6 groups to evaluate Arg at 3 levels of supplementation, 0, 0.3, or 0.6% [normal level (NARG), medium level (MARG), or high level (HARG), respectively], and 2 levels of vitamin E (VE), 40 or 80 IU/kg of feed (VE40 or VE80, respectively), in a factorial experiment. Birds were reared in floor pens with fresh pine shavings and provided a corn-soybean-based diet and water ad libitum. At d 14, all chickens were orally challenged with a mixture of Eimeria field isolates (Eimeria acervulina, Eimeria maxima, and Eimeria tenella). In vitro heterophil and monocyte oxidative burst (HOB and MOB, respectively) was measured at d 21 from cells isolated from peripheral blood. Antibody levels (IgG, IgM, and IgA isotypes, ELISA) and NO were measured at d 14 and 28. The HOB was lower in birds fed the VE40 diets but was increased with the MARG and HARG treatments, whereas birds fed the VE80 diet had a higher HOB irrespective of Arg level. Birds fed the VE80 diet had high levels of MOB, which was not further improved by Arg, whereas birds fed the VE40-MARG diet had the highest MOB response. Plasma NO was not affected by diet at d 14, but at d 28, plasma NO was higher in birds fed the VE80-MARG or the VE40-NARG diet and lower in birds fed the VE80-NARG or the VE40-MARG diet. Birds fed the VE40-HARG or VE80-MARG diet had the highest IgG levels at d 14, but at d 28, birds fed the VE80-MARG diet had the highest IgG levels. The IgM concentration was lower in birds fed NARG levels irrespective of VE levels at d 14, but at d 28, IgM levels were higher in birds fed the VE40-HARG or the VE80-MARG feed. The IgA concentration was not consistently affected at d 14 or 28. These results suggest that Arg and VE fed at levels higher than those recommended by the NRC may play complementary roles on the innate and humoral immune response against an Eimeria challenge, potentially improving vaccine efficacy and response to field infections.

Effect of the seaweed Ascophyllum nodosum on lambs during forced walking and transport

The objective of this study was to determine the effect of feeding Ascophyllum nodosum (ANOD) to lambs at 0 (control), 0.5, 1, or 2% of DMI/d for 2 wk on lamb physiology in response to forced walking and transport during hot weather. Forty-four lambs (26 kg +/- 4.3) were used, and each lamb swallowed 3 gelatin capsules filled with ANOD or their normal 16% CP, pelleted grain ration twice daily, with the amount of ANOD dependent on the treatment. The amount of ANOD did not affect ear canal temperature or cortisol concentrations during 60 min of forced walking. The range between the minimum and maximum ear canal temperature for each lamb during 12 h of transport was narrower in lambs receiving the 2% ANOD than the control group (P = 0.05), and the 2% ANOD group also had lower (P = 0.05) ear canal temperatures than the control group during hot periods of transport. After 4 (P = 0.09) and 8 h (P = 0.05) of transport, the control group tended to have greater cortisol concentrations than the 2% ANOD group. Many differences among treatments were found in plasma protein, albumin, calcium, phosphorus, glucose, blood urea nitrogen, aspartate aminotransferase, magnesium, sodium, potassium, and chloride concentrations posttransport; mainly, the control and 0.5% ANOD groups had greater (P < 0.05) concentrations than the other 2 treatments. Aldosterone concentrations were greater in the control and 0.5% ANOD group than in the 1 and 2% ANOD groups before transport, whereas the concentrations were not different after transport, suggesting pretransport concentrations were lowered by supplementation. The 1 and 2% ANOD groups lost more BW than the control group as a result of transport (P = 0.04). After transport, no differences were observed in the latency for lambs to drink, eat, or lay. There was a suppression of the IgG and IgM antibody responses at 4 and 7 d after administration of ovalbumin, with greater ANOD supplementation rates suppressing antibody response the greatest. Although ANOD decreased ear canal temperature in hot periods of transport, stabilized electrolyte concentrations, and decreased cortisol throughout transport, it also suppressed the antibody response indicating that the effect of ANOD on immune function merits further investigation.

Phase II trial of intravenous lobradimil and carboplatin in childhood brain tumors: a report from the Children’s Oncology Group

BACKGROUND

[corrected] Lobradimil is a synthetic bradykinin analog that rapidly and transiently increases the permeability of the blood-brain barrier (BBB). The combination of lobradimil and carboplatin was studied in pediatric patients with primary brain tumors in a phase II trial, the primary endpoints of which were to estimate the response rate and time to disease progression.

