Contouring in the optic plane improves the accuracy of computed tomography-based segmentation of the optic pathway

Canine optic pathway structures are often contoured on CT images, despite the difficulty of visualizing the optic pathway with CT using standard planes. The purpose of this prospective, analytical, diagnostic accuracy study was to examine the accuracy of optic pathway contouring by veterinary radiation oncologists (ROs) before and after training on optic plane contouring. Optic pathway contours used as the gold standard for comparison were created based on expert consensus from registered CT and MRI for eight dogs. Twenty-one ROs contoured the optic pathway on CT using their preferred method, and again following atlas and video training demonstrating contouring on the optic plane. The Dice similarity coefficient (DSC) was used to assess contour accuracy. A multilevel mixed model with random effects to account for repeated measures was used to examine DSC differences. The median DSC (5th and 95th percentile) before and after training was 0.31 (0.06, 0.48) and 0.41 (0.18, 0.53), respectively. The mean DSC was significantly higher after training compared with before training (mean difference = 0.10; 95% CI, 0.08-0.12; P < 0.001) across all observers and patients. DSC values were comparable to those reported (0.4-0.5) for segmentation of the optic chiasm and nerves in human patients. Contour accuracy improved after training but remained low, potentially due to the small optic pathway volumes. When registered CT-MRI images are not available, our study supports routine addition of an optic plane with specific window settings to improve segmentation accuracy in mesaticephalic dogs ≥11 kg.

Inter- and intraobserver agreement for CT measurement of mandibular and medial retropharyngeal lymph nodes is excellent in dogs with histologically confirmed oral melanoma

Mandibular and medial retropharyngeal lymph nodes are routinely evaluated with CT when staging dogs with oral melanomas. While size alone is considered inadequate for detecting nodal metastasis, it is critical in evaluating treatment response, as clinical decisions are based on changes in size. It is common for different radiologists to measure the size of pre- and posttreatment lymph nodes in the same patient. The objective of this retrospective, observer agreement study was to evaluate the inter- and intraobserver agreement in measuring canine mandibular and medial retropharyngeal lymph nodes by a diverse population of veterinary radiologists and trainees. Fourteen dogs with documented oral melanoma and head CT studies identified from records of a single institution were included in this study. North American veterinary radiologists and trainees were recruited to measure the mandibular and medial retropharyngeal lymph nodes; in triplicate. Prior to performing the study measurements, participants completed a training tool demonstrating the lymph node measurements. Overall, interobserver intraclass correlation coefficient (ICC) was 0.961 (95% confidence interval [CI]: 0.946, 0.972) and intraobserver ICC was 0.977 (95% CI: 0.968, 0.983), indicating excellent agreement (ICC > 0.9 considered excellent). Similar findings were noted following sub-analysis for most variables (experience, size, laterality, axis of measurement). These results suggest that follow-up measurement of the long and short axis of the mandibular lymph nodes and short axis of the medial retropharyngeal lymph nodes in the transverse plane, performed by different veterinary radiologists using the same method of measure, should have minimal impact on clinical decision making.

Computed tomographic appearance of sialoceles in 12 dogs

Published findings on the computed tomographic (CT) appearance of sialoceles are limited to brief descriptions from reported cases in eight dogs and one cat. The authors have seen sialoceles with CT characteristics that are not consistent with these previous reports. The purpose of this multicenter, retrospective, descriptive, case series study was to provide more detailed descriptions of the CT appearance of confirmed sialoceles in dogs. Dogs over a 10-year period with cytologically or histologically confirmed sialoceles and pre- and postcontrast CT studies of the head were included. Multiple qualitative and quantitative features were described for each sialocele with histological correlation. Twelve dogs with a total of 13 sialoceles were identified, including: seven cervical sialoceles, three complex (combined cervical and sublingual) sialoceles, two sublingual sialoceles, and one zygomatic sialocele. All sialoceles were characterized by fluid attenuating, non-contrast enhancing contents (median 18.5 HU) and soft tissue attenuating, contrast-enhancing walls. The external margins of all sialocele walls were smooth; however, the internal margins in six sialoceles were irregular with poorly defined nodular to frond-like protrusions. Mineralized foci of variable size (range < 1 mm to 4.8 mm) and attenuation (range 119 to 1253 HU) were present in seven sialoceles and histologically identified as sialoliths (three sialoceles) and osseous metaplasia (two sialoceles). A unique finding in the sialoceles in this study was the presence of intraluminal nodular to frond-like protrusions arising from the wall. This study also reports the CT appearance of cervical and complex sialoceles and sialocele mineralizations.

