Predictors of recurrence following local excision for early-stage anal squamous cell carcinoma

INTRODUCTION

There is increasing use of local excision (LE) for definitive treatment of early-stage anal squamous cell carcinoma (ASCC) to avoid the morbidity associated with chemoradiotherapy (CRT). However, the importance of different histological variables on risk of recurrence is poorly understood.

METHODS

A detailed analysis of patient characteristics, histology results, recurrence patterns and salvage treatment was conducted in consecutive T1/T2N0 ASCC patients treated by LE 2010-2021 across a UK regional cancer network multi-disciplinary team (MDT). Associations between potential predictors of disease recurrence were explored using chi-squared and Kruskal-Wallis tests for categorical and continuous variables respectively.

RESULTS

Of 621 ASCC patients discussed in the network MDT, 164 had early-stage disease (T1/T2 N0). Of these, 36 (22%) were deemed suitable for LE (median age 61 years, female to male ratio 2:1). Twenty-two LE tumours were T1; 14 were T2. There were 12 well-differentiated tumours, 21 moderate and 3 poorly-differentiated. Seven out of 36 LE patients (19.4%) developed recurrence, all of whom went on to have salvage treatment with CRT (n = 4), re-excision (n = 2) or radiotherapy (n = 1). Predictors of disease recurrence following LE were: tumour differentiation (p = 0.024), tumour depth (p = 0.033) and R1 resection margin (p = 0.034). Tumour stage and site (margin/canal) were non-significant.

CONCLUSION

LE for T1/T2 N0 ASCC of the margin or canal is a viable treatment strategy to avoid the morbidity associated with CRT and salvage treatments are still available for patients that develop recurrence. Tumour differentiation, depth and margin status are all important factors to consider when discussing management of early-stage ASCC.

The molecular landscape and associated clinical experience in infant medulloblastoma: prognostic significance of second-generation subtypes

AIMS

Biomarker-driven therapies have not been developed for infant medulloblastoma (iMB). We sought to robustly sub-classify iMB, and proffer strategies for personalized, risk-adapted therapies.

METHODS

We characterized the iMB molecular landscape, including second-generation subtyping, and the associated retrospective clinical experience, using large independent discovery/validation cohorts (n = 387).

RESULTS

iMB_Grp3 (42%) and iMB_SHH (40%) subgroups predominated. iMB_Grp3 harboured second-generation subtypes II/III/IV. Subtype II strongly associated with large-cell/anaplastic pathology (LCA; 23%) and MYC amplification (19%), defining a very-high-risk group (0% 10yr overall survival (OS)), which progressed rapidly on all therapies; novel approaches are urgently required. Subtype VII (predominant within iMB_Grp4 ) and subtype IV tumours were standard risk (80% OS) using upfront CSI-based therapies; randomized-controlled trials of upfront radiation-sparing and/or second-line radiotherapy should be considered. Seventy-five per cent of iMB_SHH showed DN/MBEN histopathology in discovery and validation cohorts (P < 0.0001); central pathology review determined diagnosis of histological variants to WHO standards. In multivariable models, non-DN/MBEN pathology was associated significantly with worse outcomes within iMB_SHH . iMB_SHH harboured two distinct subtypes (iMB_SHH-I/II ). Within the discriminated favourable-risk iMB_SHH DN/MBEN patient group, iMB_SHH-II had significantly better progression-free survival than iMB_SHH-I , offering opportunities for risk-adapted stratification of upfront therapies. Both iMB_SHH-I and iMB_SHH-II showed notable rescue rates (56% combined post-relapse survival), further supporting delay of irradiation. Survival models and risk factors described were reproducible in independent cohorts, strongly supporting their further investigation and development.

CONCLUSIONS

Investigations of large, retrospective cohorts have enabled the comprehensive and robust characterization of molecular heterogeneity within iMB. Novel subtypes are clinically significant and subgroup-dependent survival models highlight opportunities for biomarker-directed therapies.

1073 Sleep Disorders Contribute To Anger In Service Members With Posttraumatic Stress Disorder

Introduction

The emotion of anger and behavioral acts of aggression can lead to severe negative consequences, including family violence, legal charges, and death. Anger can be a symptom of posttraumatic stress disorder (PTSD), particularly in service members. Service members report difficulties managing their anger and trouble with the subsequent results. Factors that differentiate service members with PTSD who have anger related problems from those who do not are still unknown. Impaired sleep is associated with negative mood states in the general population and may be a risk factor for anger in those with PTSD. This project examines how sleep disorders commonly diagnosed in service members (i.e., obstructive sleep apnea and insomnia) relate to PTSD and anger.

