Online seminars as an information source for direct-to-consumer stem cell therapy

Aim: To attend stem cell (SC) seminars hosted by US-based direct-to-consumer SC businesses either in person or via online 'webinars' to determine accuracy and regulatory oversight of the advertised SC therapies. Methods: The therapeutic claims, costs, risks, scientific evidence in support of a therapy and any regulatory oversight were collated using pre-established checklists. Participation consisted of one live attendance of a seminar, and following COVID-19 restrictions, review of seven recorded presentations available on the internet from SC businesses. Results & conclusion: None of the SC therapies advertised by direct-to-consumer clinics reviewed were supported by proper clinical evidence nor substantiated by peer reviewed literature.

SARS-CoV-2 vaccine testing and trials in the pediatric population: biologic, ethical, research, and implementation challenges

As the nation implements SARS-CoV-2 vaccination in adults at an unprecedented scale, it is now essential to focus on the prospect of SARS-CoV-2 vaccinations in pediatric populations. To date, no children younger than 12 years have been enrolled in clinical trials. Key challenges and knowledge gaps that must be addressed include (1) rationale for vaccines in children, (2) possible effects of immune maturation during childhood, (3) ethical concerns, (4) unique needs of children with developmental disorders and chronic conditions, (5) health inequities, and (6) vaccine hesitancy. Because COVID-19 is minimally symptomatic in the vast majority of children, a higher acceptable risk threshold is required when evaluating pediatric clinical trials. Profound differences in innate and adaptive immunity during childhood and adolescence are known to affect vaccine responsiveness for a variety of childhood diseases. COVID-19 and the accompanying social disruption, such as the school shutdowns, has been disproportionately damaging to minority and low-income children. In this commentary, we briefly address each of these key issues, specify research gaps, and suggest a broader learning health system approach to accelerate testing and clinical trial development for an ethical and effective strategy to implement a pediatric SARS-CoV-2 vaccine as rapidly and safely as possible. IMPACT: As the US begins an unprecedented implementation of SARS-CoV-2 vaccination, substantial knowledge gaps have yet to be addressed regarding vaccinations in the pediatric population. Maturational changes in the immune system during childhood have influenced the effectiveness of pediatric vaccines for other diseases and conditions, and could affect SARS-CoV-2 vaccine responsiveness in children. Given that COVID-19 disease is far milder in the majority of children than in adults, the risk-benefit of a pediatric SARS-CoV-2 vaccine must be carefully weighed. The needs of children with developmental disabilities and with chronic disease must be addressed. Minority and low-income children have been disproportionately adversely affected by the COVID-19 pandemic; care must be taken to address issues of health equity regarding pediatric SARS-CoV-2 vaccine trials and allocation. Research and strategies to address general vaccine hesitancy in communities must be addressed in the context of pediatric SARS-CoV-2 vaccines.

Nurses' Attitudes toward Obese Persons and Certain Ethnic Groups

Societal attitudes toward obese persons are predominantly negative, and many health care professionals share these beliefs. This study compared attitudes toward obese persons of 67 US nurses to those of 107 Canadian nurses. Also, attitudes toward obesity were examined as a particular class of prejudice. A positive correlation was hypothesized between ethnic prejudice and prejudice regarding obese persons. Significant differences in attitudes toward obese patients were observed between the two groups on several questionnaire items, and the hypothesis was confirmed by the moderate r of .53 for US nurses. A surprising finding was a new target of ethnic prejudice: the Caucasian majority.

Making the female condom a "reality" for adolescents

Alarming rates of pregnancy, sexually transmitted diseases, and human immunodeficiency virus infection among adolescents point to the need for expanding contraceptive options for adolescents. The female condom-a female-controlled barrier method that protects both partners from sexually transmitted diseases-marks an important breakthrough in contraceptive technology. This report reviews current research on the efficacy and acceptability of the female condom and considers the feasibility of its use in the adolescent population. Specifically, the authors first consider the factors that affect teenage condom (and other contraceptive) use (efficacy, cost and availability, and acceptability) and then apply the mechanics of the female condom to these issues. Based on this analysis, recommendations for future steps to be taken by researchers, adolescent health practitioners, and the manufacturer of the female condom are presented.

Site-directed mutagenesis of human type X collagen. Expression of alpha1(X) NC1, NC2, and helical mutations in vitro and in transfected cells

Type X collagen is a short chain collagen expressed in the hypertrophic zone of calcifying cartilage during skeletal development and bone growth. The alpha1(X) homotrimer consists of three protein domains, a short triple helix (COL1) flanked by nonhelical amino-terminal (NC2) and carboxyl-terminal (NC1) domains. While mutations of the NC1 domain result in Schmid metaphyseal chondrodysplasia, which suggests a critical role for this protein domain, little biochemical detail is known about type X collagen synthesis, secretion, and the mechanisms of molecular assembly. To study these processes, a range of mutations were produced in human alpha1(X) cDNA and the biochemical consequences determined by in vitro expression, using T7-driven coupled transcription and translation, and by transient transfection of cells. Three NC1 mutants, which were designed to be analogous to Schmid mutations (1952delC, 1963del10, and Y598D), were unable to assemble into type X collagen homotrimers in vitro, but the mutant chains did not associate with, or interfere with, the efficiency of normal chain assembly in co-translations with a normal construct. Expression in transiently transfected cells confirmed that mutant type X collagen assembly was also compromised in vivo. The mutant chains were not secreted from the cells but did not accumulate intracellularly, suggesting that the unassociated mutant chains were rapidly degraded. In-frame deletions within the helix (amino acid residues 72-354) and the NC2 domain (amino acid residues 21-54) were also produced. In contrast to the NC1 mutations, these mutations did not prevent assembly. Mutant homotrimers and mutant-normal heterotrimers were formed in vitro, and the mutant homotrimers formed in transiently transfected cells had assembled into pepsin-stable triple helical molecules which were secreted.