Self-reported radiation safety behaviors among veterinary specialists and residents performing fluoroscopic procedures on small animals

OBJECTIVE

To describe the radiation safety behaviors of veterinary specialists performing small animal fluoroscopic procedures and examine potential risk factors for these behaviors, including knowledge of radiation risk and training regarding machine operating parameters.

SAMPLE

197 veterinary specialists and residents in training.

PROCEDURES

An electronic questionnaire was distributed to members of the American Colleges of Veterinary Internal Medicine (subspecialties of cardiology and small animal internal medicine), Veterinary Radiology, and Veterinary Surgery.

RESULTS

The overall survey response rate was 6% (240/4,274 email recipients). Of the 240 respondents, 197 (82%) had operated an x-ray unit for a small animal fluoroscopic procedure in the preceding year and fully completed the questionnaire. More than 95% of respondents believed that radiation causes cancer, yet approximately 60% of respondents never wore hand or eye protection during fluoroscopic procedures, and 28% never adjusted the fluoroscopy machine operating parameters for the purpose of reducing their radiation dose. The most common reasons for not wearing eye shielding included no requirement to wear eyeglasses, poor fit, discomfort, and interference of eyeglasses with task performance. Respondents who had received training regarding machine operating parameters adjusted those parameters to reduce their radiation dose during procedures significantly more frequently than did respondents who had not received training.

CONCLUSIONS AND CLINICAL RELEVANCE

On the basis of the self-reported suboptimal radiation safety practices among veterinary fluoroscopy users, we recommend formal incorporation of radiation safety education into residency training programs. All fluoroscopy machine operators should be trained regarding the machine operating parameters that can be adjusted to reduce occupational radiation exposure.

The use of fluorine-18-fluorodeoxyglucose-positron emission tomography/computed tomography as an effective method for staging in dogs with primary appendicular osteosarcoma

Fluorine-18-fluorodeoxyglucose (¹⁸ F-FDG) positron emission tomography/computed tomography (PET/CT) has been utilized in veterinary medicine to improve the detection and characterization of primary, recurrent, and secondary neoplasms; but its use as a staging tool for dogs diagnosed with appendicular osteosarcoma has not been published. The purpose of this retrospective, case series, descriptive study was to detail the use of ¹⁸ F-FDG PET/CT for staging a population of dogs with appendicular osteosarcoma, report the detection rate of secondary neoplastic lesions, and compare findings with published detection rates for other historically used imaging modalities. Seventy-one client-owned dogs with a confirmed diagnosis of appendicular osteosarcoma and staged with a whole-body ¹⁸ F-FDG PET/CT scan near the time of initial diagnosis were included. Each PET/CT study was re-evaluated for malignancy distinct from the primary disease entity based on a collective qualitative and quantitative assessment of ¹⁸ F-FDG uptake, CT appearance, and contrast enhancement characteristics. Following re-evaluation of each study, information pertaining to tissue sampling performed on identified lesions was retrieved from the medical record when available. Staging with ¹⁸ F-FDG PET/CT identified 17 of 71 (23.9%) and 12 of 71 (16.3%) dogs with a high suspicion or confirmation of a metastatic or comorbid malignant neoplasm respectively, with eight of 71 (11.3%) having both metastatic and comorbid lesions. The results of this study are suggestive that ¹⁸ F-FDG PET/CT is effective in identifying both osseous and soft tissue secondary neoplastic lesions in dogs afflicted with appendicular osteosarcoma, yielding an increased detection rate of all lesions compared those previously reported for skeletal scintigraphy or whole-body CT.

Use of MRI increases interobserver agreement on gross tumor volume for imaging-diagnosed canine intracranial meningioma