Methods

Ninety-three service members with comorbid PTSD, insomnia, and nightmares (mean age = 35.86 years, SD = 8.38, 27% female, 45% white) completed polysomnography and other measures as part of a clinical trial. A multiple regression model examined how total Apnea Hypopnea Index (AHI), AHI during REM sleep, insomnia (Insomnia Severity Index), age, and race related to PTSD symptoms (Clinical Administered PTSD Scale-5: CAPS-5). A second multiple regression model examined the same variables’ associations with anger (Dimensions of Anger Reactions-5; DAR-5).

Results

More than a third of the sample (37%) met criteria for OSA (AHI scores&gt;5) and 99% met criteria for insomnia (ISI&gt;10). Total AHI and REM AHI were not associated with CAPS-5 scores or ISI. Across OSA and PSG indices, only greater REM AHI (b=.07, p&lt;.05) and Insomnia (b=.43, p&lt;.05) were positively associated with DAR-5 anger scores. Total AHI was unrelated to anger.

Conclusion

Elevated REM AHI and insomnia were associated with greater anger in service members with PTSD. Current treatments for anger are only moderately effective. Assessing and treating comorbid sleep disorders may reduce anger and enhance successful PTSD treatment.

Support

Consortium to Alleviate PTSD (W81XWH-13-2-0065), DVA (I01CX001136-01), GDHS (W91YTZ-13-C-0015) for DVBIC.

Impact of a checklist used by pharmacists on hospital antimicrobial use: a patient-level interrupted time series study

BACKGROUND

Antimicrobial misuse leading to drug resistance is a growing concern for clinicians. Improving antimicrobial stewardship programmes through development of new tools could be part of the solution.

AIM

To evaluate antimicrobial use in hospitalized patients after implementation of an antimicrobial checklist for ward-based clinical pharmacists.

METHODS

A checklist based on quality indicators of optimal antimicrobial use was implemented to standardize hospital pharmacists' assessments of antimicrobial therapy. Antimicrobial use metrics from adults hospitalized during the control and intervention periods were assessed in an interrupted time series analysis of individual patient data. The primary endpoint was days of therapy (DOT) for all antimicrobials per 1000 days present for included patients. Secondary endpoints were the DOT of extended-spectrum antimicrobials (DOT-ES), length of therapy of all antimicrobials (LOT) and the number of pharmacist interventions.

FINDINGS

One-thousand six-hundred and nineteen patients were included: 800 and 819 in the pre- and post-checklist implementation periods, respectively. As indicated by the point estimates and their 95% confidence intervals (CIs), there were no changes in trend for DOT, DOT-ES or LOT. A change in level was not found for the DOT, while a change of -118 DOT-ES [-209,-28] and -51 LOT [-97,-4] was documented. Furthermore, pharmacists' interventions regarding antimicrobials increased by 18.7% (14.0, 23.5) and progress notes by 32.3% (27.8, 36.8).

CONCLUSION

An antimicrobial checklist used by ward-based clinical pharmacists did not decrease DOT for all antimicrobials, but decreased DOT-ES and LOT upon its implementation.

Minimal methylation classifier (MIMIC): A novel method for derivation and rapid diagnostic detection of disease-associated DNA methylation signatures

Rapid and reliable detection of disease-associated DNA methylation patterns has major potential to advance molecular diagnostics and underpin research investigations. We describe the development and validation of minimal methylation classifier (MIMIC), combining CpG signature design from genome-wide datasets, multiplex-PCR and detection by single-base extension and MALDI-TOF mass spectrometry, in a novel method to assess multi-locus DNA methylation profiles within routine clinically-applicable assays. We illustrate the application of MIMIC to successfully identify the methylation-dependent diagnostic molecular subgroups of medulloblastoma (the most common malignant childhood brain tumour), using scant/low-quality samples remaining from the most recently completed pan-European medulloblastoma clinical trial, refractory to analysis by conventional genome-wide DNA methylation analysis. Using this approach, we identify critical DNA methylation patterns from previously inaccessible cohorts, and reveal novel survival differences between the medulloblastoma disease subgroups with significant potential for clinical exploitation.

