Supporting Gang Violence Prevention Efforts: A Public Health Approach for Nurses

The impact of gang violence on a youth's risk for death or injury is tremendous. Prevention of complex societal problems, such as gang violence, requires a substantial effort and commitment from many sectors and disciplines. Nurses are uniquely positioned to help lead such efforts. Understanding the public health perspective to gang violence may be an important tool for nurses attempting to prevent this problem. The public health approach has four key components: defining and monitoring the problem; identifying risk, protective, and promoting factors; developing and evaluating interventions; and dissemination. This article outlines these components, current research on gang violence, and concludes by summarizing critical challenges for nurses to consider as they contribute to public health initiatives to prevent gang violence.

PD-0332991, a potent and selective inhibitor of cyclin-dependent kinase 4/6, demonstrates inhibition of proliferation in renal cell carcinoma at nanomolar concentrations and molecular markers predict for sensitivity

BACKGROUND

PD-0332991 is an inhibitor of cyclin-dependent kinases (CDK) 4 and 6, and was evaluated to determine its anti-proliferative effects in 25 renal cell carcinoma (RCC) cell lines.

MATERIALS AND METHODS

Half-maximal inhibitory concentrations (IC50) of PD-0332991 were determined with cell line proliferation assays, as were its effects on the cell cycle, apoptosis, and retinoblastoma (RB) phosphorylation. Molecular markers for response prediction, including p16, p15, cyclin D1 (CCND1), cyclin E1 (CCNE1), E2F transcription factor 1 (E2F1), RB, CDK4 and CDK6, were studied using array comparative genomic hybridization (CGH) and gene expression.

RESULTS

IC50 values for PD-0332991 ranged from 25.0 nM to 700 nM, and the agent demonstrated G0/G1 cell-cycle arrest, induction of late apoptosis, and blockade of RB phosphorylation. Through genotype and expression data p16, p15 and E2F1 were identified as having significant association between loss and sensitivity to PD-0332991: p16 (p=0.021), p15 (p=0.047), and E2F1 (p=0.041).

CONCLUSION

PD-0332991 has antiproliferative activity in RCC cell lines, and molecular markers predict for sensitivity to this agent.

Effect of PD-0332991, a potent and selective inhibitor of cyclin-dependent kinase 4/6, on proliferation in renal cell carcinoma at nanomolar concentrations and prediction of sensitivity by molecular markers

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Background: Cell cycle dysregulation is prevalent in renal cell carcinoma (RCC). PD-0332991 is an orally active, potent, and selective inhibitor of cyclin-dependent kinases (CDK) 4 and 6, blocking retinoblastoma (Rb) phosphorylation at nanomolar concentrations. Methods: 28 RCC and immortalized kidney cell lines were used to examine the effects of PD-0332991 on proliferation to determine the half maximal inhibitory concentration (IC50). Effects of PD-0332991 on cell-cycle, apoptosis, and Rb phosphorylation were assessed with flow cytometry and western blot analysis for five of the cell lines: RCC-HB and SW 156 (sensitive/malignant), R444 and Hs 891.T (resistant/malignant), and CCD 1103 (resistant/immortalized non-malignant). Molecular markers for response prediction were studied using array CGH and gene expression profiling. Results: Concentration-dependent inhibition of proliferation was identified in response to PD-0332991, with IC50values ranging from 25.0nM up to 700nM; five cell lines were identified as completely resistant at 1000nM. PD-0332991 induced G0/G1 cell cycle arrest, as well as induction of late apoptosis in SW 156, and Rb phosphorylation was blocked in a time-dependent fashion in both sensitive cell lines, while resistant lines were unaffected. Genotype and expression data of CDKN2A and CDKN2B were combined and a consensus was made regarding p16 and p15 status; significant association between loss and sensitivity to PD-0332991 was identified for p16 (p = 0.027). For CCND1, CCNE1, E2F1, Rb, CDK4, and CDK6 no amplifications or homozygous deletions were identified by array CGH; cell lines were then classified as having high or low expression for each of these markers. E2F1 had low expression levels significantly associated with response to PD-0332991 (p = 0.041). Conclusions: PD-0332991 shows anti-proliferative activity in RCC through blockade of the cell cycle. The decreased expression of molecular markers p16 and E2F1 predict for sensitivity to PD-0332991 in RCC.