There is a lack of information regarding interobserver agreement on canine meningioma gross tumor volume (GTV) delineation, and on the impact of MRI on this agreement. The objectives of this retrospective, secondary analysis, observer agreement study were to describe agreement between veterinary radiation oncologists on GTV for canine intracranial meningioma, and to compare interobserver agreement between delineation based on CT alone and delineation based on fused CT-MRI. Eighteen radiation oncologists delineated GTV for 13 dogs with an imaging diagnosis of meningioma on pre- and postcontrast CT, pre- and postcontrast T1-weighted magnetic resonance, and T2-weighted magnetic resonance images. Dice similarity coefficient (DSC), concordance index (CI), and center of volume (COV) were used to quantify interobserver agreement. Multilevel mixed models were used to examine the difference in volume, DSC, CI and COV 3D distance between CT and CT-MR imaging. The mean volume for GTV contours delineated using fused CT-MRI was larger than when CT alone was used for delineation (mean difference CT-MR - CT = 0.89 cm3, 95% CI 0.66 to 1.12, P < .001). Interobserver agreement on GTV was improved when MRI was used; the mean DSC and CI were higher, and the mean COV 3D distance was lower, when fused CT-MRI was used than when CT alone was used (P < .001 for all differences). Based on our results, fused CT-MRI is recommended for radiation therapy planning of canine intracranial meningioma.

Radiological protection of the patient in veterinary medicine and the role of ICRP

At the request of the Main Commission of the International Commission on Radiological Protection (ICRP), Task Group 107 (TG107) was set up to consider the issue of radiological protection of the patient in veterinary medicine. TG107, who authored this article, brought together information relating to the use of diagnostic imaging and radiation oncology in veterinary medicine. A number of specific areas were identified that appeared to be appropriate for attention by ICRP. These included the use of dose quantities and units, the need for re-evaluation of stochastic and deterministic risks from ionising radiation in animals, and the growing use of imaging and therapeutic equipment for animals that is little different from that available to humans. TG107 unanimously recommended that it was both appropriate and timely for ICRP to consider and advise on these issues, and the Main Commission agreed. This paper summarises the findings of TG107.

A pilot study of optical neuronavigation-guided brain biopsy in the horse using anatomic landmarks and fiducial arrays for patient registration

Background

Optical neuronavigation‐guided intracranial surgery has become increasingly common in veterinary medicine, but its use has not yet been described in horses.

Objectives

To determine the feasibility of optical neuronavigation‐guided intracranial biopsy procedures in the horse, compare the use of the standard fiducial array and anatomic landmarks for patient registration, and evaluate surgeon experience.

Animals

Six equine cadaver heads.

Methods

Computed tomography images of each specimen were acquired, with the fiducial array rigidly secured to the frontal bone. Six targets were selected in each specimen. Patient registration was performed separately for 3 targets using the fiducial array, and for 3 targets using anatomic landmarks. In lieu of biopsy, 1 mm diameter wire seeds were placed at each target. Postoperative images were coregistered with the planning scan to calculate Euclidian distance from the tip of the seed to the target.

Results

No statistical difference between registration techniques was identified. The impact of surgeon experience was examined for each technique using a Mann‐Whitney U test. The experienced surgeon was significantly closer to the intended target (median = 2.52 mm) than were the novice surgeons (median = 6.55 mm) using the fiducial array (P = .001). Although not statistically significant (P = .31), for the experienced surgeon the median distance to target was similar when registering with the fiducial array (2.47 mm) and anatomic landmarks (2.58 mm).

Conclusions and Clinical Importance

Registration using both fiducial arrays and anatomic landmarks for brain biopsy using optical neuronavigation in horses is feasible.

Use of PET/CT and Stereotactic Radiation Therapy for the Diagnosis and Treatment of Osteosarcoma Metastases

This case report describes the use of two new concepts in the diagnosis and treatment of metastatic osteosarcoma (OSA) in one dog. The dog was initially presented for positron emission tomography and computed tomography (PET/CT) as full-body staging following amputation and adjuvant chemotherapy for treatment of OSA of the proximal tibia. The initial PET/CT did not show evidence of metastatic disease. Six mo after OSA, diagnosis pulmonary metastatic nodules were identified and oral toceranib phosphate was initiated. Twelve mo postdiagnosis the dog developed neck pain and non-ambulatory tetraparesis and was diagnosed with a C7 vertebral metastatic lesion based on magnetic resonance imaging. A second PET/CT was performed to screen for further metastatic lesions, and a nodule within the right ischium was identified. The C7 and ischial lesions were treated with stereotactic radiation therapy (SRT). Sixteen mo postdiagnosis, a third PET/CT was performed due to increasing size of the pulmonary nodules and a right-sided liver metastasis was detected. The liver mass was treated with SRT. The PET/CT scans facilitated identification of gross metastatic lesions that were subsequently treated with SRT, which resulted in clinical improvement of the dog's neurological signs.