Comparison of pharmacological and non-pharmacological interventions to prevent delirium in critically ill patients: a protocol for a systematic review incorporating network meta-analyses

BACKGROUND

Delirium is characterized by acute changes in mental status including inattention, disorganized thinking, and altered level of consciousness, and is highly prevalent in critically ill adults. Delirium has adverse consequences for both patients and the healthcare system; however, at this time, no effective treatment exists. The identification of effective prevention strategies is therefore a clinical and research imperative. An important limitation of previous reviews of delirium prevention is that interventions were considered in isolation and only direct evidence was used. Our systematic review will synthesize all existing data using network meta-analysis, a powerful statistical approach that enables synthesis of both direct and indirect evidence.

METHODS

We will search Ovid MEDLINE, CINAHL, Embase, PsycINFO, and Web of Science from 1980 to March 2016. We will search the PROSPERO registry for protocols and the Cochrane Library for published systematic reviews. We will examine reference lists of pertinent reviews and search grey literature and the International Clinical Trials Registry Platform for unpublished studies and ongoing trials. We will include randomized and quasi-randomized trials of critically ill adults evaluating any pharmacological, non-pharmacological, or multi-component intervention for delirium prevention, administered in or prior to (i.e., peri-operatively) transfer to the ICU. Two authors will independently screen search results and extract data from eligible studies. Risk of bias assessments will be completed on all included studies. To inform our network meta-analysis, we will first conduct conventional pair-wise meta-analyses for primary and secondary outcomes using random-effects models. We will generate our network meta-analysis using a Bayesian framework, assuming a common heterogeneity parameter across all comparisons, and accounting for correlations in multi-arm studies. We will perform analyses using WinBUGS software.

DISCUSSION

This systematic review will address the existing knowledge gap regarding best practices for delirium prevention in critically ill adults by synthesizing evidence from trials of pharmacological, non-pharmacological, and multi-component interventions administered in or prior to transfer to the ICU. Use of network meta-analysis will clarify which delirium prevention strategies are most effective in improving clinical outcomes while causing least harm. The network meta-analysis is a novel approach and will provide knowledge users and decision makers with comparisons of multiple interventions of delirium prevention strategies.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42016036313.

Effect of Hypotension and Carbon Dioxide Changes in an Improved Genuine Closed Cranial Window Rat Model

The genuine closed cranial window model, in which the thinned parietal bone constitutes the covering of the preparation, has contributed to a better understanding of the pathophysiological mechanisms in migraine. In its present form, only measurements of the middle meningeal artery (MMA) are performed. The aim of this study was, in addition, to measure pial artery/arteriole (PA) diameter and cortical cerebral blood flux in the same cranial window. The model was evaluated by studying the effects of hypotension and changes in arterial carbon dioxide pressure (PaCO2), because these parameters might influence the interpretation of pharmacological experiments. Out of 23 successful experiments it was possible to measure all three parameters in 19 animals. In four, PA diameter could not be measured, while MMA diameter and local cortical cerebral blood flux (LCBFFlux) always could. Haemorrhage-induced hypotension (-64 + 0.8 mmHg) caused an increase of MMA diameter of 11.8 + 8.4%, PA diameter of 61.2 + 7.7% and a decrease in LCBFFlux of - 36.4 + 2.5%. The decrease in blood pressure did not significantly change the MMA ( P = 0.38); however, the PA diameter and the LCBF-Flux were affected ( P < 0.001). All three parameters were sensitive to hypo- and hypercapnia. In conclusion, we have shown that not only MMA but also PA diameter and LCBFFlux can be measured in the same cranial window. Tight control of PaCO2 is essential in pharmacological experiments. If test substances possess hypotensive actions, it may be difficult to interpret whether the PA dilation is caused by the induced hypotension per se or is a direct pharmacological action or a combination. In contrast, the MMA does not autoregulate and MMA diameter changes in pharmacological studies may exclusively be due to direct pharmacological effects.