PATIENTS AND METHODS

Patients were stratified by histology into five cohorts: brainstem glioma, high-grade glioma, low-grade glioma, medullobastoma/primitive neuroectodermal tumor (PNET), and ependymoma. Patients received carboplatin adaptively dosed to achieve a target AUC of 3.5 mg min/ml per day (7 mg.min/ml/cycle) intravenously over 15 min on 2 consecutive days and lobradimil 600 ng/kg ideal body weight/day on 2 consecutive days each 28 day cycle.

RESULTS

Forty-one patients, age 2-19 years, were enrolled; 38 patients, including 1 patient ultimately determined to have atypical neurocytoma, were evaluable for response. No objective responses were observed in the brainstem glioma (n=12) and high-grade glioma (n = 9) cohorts, although two patients with high-grade glioma had prolonged disease stabilization (>6 months). The study was closed for commercial reasons prior to achieving the accrual goals for the ependymoma (n = 8), medulloblastoma/PNET (n = 6) and low-grade glioma (n = 2) cohorts, although responses were observed in 1 patient with PNET and 2 patients with ependymoma.

CONCLUSION

The combination of lobradimil and carboplatin was inactive in childhood high-grade gliomas and brainstem gliomas.

Oral (gavage), in utero and postnatal exposure of Sprague-Dawley rats to low doses of tributyltin chloride. Part 1: Toxicology, histopathology and clinical chemistry

Tributyltin (TBT) is a biocide that contaminates foods, especially shellfish. TBT is an endocrine disrupter in several marine species and is neurotoxic and immunotoxic in mammals. We have examined the effects of exposure to low doses of tributyltin chloride (TBTC) from day 8 of gestation until adulthood. Pregnant rats were gavaged daily with 0, 0.025, 0.25 or 2.5 mg TBTC/kg body weight from day 8 of gestation until weaning. Stomach contents of suckling pups contained undetectable levels of TBT and dibutyltin (DBT) levels were detectable only in the highest TBTC dose used, indicating negligible lactational transfer to pups. Post weaning, pups were gavaged daily with the same dose of TBTC administered to their mothers and sacrificed on post-natal days (PND) 30 (males and females), 60 (females) and 90 (males). TBTC had no effects on dams' body weights, food consumption, litter size, sex ratio or survival of pups to weaning. However, all doses of TBTC significantly affected parameters of the growth profile of the pups (mean body weights, average slope, curvature) and the ratio of weekly food consumption to weekly body weight gain indicated enhanced food conversion to body mass in females but a decreased conversion in males. Liver, spleen and thymus weights were also affected by TBTC. In male pups dosed at 2.5 mg/kg/day, reduced serum thyroxine levels were evident, indicating that the thyroid is a target for TBTC toxicity. No histopathological lesions were seen in the liver but elevated serum alanine aminotransferase, gamma-glutamyl transferase and amylase indicated hepatotoxicity. Significant decreases in liver weights in female pups exposed to 0.025 mg/kg/day TBTC were observed at PND 60. Decreases in spleen and thymus weights also pointed towards toxic effects of TBTC on the immune system. The 0.025 mg/kg/day TBTC should have been a no affect dose and yet this dose caused significant effects on growth profiles, decreased liver weights and elevated serum GGT levels in females.

Oral (gavage), in utero and post-natal exposure of Sprague–Dawley rats to low doses of tributyltin chloride

The immunotoxic effects of tributyltin chloride (TBTC) were examined in the offspring of Sprague-Dawley rats exposed in utero from day 8 of gestation, through lactation and post-weaning until pups reached the age of 30 days (male and female), 60 days (female) and 90 days (male). Daily oral (gavage) doses of 0.025, 0.25 and 2.5 mg/kg body weight/day were administered in olive oil 7 days/week. Immunologic endpoints were investigated at the termination of each study. Statistically significant results (P<0.05) included the following: At 30 days, the mean percent and absolute natural killer (NK) cell numbers were increased in male and female rats treated with the high TBTC dose. At 60 days, female rats had increased mean serum IgM levels at the low and high TBTC doses, increased mean percentage CD4(+)8(+) (immature) T lymphocytes at the middle and high doses, a non-linear dose-response increase in NK cell activity at the 50:1 and 100:1 effector:target cell ratios (pairwise comparisons significant at the low dose compared with control), and increased mean numbers of L. monocytogenes colony-forming bacteria on Day 2 post-infection (significant for trend) and Day 3 post infection (pairwise comparisons significant only in the middle dose). The 90-day male rats had decreased mean serum IgA levels at the middle dose group; increased IgM levels at the high dose group, increased IgG levels at the middle and high doses; decreased IgG2(a) in the high dose compared to the control; a dose-related increase in the mean percentage NK cell numbers (pairwise comparisons significant at the high dose compared with the control) and increased mean NK cell activity (pairwise comparisons significant at all dose groups compared with the control). The delayed-type hypersensitivity response to oxazolone was increased in the low and middle doses and decreased in the high dose. Thymus atrophy was observed in the high TBTC dose across all ages. Thus, in utero and post-natal treatment of F1 rats with low levels of TBTC affected some aspects of humoral and cell mediated immunity as well as the number and function of cells which are involved in the host's immunosurveillance mechanisms against tumours and viral infections.