Assessment of intravenous adipose-derived allogeneic mesenchymal stem cells for the treatment of feline chronic kidney disease: a randomized, placebo-controlled clinical trial in eight cats

Objectives

Feline chronic kidney disease (CKD) is characterized by chronic tubulointerstitial nephritis, and inflammation contributes to the progression of renal fibrosis. Mesenchymal stem cells (MSCs) have demonstrated anti-inflammatory and antifibrotic effects in rodent CKD models. However, few randomized trials evaluating the effectiveness of MSC therapy for diseases in companion animals have been reported. The purpose of this study was to evaluate the effectiveness of allogeneic MSCs for the treatment of feline CKD using a randomized, placebo-controlled trial.

Methods

MSCs were isolated from the cryopreserved adipose tissues of specific pathogen-free research cats and culture expanded. CKD cats were enrolled in a randomized, placebo-controlled, blinded one-way crossover clinical study. Four CKD cats were randomized to receive 2 × 106 MSCs/kg intravenously at 2, 4 and 6 weeks. Four CKD cats were randomized to receive placebo, with two cats crossing over to the MSC treatment group and one cat failing to complete the trial. Complete blood counts, chemistry and urinalysis were performed at weeks 0, 2, 4, 6 and 8. Glomerular filtration rate (GFR) via nuclear scintigraphy and urine protein:creatinine ratio (UPC) were determined at weeks 0 and 8.

Results

Six cats received three doses of allogeneic MSC culture expanded from cryopreserved adipose without adverse effects. No significant change in serum creatinine, blood urea nitrogen, potassium, phosphorus, GFR by nuclear scintigraphy, UPC or packed cell volume was seen in cats treated with MSCs. Individual changes in GFR were 12%, 8%, 8%, 2%, –13% and –67% in treated cats compared with 16%, 36% and 0% in placebo-treated cats.

Conclusions and relevance

While administration of MSC culture expanded from cryopreserved adipose was not associated with adverse effects, significant improvement in renal function was not observed immediately after administration. Long-term follow-up is necessary to determine whether MSC administration affects disease progression in cats with CKD.

Stereotactic radiation therapy for treatment of canine intracranial meningiomas

The objective of this study is to determine the rate of toxicity, median survival time (MST) and prognostic factors in dogs with presumed intracranial meningiomas that were treated with stereotactic radiation therapy (SRT). Patient demographics, neurological history, details of SRT plans and response to treatment (including toxicity and survival times) were examined for potential prognostic factors. Overall MST (MST) due to death for any cause was 561 days. There was a mild to moderate exacerbation of neurological symptoms 3-16 weeks following SRT treatments in 11/30 (36.7%) of dogs. This presumed adverse event was treated with corticosteroids, and improvement was seen in most of these dogs. Death within 6 months of treatment as a result of worsening neurologic signs was seen in 4/30 (13.3%) of dogs. Volume of normal brain that received full dose at a prescription of 8Gy × 3 fractions was predictive of death due to neurological problems within this 6-month period.

Abdominal ultrasonographic findings in acromegalic cats

Objectives

Acromegaly is increasingly recognized as a cause of insulin resistance in cats with diabetes mellitus (DM). The objective of this study was to determine if ultrasonographic changes in selected abdominal organs of acromegalic cats could be used to raise the index of suspicion for this condition.

Methods

In this retrospective case-control study, medical records of cats presenting to North Carolina State University or Colorado State University from January 2002 to October 2012 were reviewed. Cats were included in the acromegaly group if they had insulin-resistant DM with increased serum insulin-like growth factor (IGF-1) concentrations and had an abdominal ultrasound examination performed with report available. A control group included age-matched cats that had abdominal ultrasound examination performed for investigation of disease unlikely to involve the kidneys, adrenal glands, pancreas or liver.

Results

Twenty-four cats were included in each group. IGF-1 concentrations in the acromegaly group ranged from >148 to 638 nmol/l. When compared with age-matched controls, cats with acromegaly demonstrated significantly increased median left and right kidney length, significantly increased median left and right adrenal gland thickness, and significantly increased median pancreatic thickness. Hepatomegaly and bilateral adrenomegaly were reported in 63% and 53% of acromegalic cats, respectively, and in none of the controls. Pancreatic abnormalities were described in 88% of the acromegalic cats and 8% of the controls.

Conclusions and relevance

These findings indicate that compared with non-acromegalic cats, age-matched acromegalic patients have measurably larger kidneys, adrenal glands and pancreas. Diagnostic testing for acromegaly should be considered in poorly regulated diabetic cats exhibiting organomegaly on abdominal ultrasound examination.