Exploratory ensemble designs for environmental models using k-extended Latin Hypercubes

In this paper we present a novel, flexible, and multi-purpose class of designs for initial exploration of the parameter spaces of computer models, such as those used to study many features of the environment. The idea applies existing technology aimed at expanding a Latin Hypercube (LHC) in order to generate initial LHC designs that are composed of many smaller LHCs. The resulting design and its component parts are designed so that each is approximately orthogonal and maximises a measure of coverage of the parameter space. Designs of the type advocated for in this paper are particularly useful when we want to simultaneously quantify parametric uncertainty and any uncertainty due to the initial conditions, boundary conditions, or forcing functions required to run the model. This makes the class of designs particularly suited to environmental models, such as climate models that contain all of these features. The proposed designs are particularly suited to initial exploratory ensembles whose goal is to guide the design of further ensembles aimed at, for example, calibrating the model. We introduce a new emulator diagnostic that exploits the structure of the advocated ensemble designs and allows for the assessment of structural weaknesses in the statistical modelling. We provide illustrations of the method through a simple example and describe a 400 member ensemble of the Nucleus for European Modelling of the Ocean (NEMO) ocean model designed using the method. We build an emulator for NEMO using the created design to illustrate the use of our emulator diagnostic test. © 2015 The Authors. Environmetrics published by John Wiley & Sons Ltd.

60 MHz 1H NMR spectroscopy for the analysis of edible oils

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We present the first results from a new 60 MHz ¹H NMR bench-top spectrometer.

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Using chemometrics, we detected hazelnut oil adulteration of olive oil at 11.2%w/w.

•

Bench-top 60 MHz NMR performs at least as well as FTIR for this type of application.

We report the first results from a new 60 MHz ¹H nuclear magnetic resonance (NMR) bench-top spectrometer, Pulsar, in a study simulating the adulteration of olive oil with hazelnut oil. There were qualitative differences between spectra from the two oil types. A single internal ratio of two isolated groups of peaks could detect hazelnut oil in olive oil at the level of ∼13%w/w, whereas a whole-spectrum chemometric approach brought the limit of detection down to 11.2%w/w for a set of independent test samples. The Pulsar’s performance was compared to that of Fourier transform infrared (FTIR) spectroscopy. The Pulsar delivered comparable sensitivity and improved specificity, making it a superior screening tool. We also mapped NMR onto FTIR spectra using a correlation-matrix approach. Interpretation of this heat-map combined with the established annotations of the NMR spectra suggested a hitherto undocumented feature in the IR spectrum at ∼1130 cm⁻¹, attributable to a double-bond vibration.

Depletion of RUNX1/ETO in t(8;21) AML cells leads to genome-wide changes in chromatin structure and transcription factor binding

The t(8;21) translocation fuses the DNA-binding domain of the hematopoietic master regulator RUNX1 to the ETO protein. The resultant RUNX1/ETO fusion protein is a leukemia-initiating transcription factor that interferes with RUNX1 function. The result of this interference is a block in differentiation and, finally, the development of acute myeloid leukemia (AML). To obtain insights into RUNX1/ETO-dependant alterations of the epigenetic landscape, we measured genome-wide RUNX1- and RUNX1/ETO-bound regions in t(8;21) cells and assessed to what extent the effects of RUNX1/ETO on the epigenome depend on its continued expression in established leukemic cells. To this end, we determined dynamic alterations of histone acetylation, RNA Polymerase II binding and RUNX1 occupancy in the presence or absence of RUNX1/ETO using a knockdown approach. Combined global assessments of chromatin accessibility and kinetic gene expression data show that RUNX1/ETO controls the expression of important regulators of hematopoietic differentiation and self-renewal. We show that selective removal of RUNX1/ETO leads to a widespread reversal of epigenetic reprogramming and a genome-wide redistribution of RUNX1 binding, resulting in the inhibition of leukemic proliferation and self-renewal, and the induction of differentiation. This demonstrates that RUNX1/ETO represents a pivotal therapeutic target in AML.

Hemoglobin A2Fitzroy δ 142 ALA → ASP: A New Delta-Chain Variant

HbA2 Fitzroy is a new delta-chain variant with the amino acid substitution delta 142 (H2O) Ala----Asp. This variant was detected solely due to its abnormal electrophoretic mobility.

Local control with conventional and hypofractionated adjuvant radiotherapy for ductal carcinoma in-situ: is there a difference in outcome?