Gain of chromosome 8q is associated with metastases and poor survival of patients with clear cell renal cell carcinoma

BACKGROUND

The aim of this study was to evaluate the prevalence of chromosome 8q gain in clear cell renal cell carcinoma (CCRCC) and to correlate the findings with tumor phenotype and disease-specific survival (DSS).

METHODS

The tumor karyotypes of 336 consecutive patients with CCRCC were prospectively evaluated with classical cytogenetic analysis. Chromosome 8q status was correlated with clinicopathological variables, and its impact on DSS was evaluated.

RESULTS

Gain of 8q occurred in 28 tumors (8.3%). Gain of 8q was associated with a higher risk of regional lymph node (21.4% vs 6.2%, P = .011) and distant metastases (50.0% vs 24.4%, P = .006), and greater tumor sizes (P = .030). Patients with gain of 8q had a 3.22-fold increased risk of death from CCRCC (P < .001). In multivariable analysis, gain of 8q was identified as an independent prognostic factor (hazard ratio, 2.37; P = .006). The concordance index of a multivariable base model increased significantly following inclusion of 8q gain (P = .0015).

CONCLUSIONS

Gain of chromosome 8q occurs in a subset of CCRCCs and is associated with an increased risk of metastases and death from CCRCC. Because the proto-oncogene c-MYC is among the list of candidate genes located on 8q, our data suggest that these tumors may have unique pathways activated, which are associated with an aggressive tumor phenotype. If confirmed, defining tumors with gain of 8q may assist in identifying patients who would benefit for specific c-MYC inhibitors or agents that target the MAPK/ERK (mitogen-activated protein kinase) pathway.

Suicidal ideation, friendships with delinquents, social and parental connectedness, and differential associations by sex: findings among high-risk pre/early adolescent population

BACKGROUND

The association between suicidal ideation, friendships with delinquents, and social/parental connectedness among pre/early adolescents who reside in high-risk communities is poorly understood.

AIMS

This study examined among high-risk youths: (1) the association between suicidal ideation and having delinquent friends, school connectedness, social support, and different parenting styles (i.e., caring only, supervision only, caring with supervision); and, (2) the differential associations by sex.

METHODS

The associations were assessed among 2,598 pre/early adolescents using logistic regression. The analyses were adjusted for demographic, mental distress, illicit substance use, and peer/date violence victimization factors. The interaction terms determined differences by sex.

RESULTS

After adjusting for demographic factors and mental distress, suicidal ideation was positively associated with having delinquent friends; however, after factoring in illicit substance use and violence victimization, this association was negative for males. After adjusting for all factors, suicidal ideation was negatively associated with school connectedness and all parenting styles; however, the association between suicidal ideation and having parental caring with supervision was stronger for females.

CONCLUSIONS

The results suggest the potential benefits of increasing school connectedness and improving parent-child interactions, particularly among females, and the potential benefits of violence and substance-abuse prevention strategies for youths, particularly males, connected with delinquent peers.

Non–clear cell histology in patients with metastatic RCC as a prognostic indicator in the targeted therapy era

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Background: The role of targeted therapy (TT) in metastatic renal cell carcinoma (mRCC) having non-clear cell histology (non-ccRCC) is still being defined. We sought to examine the factors associated with survival outcomes in patients presenting with various histological subtypes in the TT era.