Evaluation of ergonomic risk factors among veterinary ultrasonographers

Between 65% and 91% of human-patient sonographers report musculoskeletal symptoms related to their work activities. Ergonomic risk factors associated with musculoskeletal symptoms and musculoskeletal disorders (MSDs) include force, repetition, and awkward postures of the upper extremities. We hypothesized that veterinary sonographers experience similar risk factor exposures as their colleagues in human-patient sonography, and that work-related exposures may lead to similar prevalence of musculoskeletal symptoms and disorders. The Occupational Safety and Health Administration and Society of Diagnostic Medical Sonography published MSD prevention guidelines in 2003. Similar guidance for sonographers examining animal patients does not exist. This cross-sectional study was designed to evaluate the prevalence of musculoskeletal symptoms among veterinary sonographers and identify reported risk factors. A 59-item survey questionnaire was administered via email to veterinary specialists likely to perform ultrasound. Musculoskeletal pain related to performing ultrasound exams was reported by 62% of the respondents. Musculoskeletal symptoms were significantly associated with female gender (odds ratio [OR], 4.55; 95% confidence interval [CI], 2.04-10.19), age (OR, 1.06; 95% CI, 1.01, 1.10), previous work-related trauma (OR, 6.86; 95% CI, 1.71, 27.40), not consistently using a normal height chair (OR, 2.63; 95% CI, 1.19, 5.80), and 15°-45° abduction of shoulder (OR, 2.34; 95% CI, 1.11, 4.92) . It was concluded that the prevalence of musculoskeletal symptoms among veterinary sonographers was similar to that occurring in human-patient sonographers. © 2012 Veterinary Radiology & Ultrasound.

DEVELOPMENT OF A WHOLE BODY MAGNETIC RESONANCE IMAGING PROTOCOL IN NORMAL DOGS AND CANINE CANCER PATIENTS

Whole body magnetic resonance imaging (whole body MR imaging) could potentially provide accurate cancer staging as a single imaging modality. This study was done to develop a whole body MR imaging protocol for a 1.5T MR instrument using four normal Beagle dogs (Phase 1) and then to assess the protocol's feasibility in cancer-bearing dogs (Phase II). In Phase I, anesthetized dogs were placed in dorsal recumbency with limbs flexed along the torso. T1, T2, and short tau inversion recovery sequences were acquired by spin echo or fast spin echo, and also using the more rapid single shot fast spin echo and gradient echo pulse sequences. Three large overlapping fields of view (FOV) were used to visualize the entire body and the sagittal and dorsal imaging planes were compared. Relative examination time, image quality, organ visibility and signal intensity were evaluated. Phase I results were used to establish a protocol that balanced image quality with examination time. In Phase II, whole body MR imaging was done on 10 dogs with cancer. Examination times were 60-75 min. Image quality was sufficient for all known lesions to be visualized, including mass lesions, pulmonary infiltrate, and lymphadenomegaly. Skeletal detail was sufficient to visualize known neoplastic lesions of the appendicular skeleton, yet it was suboptimal because of the large FOV and use of the body coil. Additional modifications of a whole body MR imaging protocol and continued technological improvements in MR imaging will further increase its potential for veterinary cancer staging.

Fast apple (Malus x domestica) and tobacco (Nicotiana tobacum) leaf polyphenol oxidase activity assay for screening transgenic plants

A spectrophotometric assay method for the analysis of polyphenol oxidase (PPO), in apple and tobacco leaves, has been optimized to increase efficiency in the screening of large numbers of transgenic plants. Crude protein extracts from leaf punches were prepared in a FastPrep homogenizer. The addition of Triton X-100 during extraction resulted in 44 and 74% increases in the PPO activity recovered, from apple and tobacco, respectively. The enzyme kinetics differed markedly between apple and tobacco. Apple leaf PPO was isolated in a latent state and was activated by the addition of SDS. In contrast, tobacco PPO activity was inhibited by SDS, particularly at acidic pH. Apple PPO showed a pronounced pH optimum around pH 6, whereas the pH profile for tobacco PPO was much flatter, with a broad optimum around pH 4. The calculated Km' value for apple PPO, using 4-methylcatechol as substrate, was 8.1, and for tobacco the Km was 4.3. The PPO reaction was strongly inhibited by tropolone, a Cu competitor, and restored by the addition of Cu2+. Several factors affecting variability in leaf PPO activity levels in plants are discussed.