Abstract #1162

Purpose&#x2028; Trials of adjuvant whole breast radiotherapy (WBRT) following breast-conserving surgery for invasive breast cancer indicate equivalent efficacy and morbidity for conventional and hypofractionated treatment. WBRT for ductal carcinoma in-situ (DCIS) improves local control, however an optimal dose fractionation remains undefined. Our group policy allowed for the use of both schedules, therefore we compared local control in women with DCIS following breast-conserving surgery.&#x2028; Methods&#x2028; Two hundred and sixty six patients treated between January 1999 and December 2004 with conventional (50 Gy/25 fractions) or hypofractionated (42.4 Gy/16 daily fractions or 40 Gy/16 fractions + 12.5 Gy/5 fraction boost) radiotherapy schedules to the whole breast after breast-conserving surgery for DCIS were identified and retrospectively reviewed. Treatment schedules were evaluated for outcomes in terms of ipsilateral breast recurrence.&#x2028; Results&#x2028; The median age at diagnosis 56.7 years (range 32.2-83.8 years), and 82% (218 patients) presented with mammographic abnormality. Median tumour size was 1.5 cm (range 0.4-10 cm), grade 3 tumours were present in 105 women (39%), and comedonecrosis in 145 (55%). Fifty-one patients (19%) had multifocal disease. Median follow-up was 45.1 months (range 0.7-106.8 months). Prognostic features were well matched in both groups.&#x2028; One-hundred and four patients (39%) were treated with conventional and 162 (61%) with hypofractionated WBRT. There were a total of 14 confirmed local recurrences in the previously radiated breast. Six recurrences occurred in the 104 (5.8%) patients treated with a conventional schedule and 8 of 162 (4.9%) patients treated with a hypofractionated schedule. Actuarial risk of recurrence at 4 years was 7% with hypofractionated WBRT and 5% with a standard schedule (p=0.85).&#x2028; &#x2028; Eight patients recurred with DCIS and 6 with invasive carcinomas, all 14 were treated surgically with adjuvant treatment as indicated clinically, 1 patient with clinical recurrent disease refused biopsy and further conventional treatment. Univariate analysis showed a trend to increased risk of recurrence with grade 3 tumours (10% at 4 years vs. 3% for grade1/2, p=0.053) and presence of comedonecrosis (8% vs. 2%, p=0.096), but not multi-focal disease (7% vs. 5%, p=0.78).&#x2028; Conclusions&#x2028; Hypofractionated adjuvant WBRT schedules following breast-conserving surgery for DCIS have comparable local control rates to a conventional radiation schedule. Hypofractionated WBRT is more convenient for patients, has equivalent morbidity and should be considered in this patient group.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1162.

Identifying barriers to prehospital thrombolysis in the treatment of acute myocardial infarction

BACKGROUND AND OBJECTIVES

After an acute myocardial infarction (AMI) prehospital thrombolysis (PHT) reduces mortality compared with inhospital thrombolysis. In practice, a relatively small proportion of the total population with AMI receives PHT. This study was designed to identify the current barriers to PHT.

METHODS

A retrospective practice review of 57 consecutive patients treated in or before arrival at a district general hospital emergency department. All patients received thrombolysis for an AMI.

RESULTS

The main barriers to delivery of PHT appear to be the inclusion and exclusion criteria laid out in the ambulance service central guidelines. Despite recent widening of the inclusion criteria, 54% of patients eligible for immediate treatment on arrival in hospital either received or were eligible for PHT.

CONCLUSION

To increase the number of patients who are eligible for PHT these guidelines need to be revised further in line with inhospital criteria for thrombolysis.

When is a door not a door? The difference between documented and actual arrival times in the emergency department

OBJECTIVES

An observational study to determine the difference between documented ambulance arrival times and the actual arrival times of patients from the ambulance into the emergency department.

METHODS

In a busy, purpose built, modern emergency department with easy access, we recorded the time that ambulance borne patients were wheeled over the threshold of the clinical area and compared this to the times recorded by the ambulance trusts as the official ambulance arrival times.

RESULTS

352 ambulance arrivals were observed. Data were incomplete in 34 instances (9.5%) and were not included in the analysis. For the remaining 318 arrivals, the median time difference was 2 min 1 s (range 5 s to 21 min 45 s). In a subgroup of chest pain patients (45 patients), the median time difference was 2 min 11 s (range 23 s to 5 min 38 s). The difference between the chest pain group and the remaining patients was not significant (p = 0.528).

CONCLUSIONS

There is inevitably some delay between the arrival of an ambulance and the arrival of the patient into a clinical area. This study quantifies that difference. In an era of stringent time related standards, this paper highlights the need for accurate recording of times to enable us to carry out valid audit of these standards. This study supports the redefining of an arrival time as the time when the patient arrives in the clinical area.