Methods: The UCLA Kidney Cancer Program database containing records of over 2000 patients was queried. The clinicopathologic factors between patients with clear cell subtype (ccRCC) and those with non-clear cell histology were compared using the Student’s T-test and the chi-square test for continuous and categorical variables, where appropriate. Survival outcomes were estimated using Kaplan-Meier (log rank). Univariate and multivariate Cox regression models were used to identify independent associations with survival.

Results: Of 157 patients treated with FDA-approved TT, 132 (84%) had ccRCC while 25 (16%) had non-ccRCC. The two groups were balanced for baseline demographic variables, including gender, race, BMI, pack-years of smoking, T-stage, Fuhrman grade, performance status and UCLA Integrated Staging System (UISS) risk category. Median survival of patients with ccRCC and non-ccRCC was 41.6 and 18.1 months (p<0.001). In univariate analysis, non-ccRCC was associated with a 2.7-fold risk of cancer specific death compared to ccRCC patients. Among patients receiving TT-only, median survival of patients with ccRCC and non-ccRCC was 35 and 15.4 months (p=0.007). A subset of ccRCC patients treated sequentially with IMT followed by TT had a median survival of 73 months. Worsening UISS risk class and non-ccRCC histology, but not age, gender, race, tobacco exposure history, or tumor size, were independently associated with the risk of cancer death.

Conclusions: Non-clear cell histology remains a significant and independent risk factor for cancer specific death for mRCC patients treated by TT even after controlling for UISS risk category.

[Table: see text]

Systemic therapy for metastatic renal cell carcinoma: a review and update

An in-depth understanding of metastatic renal cell carcinoma (mRCC) is important so that practitioners can make informed evidenced-based decisions with patients to optimize not only quantity of life but quality of life as well. Therefore, this review focuses on the biology of mRCC as it relates to targets for therapy, as well as on the small molecules rationally designed with these targets in mind. In addition, anticipated emerging therapies are highlighted, including the new tyrosine kinase inhibitors axitinib and tivozanib, as well as new immune-based therapies such as dendritic cell-based vaccines and antibodies. We also briefly review recent reports from the emerging field of predicting drug response based on molecular markers. And finally, management of metastatic non-clear cell RCC histologies are discussed focusing on available evidence to direct decision making when assessing therapeutic options.

Anti-galactose-alpha(1,3) galactose antibody production in alpha1,3-galactosyltransferase gene knockout mice after xeno and allo transplantation

Antibodies (Abs) that mediate the hyperacute rejection and acute vascular rejection/delayed xenograft rejection of pig organs in humans and Old World primates are predominantly directed at a single carbohydrate epitope, galactose-alpha1,3-galactose (alpha1,3Gal). The T-cell dependence of elicited anti-alpha1,3Gal Ab responses in humans and Old World primates is controversial. In this study we have characterized anti-alpha1,3Gal Ab production in mice with disrupted alpha1,3-galactosyltransferase genes (GT-Ko mice) and determined the T-cell dependence of anti-alpha1,3Gal Ab responses, following xenograft and allograft transplantation. GT-Ko mice produce natural anti-alpha1,3Gal IgM and IgG in an age-dependent manner, however, these Abs could not elicit hyperacute rejection nor affect the rate of cardiac xenograft (3-5 days) or allograft rejection (7-9 days). Transplantation of xenogeneic Lewis rats hearts elicited modest anti-alpha1,3Gal Ab, but vigorous xenoAb responses. The anti-alpha1,3Gal Ab response was restricted to the IgM and IgG3 subclass while the xenoAb response comprised IgM and all four IgG subclasses. Transplantation of allogeneic C3H hearts elicited weak anti-alpha1,3Gal Ab responses that were primarily IgM, but vigorous alloAb responses. Despite the restriction of elicited anti-alpha 1,3Gal Ab responses to the IgM and IgG3 isotypes, these responses are T-cell dependent. The ability of allografts to elicit weak anti-alpha1,3Gal but strong allo-Ab responses, can be explained by the dependence of alpha1,3Gal-specific B cells on cognate help from T cells.