Fatigue in 7- to 12-year-old patients with cancer from the staff perspective: an exploratory study

PURPOSE/OBJECTIVES

To document and analyze the perspectives of staff members who provide direct care to 7- to 12-year-old patients with cancer regarding the nature and characteristics of fatigue, causes of fatigue, and effective interventions for this population of young patients.

DESIGN

Exploratory.

SETTINGS

A pediatric oncology unit at a children's hospital in the southwest and a pediatric research center for childhood catastrophic diseases in the mid-south.

SAMPLE

A convenience sample of 38 staff members (8 advanced practice nurses, 23 staff nurses, 2 nurses managers, 3 nutritionists, 1 chaplain, and 1 physician) whose experience in pediatric oncology ranged from two months to 23 years.

METHODS

Nine open-ended questions were posed to staff members during focus group sessions. Staff responses were analyzed using content analysis techniques and the Wilson concept analysis technique.

MAIN RESEARCH VARIABLE

Staff perceptions of fatigue in 7- to 12-year-old patients with cancer.

FINDINGS

Fatigue is a state of diminished to complete loss of energy or will that is influenced by environmental, biochemical, personal, cultural, and treatment-related factors. This state, which may be acute, episodic, or chronic, can be accompanied by a changing emotional or mental state.

CONCLUSIONS

Staff perceive fatigue to be a debilitating symptom for these children. When attempting to determine the presence or absence of fatigue, staff primarily compare a child's current state with his or her previous state rather than that of other children. Staff see themselves as having a role in causing and alleviating fatigue in this patient group.

IMPLICATIONS FOR NURSING PRACTICE

Staff can use these findings to help them identify the presence of fatigue in these children and to identify contributing and alleviating factors.

The 1992 APON Delphi study to establish research priorities for pediatric oncology nursing. Association of Pediatric Oncology Nurses

The Association of Pediatric Oncology Nurses (APON) recently sponsored a two-wave Delphi study to identify the most important research priorities for pediatric oncology nursing. Seventy-five research priorities were rated for importance by 227 APON members. The majority of these members were inpatient or ambulatory care nurses who had been in pediatric oncology more than 25 months. The top 10 research priorities were primarily about nursing procedures and psychosocial care needs of patients and families. The top priority was to "measure the quality of life and late effects of treatment in long-term survivors of childhood cancer." Study findings will be used to encourage researchers to conduct research on these priorities and to encourage funding organizations to support research related to these priorities.

Diet diversity and risk of colon cancer in western New York

The effect of diet diversity on colon cancer risk was examined among 205 male and 223 female cases with incident primary histologically confirmed colon cancer and age-, sex-, and neighborhood-matched controls. Diversity was defined as the number of food items on the food frequency interview reported eaten, more than monthly for total foods and for fruits, vegetables, grains, and meats. Adjusted risk of colon cancer associated with total diversity was increased for men in the highest quartile compared with those in the lowest [odds ratio (OR) 1.99, 95% confidence interval (CI) 0.95-4.15] but not for women. There was little association between risk and diversity within specific food groups for either sex, except risk of colon cancer was positively related to meat diversity in men (OR 6.78, 95% CI 2.80-16.45, highest quartile referent to lowest). We found that total diversity was positively related to colon cancer risk independent of other possible confounders. Diversity measures may capture additional diet-related disease risk elements, thus having implications for future recommendations regarding diet and disease.

Dietary patterns and colon cancer in western New York

Seven dietary patterns were identified among control subjects in the Western New York Diet Study (1975-1986) by application of principal components analysis to data from a 95-item food frequency interview. The results of case-control analyses of colon cancer risk for these patterns are presented. Cases were matched with neighborhood controls on the bases of age and sex; 205 colon case-control male and 223 female pairs were obtained. The dietary patterns and intakes of energy, total fat, and dietary fiber were examined with logistic regression for their individual contributions to risk. In males, three of these dietary patterns were associated positively with fat and energy consumption; they elevated risk for colon cancer and accounted for more risk than did the specific nutrients. Control for energy and fat intakes allowed the protective influences of additional dietary patterns to be expressed. No patterns elevated risk in women; two patterns were protective for colon cancer. Controlling for energy and fat intake enhanced the protection afforded by one of these patterns but had no influence on that of the other. Measures of foods rather than single nutrients may be more inclusive of dietary exposures to risk as well as being related more directly to underlying health behaviors. Therefore they may be better able to account for risk in diseases with multiple causation.