A depletable pool of adenosine in area CA1 of the rat hippocampus

Adenosine plays a major modulatory and neuroprotective role in the mammalian CNS. During cerebral metabolic stress, such as hypoxia or ischemia, the increase in extracellular adenosine inhibits excitatory synaptic transmission onto vulnerable neurons via presynaptic adenosine A(1) receptors, thereby reducing the activation of postsynaptic glutamate receptors. Using a combination of extracellular and whole-cell recordings in the CA1 region of hippocampal slices from 12- to 24-d-old rats, we have found that this protective depression of synaptic transmission weakens with repeated exposure to hypoxia, thereby allowing potentially damaging excitation to both persist for longer during oxygen deprivation and recover more rapidly on reoxygenation. This phenomenon is unlikely to involve A(1) receptor desensitization or impaired nucleoside transport. Instead, by using the selective A(1) antagonist 8-cyclopentyl-1,3-dipropylxanthine and a novel adenosine sensor, we demonstrate that adenosine production is reduced with repeated episodes of hypoxia. Furthermore, this adenosine depletion can be reversed at least partially either by the application of exogenous adenosine, but not by a stable A(1) agonist, N(6)-cyclopentyladenosine, or by endogenous means by prolonged (2 hr) recovery between hypoxic episodes. Given the vital neuroprotective role of adenosine, these findings suggest that depletion of adenosine may underlie the increased neuronal vulnerability to repetitive or secondary hypoxia/ischemia in cerebrovascular disease and head injury.

Abdominal wound with enterocutaneous fistula: a case study

The care of an elderly male surgical patient with an enterocutaneous fistula located in an abdominal wound is described. The fistula is believed to have been related to multiple surgeries, wound dehiscence, and malnutrition. This article presents a brief overview of enterocutaneous fistulas and a pictorial demonstration of an alternative wound management technique that was used intermittently over several months to contain corrosive intestinal effluent until a commercial wound manager could be instituted.

Biofilms, the customized microniche

Images

Septo-optic dysplasia: the clinical insignificance of an absent septum pellucidum

Neurodevelopmental assessments were performed on seven patients with optic nerve hypoplasia and absence of the septum pellucidum on MRI. The evaluation included neurological status, language development, neuropsychological functioning, and behavioral and emotional adjustment. Six of the seven were found to have normal cognitive development, intact neurological status, normal language development and age-appropriate behavior. Abnormal findings included early poor motor coordination, which was felt to be closely related to decreased visual acuity, as well as subtle visual attentional problems which occurred even in patients who had normal vision in one eye. Congenital absence of the septum pellucidum was not associated with significant intellectual, behavioral or neurological deficits in the majority of these patients.

Continuing education requirements to maintain occupational therapy licensure

Different states use a variety of regulatory mechanisms to monitor the quality of practice in occupational therapy. The requirement for mandatory continuing education has been adopted by fewer than half of American states, but there is reason to predict that this trend will increase. This study investigates the patterns linking licensure to continuing education and recommends actions to ensure uniformity and accountability.

Effect of anaerobic cecal microflora and dietary lactose on colonization resistance of layer chicks to invasive Salmonella enteritidis

The effect of oral inoculation with anaerobic cultures of cecal microflora and providing lactose in the feed on colonization resistance to invasive Salmonella enteritidis was evaluated in newly hatched leghorn chicks. Salmonella colonization of the ceca, tissue invasion and organ colonization, horizontal transmission, and seroconversion were significantly decreased (P less than 0.01) in chicks inoculated with cecal flora. The addition of lactose to the feed, in the absence of cecal microflora, failed to provide protection. Dietary lactose enhanced colonization resistance in chicks that were inoculated with anaerobic cultures of cecal flora. The results indicated that establishment of normal cecal flora in layer chicks together with the addition of lactose to the diet markedly increases resistance to cecal colonization and organ invasion, and decreases horizontal transmission of S. enteritidis.