Platelet-activating factor increases intracellular calcium levels in preimplantation stage embryos

Platelet-activating factor [1-O-alkyl-2-acetyl-sn-glycero-3-phosphocholine;PAF] has an active role in preimplantation embryo development. PAF has been shown to act via the receptor mediated inositol triphosphate-diacylglycerol (IP3/DAG) pathways in non-reproductive cells to increase intracellular calcium ([Ca++]i) levels. Molecular evidence on the presence of the PAF-receptor in mouse preimplantation embryos has recently been reported, however the effect of PAF on embryonic [Ca++]i is unclear. Therefore, the study objective was to determine the effect of PAF on [Ca++]i in the mouse preimplantation embryo. Two-cell embryos were collected from PMSG/hCG primed mature female CFW mice, washed in modified M16 (phenol red free) and loaded with FURA-2AM (0.2 microM). Background [Ca++]i levels were measured for a minimum of 120 seconds prior to treatment. PAF or lyso-PAF (the biological inactive form) were added [10-7 M final concentration] and [Ca++]i levels measured. Background, nonstimulated, [Ca++]i levels had a mean of 131.4 nM. [Ca++]i levels began to increase by 4.6 seconds with maximum levels reached by 179.9 seconds after PAF exposure, baseline levels returned by 460 seconds. Maximum [Ca++]i levels (405.9 nM mean) were 3X that of non-PAF or lyso-PAF exposure. The results further demonstrate the magnitude of PAFs' action in the preimplantation embryo period. PAF's mechanism of action, in preimplantation mouse embryos, appears to involve a PAF-receptor mediated increase in intracellular calcium.

Food-containing hypocaloric diets are as effective as liquid-supplement diets for obese individuals with NIDDM

OBJECTIVE

This study was designed to determine if food-containing hypocaloric diets are as effective as liquid-supplement diets in promoting weight loss for obese individuals with non-insulin-dependent diabetes mellitus (NIDDM).

RESEARCH DESIGN AND METHODS

Forty NIDDM subjects with body mass indexes (BMIs) of 30-40 kg/m2 were randomized to one of two 800-kcal diets for 12 weeks. Group A received liquid supplement only, and group B received supplement plus an evening meal. Both groups received an intensive behavioral education program.

RESULTS

Weight loss and improvements in glycemic, blood lipid, and blood pressure parameters were similar for the two groups. Weight loss averaged 15.7 kg for the entire group. The need for insulin, anti-diabetes, and anti-hypertensive medication decreased significantly. No serious side effects were observed.

CONCLUSIONS

Both food-containing and supplement diets providing 800 kcal a day effectively promote weight loss for obese individuals with NIDDM.

International Federation of Clinical Chemistry (IFCC). Scientific Committee, Analytical Section. IFCC/WHO principles and recommendations on evaluation of diagnostic reagent sets used in health laboratories with limited resources. Part 3. Selection and evaluation using reference materials. General considerations

The purpose of this document is to provide general considerations for the selection and evaluation of clinical chemistry kits in laboratories with limited resources. Separate documents have been developed to provide guidance on experimental procedure, the statistical treatment and interpretation of the data and criteria for acceptable performance of diagnostic kits designed to measure specific analytes.

Revised recommendation (1983) on evaluation of diagnostic kits. Part 2. Guidelines for the evaluation of clinical chemistry kits

The purpose of the document is to state the policy of IFCC on the evaluation of clinical chemistry kit methods. Subsequent documents will provide specific guidance on experimental procedure, the interpretation of data and criteria for acceptable performance.