High-risk health behaviors associated with various dietary patterns

We have previously identified dietary patterns among 1,475 male and 780 female normal healthy control subjects in a case-control study of cancer at various sites. In this paper we examine the presence, among persons exhibiting these dietary patterns, of individual health behaviors that may contribute to risks for cancer. Specifically we examine trimming of separable fat from meats, fats used in cooking and as additions to foods, alcohol consumption, and smoking. Results indicate that men and women differ in possession of these high-risk behaviors. Women are more likely to trim fat from meat, consume less alcohol, and have lower exposures to smoking. Their dietary patterns are more independent of the fats used. Several eating patterns are positively associated with total fat intake but differ in their associations with high-risk behaviors. These data suggest that assessing risk associated with dietary patterns sheds more light on disease relationships than studies of single nutrients.

Patterns in food use and their associations with nutrient intakes

This study used the frequency of food-use data collected previously in the Western New York Diet Study, a case-control study of diet and cancer at various sites, to develop measures of dietary patterns for subsequent use in epidemiologic research. Factor analysis was applied to frequency-of-use data of 110 foods for 1475 male and 780 female control subjects. Nine dietary-pattern factors were extracted for each gender. Correlational analyses examined relationships with intakes of nutrients of concern to cancer epidemiologists--energy, total fat, dietary fiber, and vitamins A and C. Findings indicate that the usual measure for assessing dietary risks, quantile of nutrient intake, reflects several dietary patterns differing in their composition of cancer risk factors. Furthermore, patterns may relate to such variables as age, ethnicity, and income, which are themselves related to cancer. This approach may provide a comprehensive measure of dietary exposure for epidemiologic research.

Absence of diuresis during a 7-day saturation dive at 2.5 ATA N2-O2

Three male divers were studied for 2 days during each of the predive and postdive 1 ATA air control periods and for 7 days at 2.5 ATA (2.3 ATA N2 and 0.2 ATA O2). The chamber temperature was always maintained at a comfort level. Average urine flow remained at 1500 ml.day-1 during both predive and 2.5 ATA periods; urine osmolality also remained constant at around 700 mOSM/kg. On the other hand, daily excretion of Na increased significantly from 139 mEq during the predive period to 178 mEq at 2.5 ATA (P less than 0.05) but returned to the predive level during the postdive period. In contrast, daily K excretion decreased progressively with a significant decrease during the postdive period (P less than 0.05). Plasma osmolality, Na, and K remained unchanged, whereas a 6% reduction of total protein concentration at 2.5 ATA (P less than 0.05) was observed. A quantitatively similar decrease (8%) was observed for hematocrit during the 2.5 ATA period, which did not recover at postdive. These changes were accompanied by a significant increase in urinary excretion of antidiuretic hormone (P less than 0.05) and by decreases in both plasma renin and aldosterone (P less than 0.05) level and urinary excretion of aldosterone (P less than 0.05). Plasma atrial natriuretic factor remained unchanged throughout the entire dive period.

Frequency of food use data and the multidimensionality of diet

Cancer epidemiologists rely heavily on the frequency of food use technique to assess dietary risk factors. We found that the accepted procedures for arraying individuals along a continuum, based on their positions within distributions of intakes of specific nutrients, simultaneously array them on other dietary characteristics. A unidimensional approach to dietary assessment could confound cancer risk assessments, and the effects could differ for men and women. We found that men consumed more calories and energy-containing nutrients than women, who were more likely to consume larger amounts of vitamins A and C. Dietary variety was similar for men and women, despite compositional differences in diet. Diets of men contained proportionately more meats, grains and nuts, and alcohol. Diets of women contained more fruits, vegetables, and poultry and fish. Among men, we found stronger intercorrelations among energy intake and intakes of fat, fiber, and vitamin C and among fat intake and intakes of fiber and vitamins A and C. Compositional differences in diet across quartiles of nutrient intake were not consistent for men and women, suggesting that the constellation of dietary risk factors may differ for the two sexes. Men in the lowest quartiles of energy, fiber, and vitamin A intakes had the greatest percent contribution of alcohol to the diet. This pattern was not observed for fat intake levels. Measures of dietary patterns may be needed for more accurate descriptions of the associations of cancer risk and diet.

Campylobacter pylori gastritis in the acquired immunodeficiency syndrome

Campylobacter pylori has been associated with gastritis, duodenitis, and duodenal ulceration in the immunocompetent individual. It has been described within the superficial mucus layer, in interepithelial junctions, and occasionally in the microcanaliculi of epithelial cells, but never in the lamina propria. We describe a case of invasive C. pylori in a patient with the acquired immunodeficiency syndrome and discuss its clinical presentation and histopathological findings.