Early detection of carpal erosions in patients with rheumatoid arthritis: a pilot study of magnetic resonance imaging

A pilot study comparing standard radiography to magnetic resonance imaging (MRI) was performed on the wrists of 10 patients with early (anatomic Stage I or II) rheumatoid arthritis (RA). MRI was found to be superior to standard radiographs in 2 respects: (1) synovial inflammation was impressively demonstrated on T2 weighted images, whereas plain films merely suggested soft tissue swelling; and (2) T1 and T2 weighted images clearly revealed erosions of several carpal bones which were not noted on standard radiographs. Although the expense of MRI currently precludes its routine use in clinical practice, the apparent sensitivity of this diagnostic modality for detecting early changes in RA might make it an invaluable tool for therapeutic decision making or for assessing response in interventional trials.

Abnormalities of plasma and erythrocyte essential fatty acid composition in epidermolysis bullosa: influence of treatment with diphenylhydantoin

The fatty acid composition of plasma and erythrocyte phospholipids was determined in children with various subtypes of epidermolysis bullosa (EB) and in their parents. Patients with recessive dystrophic, dominant dystrophic, simplex, or junctional forms of EB had a higher percentage composition of arachidonic acid in plasma and/or erythrocyte phospholipids compared to age-matched controls. Epidermolysis bullosa patients treated with diphenylhydantoin had lower levels of arachidonic acid in plasma and erythrocyte phospholipids than did untreated EB patients. Parents of children with the recessive dystrophic or junctional EB subtypes had higher linoleic and arachidonic acids in plasma and erythrocyte phospholipids than did controls. Plasma and erythrocyte total lipids were within the normal range in children with EB. Plasma zinc was also normal but plasma copper was elevated in children with recessive dystrophic EB. We conclude that higher arachidonic acid in plasma and erythrocytes may be related to the pathology of EB.

Treatment of junctional epidermolysis bullosa with epidermal autografts

We have successfully treated chronic facial erosions in three boys with junctional epidermolysis bullosa. In each patient, keratinocytes were harvested from the roof of suction blisters created on clinically uninvolved skin. They were grown in tissue culture on collagen sponges and grafted onto facial erosions that were previously treated with 2% mupirocin ointment. This experimental antibiotic ointment has proved efficacy in eradicating cutaneous pathogens such as Staphylococcus aureus from chronic wounds. In two patients, complete reepithelialization was achieved over 7 and 10 months, respectively, and partial reepithelialization occurred in another patient in whom treatment is ongoing. Epidermal autografts are a promising means for improving function and appearance in eroded skin caused by junctional epidermolysis bullosa.

Interstitial deletion and ring chromosome derived from 16q

An interstitial deletion of 16q was identified in an infant with failure to thrive, dysmorphic facies, and congenital heart defects. The mother of this infant had a similar deletion of 16q with ring formation of a fragment presumed to be derived from the deleted portion of 16q. We discuss these cases and compare them to other reports of 16q deletions.

Phenol cauterization for ingrown toenails

A new clinic was set up to deal with all toenail problems referred to a large general hospital. Ingrowing toenails were the commonest problem dealt with and phenol cauterization, either partial or complete, was the standard form of treatment. Over a 2-year period 1013 phenol cauterizations were carried out on 631 patients. After a minimum of 12 months follow-up, the recurrence rate was 2.96%. All recurrences were successfully treated by repeat phenol cauterization. We conclude that phenol cauterization should replace surgical ablation in the treatment of ingrown toenails.

Grafting of skin ulcers with cultured autologous epidermal cells

We treated five adult individuals with six full-thickness chronic ulcerations in the skin caused by venous insufficiency, sickle cell anemia, or surgical wounds. Each patient received applications to the ulcerations of sheets of autologous epidermal cells grown in culture. All patients experienced relief of pain after grafting. Four of the six ulcers healed completely in 21 to 35 days, and three of the four remained healed for up to 2 years. One ulceration recurred within 2 months. Our experience suggests that cultured autologous epidermal grafts can provide continuous covering, relief from pain, and rapid healing of chronic debilitating ulcerations of the skin.