Percent body fat measured by BIA and DEXA in obese, African-American adolescent girls

OBJECTIVE

To compare the estimation of body fat between bioelectrical impedance analysis (BIA) and dual energy X-ray absorptiometry (DEXA) in overweight, African-American female adolescents.

SUBJECTS

In total, 54 African-American adolescent female subjects were recruited for Study 1. Each adolescent's body mass index was greater than the 85th percentile and their average body fat was 45% according to DEXA. A total of 26 African-American adolescent female subjects were available for Study 2, and had an average body fat of 26% according to DEXA.

MEASUREMENTS

Percent body fat was measured by DEXA and BIA. Seven different BIA equations were tested. Both sets of data were analyzed using Bland-Altman regression analyses, utilizing percent body fat measured by DEXA as the criterion.

RESULTS

The Kushner equation provided estimates that were unaffected by body fat in both studies. Estimates were unbiased when applied to the exclusively overweight sample and biased when utilized with the separate sample of normal weight and obese girls. The remaining equations were biased, provided inconsistent estimates across body weight, or were biased and provided inconsistent estimates. Ethnicity-specific and ethnicity-combined equations performed similarly in the obese sample, but became more disparate when applied to a sample encompassing a wider body weight range. The limits of agreement between all BIA equations and the DEXA estimates ranged from 6 to 9%.

CONCLUSION

The study suggests that the Kushner BIA equation is appropriate for use with African-American female adolescents across the weight spectrum, while the majority of BIA equations underestimated percent body fat as body fat increased.

Assessment of the environmental impact of artificial effluent lagoon in Jiayuguan City of China

An artificial effluent lagoon for storing wastewater were excavated in Jiayuguan City since 1994. As a part of a demonstration project of Sino-Australia cooperation, an assessment of the environmental impact of the lagoon was carried out. The assessment was based on field and laboratory tests and predictive model. The main impacts from the lagoon site are likely to be on the groundwater system, and, to a lesser extent, on ambient air quality in the vicinity. Currently it is expected that groundwater is being polluted with effluent from the effluent lagoon. Air pollution (odor nuisance) is mainly caused by untreated effluent in the irrigation channel. The impact of high total dissolved salt (TDS) on groundwater is likely to be significant in the long run if the lagoon is continuously used. There is, consequently, no likelihood of contamination of surface water system, particularly of the city water supply system, from infiltration of effluent at the lagoon.

Mitogen-activated protein kinase (MAPK) pathway activation: effects of age and acute exercise on human skeletal muscle

The purpose of this investigation was to examine the activation (phosphorylation) and total protein content of MAPK signalling cascade proteins (ERK 1/2, p90RSK, Mnk 1, eIF4E, p38 MAPK, JNK/SAPK, MKP 1) at rest and following exercise, in sedentary young and old men. Eight young (22 +/- 1 years; YM) and eight old (79 +/- 3 years; OM) men underwent a resting muscle biopsy of the vastus lateralis; they then performed a knee extensor resistance exercise session (29 contractions at approximately 70 % of max), followed by a post-exercise biopsy. Western immunoblot analysis demonstrated that the OM had higher resting phosphorylation of ERK 1/2, p90RSK, Mnk 1, p38 MAPK and JNK/SAPK proteins versus YM (P < 0.05). The resistance exercise bout caused an increase in phosphorylation of the ERK 1/2, p90RSK and Mnk 1 proteins (P < 0.05) in the YM. Conversely, the OM had a decrease in ERK 1/2, p90RSK, Mnk 1, p38 MAPK and JNK/SAPK phosphorylation (P < 0.05) after the exercise bout. Neither group showed a change in eIF4E phosphorylation. The total amount of protein expression of the MAPK signalling proteins was not different between the YM and OM, except that there was a higher (P < 0.05) MKP 1 protein content in the OM. This investigation is the first to provide evidence that MAPK proteins are differentially activated at rest and in response to a bout of resistance exercise in skeletal muscle of young and old men. These findings may have implications for other processes (e.g. transcription and translation) involved in skeletal muscle type and growth, when examining the changes occurring with ageing muscle before and after resistance exercise/training.