Serum calcium methodology--a Canadian assessment based on the application of the reference method

The reference method for serum calcium [J.P. Cali, G.N. Bowers Jr., D.S. Young (7)] has provided target values in six voluntary interlaboratory studies each using five or six human serum samples, mostly in liquid form. Eighteen method/instrument categories, used by at least five laboratories in the last two studies, have been rated in four classes for inter- and intra-laboratory accuracy and for precision. There has been a noticeable improvement in the performance of some individual laboratories but no real improvement in the overall results. Certain poor performance procedures were used less often in the most recent studies; however, some continue to be used. There has been a great increase in automated procedures but the results were not consistently reliable. There was wide diversity in the sources of supply of standards and quality control materials and their use in the laboratories. The wide variety of laboratory reference ranges (normal ranges) for the adult male was not consistent with the analytical results and differences in clinical interpretation occurred. On a daily workload basis the best procedures account for approximately 80% of the analytical tests performed per day whereas the worst procedures account for only 3% of the tests per day.

Production of low glucose serum for quality control and evaluation of yeast treatment, lyophilization and storage conditions on serum constituents

In order to provide quality control serum in the hypoglycemic range, pooled human serum was treated with yeast. Yeast destroyed about 50% of the serum glucose in about 4 1/2 hrs. The yeast-treated serum remained suitable for quality control of the most commonly analyzed clinical chemistry constituents which showed only very little change in most cases. Serum triglycerides were increased by about 40% and bilirubin decreased by about 20% during the treatment. Lyophilization of serum samples (yeast-treated or not) resulted in significant decreases of some enzymes activities. Exposure at 22 degrees C of samples lyophilized (7 days) and non-lyophilized (4 days) resulted in practically no change except for certain enzymes. No significant differences were observed in the clinical chemistry measurements including glucose one month and three months after preparation of samples lyophilized (stored in a refrigerator) and non-lyophilized (store in a freezer).

A scheme for the evaluation of methods in clinical chemistry with particular application to those measuring enzyme activities. Part I: general considerations

A 20-point system is presented whereby commercially produced clinical chemistry procedures, i.e., in vitro diagnostic kits, may be assessed for adequacy of packaging, labelling and enclosed literature. Criteria are given for the selection of a reference method to use in the test method evaluation and the design of a patient comparison study using these two methods is described. The importance of standards and calibration materials as they relate to accuracy and specificity is discussed. A procedure for assessing accuracy by recovery studies is outlined. A method for the assessment of precision on a within-day and a day-to-day basis is described.

A scheme for the evaluation of methods in clinical chemistry with particular application to those measuring enzyme activities. Part II: analysis of data and performance assessment

Recommendations are made concerning the editing of day-to-day reproducibility data for establishment of precision in the evaluation of a clinical chemistry method. The concept of diagnostic and equalized diagnostic indices is introduced together with formulae for their generation from the usual precision and accuracy data acquired in method evaluations. These indices allow direct comparison of data obtained from procedures for measuring enzyme activities which employ a variety of experimental conditions and units in their protocols. The equalized diagnostic index permits assessment of the suitability of the normal range assignment. Permissible limits of variation (PLV) and permissible limits of discrepancy (PLD) have been developed empirically from detailed examination of data from method evaluations and proficiency testing surveys in the published literature. The application of the diagnostic indices and the two permissible limits of criteria have been illustrated using data from the assessment of 19 kits measuring CPK activity. The inconsistency of the correlation coefficient in method comparisons is confirmed.

An investigation of factors influencing the measurement of creatine phosphokinase activity in serum using coupled enzymatic methods

1. The factors influencing the measurement of creatine phosphokinase (CPK) activity in serum by coupled enzymatic methods were investigated to establish optimum conditions for this type of assay. Such a study was indicated following observations by the authors of poor performance of commerically produced reagent kits together with the failure of most of the established an well accepted methods to operate under true optimum zero order kinetics in the reaction phase state. 2. The factors invested were the effects of pH, substrate concentrations (creatine phosphate, glucose and NADP+), added auxiliary (hexokinase) and indicator (glucose-6-phosphate dehydrogenase) enzymes, dithiothreitol (DTT) as an activator and conditions of storage of substrate stability. DTT was found to be a suitable activator but not a reactivator of the reaction. The optimum concentrations of creatine phosphate, glucose and NADP+ were found to be 20.0, 20.0 and 2.0 mmol/litre, respectively. Optimum activieies of the enzymes, glucose-6-phosphate dehydrosenase and hexokinase were 1000 and 2000 units/litre, respectively. 3. The between-day precision of the method for measuring serum at pH 6.8 and 30 degrees C at three activity levels under the optimum conditions developed was excellent yielding coefficients of variation ranging from 2.0 to 2.7%.