Diet diversity and nutrient intake

Variety is espoused as a key to dietary adequacy, yet data from new shortcut dietary measures suggest that intakes of relatively few foods can accurately classify individuals according to nutrient intake. This study examines diet diversity, caloric intake, and nutrient density values as contributors to the level of selected nutrients in the diets of 1,747 white men and 1,898 white women, 18 to 34 years old, completing the 24-hour recall in NHANES II. Nutrient intake was directly related to both number of foods eaten and total calories consumed, as well as to nutrient density values. For fat, saturated fat, and potassium, higher caloric consumption alone may account for substantial differences in nutrient intakes between the lowest and highest quartiles. For cholesterol, calcium, and vitamin A, differences in dietary density were more important in explaining nutrient intake differences. Both caloric intake and nutrient density influence sodium intake from food sources. For some nutrients, an overall measure of diversity may be useful for estimating intakes. For others, nutrient-specific diversity indexes would likely be needed. Knowledge of specific foods in diets with high levels of nutrients could aid the construction of food frequency instruments.

Living arrangements and dietary patterns of older adults in the United States

Living arrangements and dietary patterns were examined for 3,477 adults aged 65 to 74 from the first National Health and Nutrition Examination Survey 1971 to 1974 (NHANES I). Several indicators of dietary variety, diet composition, and energy and nutrient intake from both the 24-hour recall, and the dietary frequency questionnaires were analyzed. Dietary patterns of older men were associated more strongly with type of living arrangement and income compared with older women. Men living with a spouse consistently had more favorable dietary patterns than either those living alone or those living with someone other than a spouse. Low income men who were not living with a spouse were at highest risk of poor dietary intake. Income was associated more consistently with the dietary indicators than type of living arrangement for women. Income, however, was still a less consistent influence on dietary patterns of older women compared to older men.

Establishment of MICs of moxalactam for control and reference anaerobic organisms in agar dilution and microdilution techniques

The MICs of moxalactam were determined for eight National Committee for Clinical Laboratory Standards control and reference strains and for Fusobacterium nucleatum ATCC 10953 by agar and microdilution techniques. The recommended MIC for the control strain Bacteroides fragilis in both agar and microdilution tests is 0.5 micrograms/ml. Recommended MICs for Bacteroides thetaiotaomicron ATCC 29741 and Clostridium perfringens ATCC 13124 by agar dilution are 8 and 0.063 micrograms/ml, respectively. These two strains gave inconsistent results in microdilution tests. Variation in results with microdilution procedures was seen, which illustrates problems in reading endpoints and with modifications of media. Recommended MICs for the reference strains are presented.

Establishment of minimum inhibitory concentrations of cefoperazone for control and reference anaerobic organisms

The minimum inhibitory concentrations of cefoperazone were determined in a collaborative study for eight National Committee for Clinical Laboratory Standards control and reference strains of anaerobic bacteria by agar and microdilution techniques with several types and sources of media. Recommended minimum inhibitory concentrations for the control strains, Bacteroides fragilis ATCC 25285 and Bacteroides thetaiotaomicron ATCC 29741, are 32 to 64 micrograms/ml and 64 micrograms/ml, respectively. Clostridium perfringens ATCC 13124 gave inconsistent results, and no value is recommended. Recommended values for reference strains are presented. Modification of media did not significantly change the minimum inhibitory concentrations.

Relationship between dietary and biochemical measures of nutritional status in HANES I data

Data from the first National Health and Nutrition Examination Survey were examined for individual 24-h dietary intakes of protein, vitamin A, thiamin, riboflavin, and iron, and for laboratory indices of the same nutrients in blood and urine. Mean intake values were close to or above reference standards for all nutrients except iron. Substandard laboratory values were recorded for: serum albumin and vitamin A--less than 3% of subjects; urinary thiamin/creatinine excretion--3 and 8% of white and Black subjects, respectively; Hb, hematocrit, and percentage transferrin saturation--5 to 15% of whites and 18 to 27% of Black subjects; serum iron--less than 6% of subjects. Individual dietary recall data were of limited value in predicting the laboratory indices; regression analyses indicated that sociodemographic variables may be of greater predictive value.

The tiers not the tears

What can we expect from the Royal Commission? Author fears that the health service's administrative structure will once again be given top billing and its social objectives relegated to a walk-on part.