Mood change through physical exercise in nine- to ten-year-old children

The present study assessed the effect of two types of physical exercise on the self reported mood of 64 9 and 10-yr.-old children who responded to a self-report mood meassure after two different types of aerobic exercise of 15 min., and after a 15-min. video. Significant increases in positive mood and significant decreases in negative mood were found after each exercise treatment; however, positive mood decreased and negative mood increased following the video treatment. Interestingly, no significant difference in mean mood scores was found between the two exercise treatments. These data suggest that short bouts of physical exercise have psychological benefits for children.

Comparative expressed sequence hybridization to chromosomes for tumor classification and identification of genomic regions of differential gene expression

Altered expression of genes can have phenotypic consequences in cancer development and treatment, developmental abnormalities, and differentiation processes. Here we describe a rapid approach, termed comparative expressed sequence hybridization (CESH), which gives a genome-wide view of relative expression patterns within tissues according to chromosomal location. No prior knowledge of genes or cloning is required, and minimal amounts of tissue can be used. Expression profiles are achieved in a manner similar to the identification of chromosomal imbalances by comparative genomic hybridization analysis. The approach is demonstrated to indicate a chromosomal region that harbors overexpressed genes that may be associated with a drug-resistant phenotype. In addition, known and new regions of differential gene expression in both normal tissues and tumor samples from the soft tissue sarcoma group of rhabdomyosarcoma (RMS) are indicated. These regions included 2p24; overexpression of MYCN at 2p24 was confirmed by quantitative reverse transcription-PCR for all of the alveolar RMS cases and did not necessarily correspond to genomic amplification. Evidence including region specific microarray analysis indicated that overexpression of several genes from a region may be required for detection by CESH. This evidence is consistent with clusters of functionally related genes and mechanisms that affect the expression of a number of genes at a particular genomic location. The distinctive CESH profiles demonstrated in different subtypes of RMS show potential for tumor classification.

Calcified cutaneous nodules on the heels of children: a complication of heel sticks as a neonate

We report the presence of calcified nodules on the heels secondary to heel sticks in healthy monozygotic twins in childhood. The subjects were born preterm at 34 weeks. The heels were normal at birth. While in the hospital, they underwent multiple heel sticks as a means of venesection. The wounds failed to heal normally and warty lesions developed. Calcified cutaneous nodules secondary to heel sticks have been reported primarily in high-risk, preterm infants. There have also been two reports of their development in normal healthy infants. To date, all reported lesions have been asymptomatic, with spontaneous resolution by 18-30 months. These cases indicate that such lesions can in fact be chronic, extending into childhood, when they may become symptomatic. Dermatologists should therefore consider this diagnosis as a cause of warty, calcified nodules on the heel in childhood as well as in infants and in neonates.

The effect of hair loss on quality of life

BACKGROUND

The aim of this study was to quantify the effect of hair loss on quality of life. Patients were recruited from an alopecia support group, and were assessed using the Dermatology Life Quality Index (DLQI) and an adapted version of the DLQI. Financial utility questions, an abbreviated version of the Center for Epidemiologic Studies Depression Scale and open-ended questions were also used.

OBSERVATIONS

Seventy (90% response rate) questionnaires were returned. DLQI scores in responders with hair loss (mean score = 8.3, SD = 5.6, range 0-23, n = 70) were similar to those recorded in severe psoriasis. The hair loss continued to have a significant impact on life quality well after the initial event (median duration of hair loss = 138 months +/- 114; range 7-588, n = 70). Forty per cent of patients also felt dissatisfied with the way in which their doctor dealt with them.

CONCLUSIONS

This study specifically identifies the feelings of loss of self-confidence, low self-esteem and heightened self-consciousness in people affected by hair loss.

Healing of an MRSA-colonized, hydroxyurea-induced leg ulcer with honey

BACKGROUND

With the everincreasing emergence of antibiotic-resistant pathogens, in particular methicillin-resistant Staphylococcus aureus (MRSA) in leg ulcers, a means of reducing the bacterial bioburden of such ulcers, other than by the use of either topical or systemic antibiotics, is urgently required.

METHODS

We report the case of an immunosuppressed patient who developed a hydroxyurea-induced leg ulcer with subclinical MRSA infection which was subsequently treated with topical application of manuka honey, without cessation of hydroxyurea or cyclosporin.

RESULTS

MRSA was eradicated from the ulcer and rapid healing was successfully achieved.

CONCLUSION

Honey is recognized to have antibacterial properties, and can also promote effective wound healing. A traditional therapy, therefore, appears to have enormous potential in solving new problems.