An evaluation of commercial kits for creatine phosphokinase assay

1. The evaluation of seven colorimetric and twelve kinetic or ultra-violet (UV) creatine phosphokinase (CPK) kit methods for their reliability as a diagnostic tool in clinical laboratories has revealed that over 35% of such commercial products readily available in Canada do not yield reliable results. 2. Six out of seven colorimetric kits failed to meet the criteria of minimum reliability as did one of the twelve UV kinetic kits.

The use of in vitro diagnostic kits in hospital laboratories in Canada

1. A survey conducted among hospital laboratories has yielded data from 640 institutions concerning the use of diagnostic kits and reagents in Canada. 2. Kits designed to test for chemical constituents were most frequently used in hospitals of 51 to 600 bed capacity whereas the ones for enzymes were most extensively used in 201 to 700 bed-size institutions. Kits based on the CPB principles were generally used in hospitals of more than 200 beds whereas those based on RIA were only in frequent use where the bed capacity was 351 or more. 3. The following tests were most often performed by kits: aminotransferases, amylase, urea, LDH, phosphatases, glucose, CPK, bilirubin, calcium, uric acid, T-4, T-3, digoxin and vitamin B12. 4. The survey reflects a continuing and increasing usage of in vitro diagnostic kits and associated blood analyzer systems. It also indicates a significant adoption of assay kits which utilize RIA and CPB principles.

Assessment of Two Blood-Analyzer Systems Intended for Diagnostic Testing in the Physician's Office

We have assessed the Bio-Dynamics "Unitest System" and the Dow Chemical "Diagnostest." Day-to-day reproducibility and within-day precision of the Unitest uric acid and urea nitrogen kits were beyond acceptable limits of error. For Diagnostest, day-to-day reproducibility of bilirubin was outside these limits for two concentrations of bilirubin, one each for uric acid and cholesterol. The Unitest kit gave falsely high readings for cholesterol such that incorrect diagnoses could result. The Diagnostest cholesterol procedure gave values significantly lower than those obtained with the AutoAnalyzer. With Unitest, low results were found on specimens with supranormal uric acid; with Diagnostest low results were obtained for supranormal concentrations of urea nitrogen. Both systems yielded acceptable results for glucose and hemoglobin. We conclude that personnel not technically trained could not obtain reliable data with these systems.

A survey of hemoglobin values in Canada

A compilation of hemoglobin values has been made from submissions from laboratories in Canada using the cyanmethemoglobin standard prepared and distributed by the Canadian Communicable Disease Centre (formerly the Laboratory of Hygiene). From 84 participating laboratories 21,580 values were analyzed statistically by age and sex. "Medical referrals", exclusive of blood dyscrasias, were included but were documented separately from "well persons". In most age groupings no significant difference in these two categories was found.Values for boys and girls were similar up to 12 years of age. For adult women from 18 to 84 years the mean value was 13.0 g. per 100 ml. (95% confidence limits 10.8-15.2 g.); for pregnant women 19 to 44 years the mean value was 12.2 g. per 100 ml. (9.7-14.6 g.). For men aged 17 to 24 years the mean value was 15.0 g. per 100 ml. (12.8-17.3 g.); 25-49 years 14.6 g. per 100 ml. (12.4-16.9 g.); 50-69 years 14.3 g. per 100 ml. (11.8-16.8 g.). It is noteworthy that for the most part the mean values were slightly lower than those frequently quoted as "normal" and that the mean values, particularly for the male, were lower with increasing age.