A comparative study of intravenous versus intralymphatic interleukin-2, with assessment of effects of interleukin-2 on both peripheral blood and thoracic-duct lymph

Recombinant human interleukin-2 (IL-2) was administered by the intravenous (i.v.) or intralymphatic (i.l.) route to 14 patients with advanced malignancy. IL-2 was given in doses of 600,000 IU/kg or 1,050,000 IU/kg daily x 5. Thoracic duct (TD) catheters were placed, and both TD lymphocytes (TDL) and peripheral blood lymphocytes (PBL) were studied. Five of eight patients at the 600,000 IU/kg dose experienced grade III toxicity as did five of six patients at the 1,050,000 IU/kg dose. Two episodes of grade IV toxicity were seen at the higher dose. The i.l. and i.v. routes had a similar toxicity profile excepting lymphangitis/pedal infection, seen only with i.l. administration. One partial response was seen in a patient with renal cell carcinoma. Lymphopenia was seen early in therapy, with lymphocytosis by day 6. Lymphoid yield of the TD catheter fell early in therapy, then increased over baseline by the end of treatment. Intralymphatic administration resulted in a prolonged serum t1/2 and lower serum levels than did i.v. administration, but resulted in higher TD levels. Antibodies against IL-2 were ubiquitous but had no clear effects. Lymphocyte trafficking studies suggested that IL-2 affected lymphocyte redistribution to liver, spleen, bone marrow, and lymph nodes. NK activity and phenotype and LAK activity increased in response to IL-2, with no advantage for TDL. Tumor necrosis factor-alpha and gamma-interferon levels increased sporadically with treatment. The i.l. route offered no advantage over the i.v. route, and TDL offered no advantage over PBL.

Sexual abuse prevention programs for preschool children: what do parents prefer?

Using structured interviews, 21 parents of preschool children at a suburban day-care center were introduced to the problem of child sexual abuse and to three different techniques currently used in preventing it. Parental support for teaching preschool children personal safety skills was unanimous and the school-based videotaped role-play program, which explicitly demonstrates personal safety skills, was the first choice of 57% of the parents.

Interferon-alpha primed tumor-infiltrating lymphocytes combined with interleukin-2 and interferon-alpha as therapy for metastatic renal cell carcinoma

Murine models demonstrate therapeutic synergy for the combination of interleukin-2, interferon-alpha and tumor-infiltrating lymphocytes. We treated 11 patients with metastatic renal cell carcinoma with a novel regimen consisting of in vivo primed tumor-infiltrating lymphocytes, interferon-alpha and interleukin-2. Patients received interferon-alpha before radical nephrectomy; in vivo primed tumor-infiltrating lymphocytes were isolated and expanded in vitro. Low dose continuous infusion interleukin-2 at a dose of 2 x 10(6) units per m.2 per day was administered for 96 hours during each treatment week and interferon-alpha was administered as a subcutaneous injection at a dose of 6 x 10(6) units per m.2 per day on days 1 and 4 of the interleukin-2 infusion. No therapy was given during the last 3 days of a treatment week. One course of therapy consisted of 3 weeks of therapy followed by 3 weeks of rest. Patients were treated until maximal response, disease progression or dose limiting toxicity. A maximum of 6 courses of therapy were administered. Eleven patients underwent interferon-alpha priming and subsequent radical nephrectomy. In vivo primed tumor-infiltrating lymphocytes were successfully expanded in all 11 patients with an expansion index of greater than 170. In vivo primed tumor-infiltrating lymphocytes maintained their lytic activity for greater than 5 to 8 weeks in culture as demonstrated in the 4-hour 51chromium release assay. Ten patients underwent multimodality biological therapy and 3 (30%, 95% confidence interval 6 to 65%) have achieved complete response (2 clinical and 1 surgical) with durations of 24+, 23+ and 5+ months. Patients with stable disease received no additional therapy. No deaths and no grade 4 toxicities occurred. Immunotherapy using a combination of interferon-alpha primed tumor-infiltrating lymphocytes, low dose continuous infusion interleukin-2 and interferon-alpha can induce significant and durable antitumor responses in some patients with advanced renal cell carcinoma.

Tumour necrosis factor production by IL-2-activated macrophages in vitro and in vivo

Purified human and murine monocytes can be activated in vitro by human recombinant IL-2 to secrete tumour necrosis factor (TNF). TNF mRNA is detected within 4 h of addition of IL-2. Signal transduction does not appear to require expression of the Tac peptide of the IL-2 receptor. IL-2 does, however, induce Tac mRNA and Tac peptide expression on peripheral blood monocytes (PBM). In addition to these in vitro studies, PBM retrieved from IL-2-treated cancer patients and mice have been shown to have a greatly increased capacity for TNF production. These studies identify a pathway for macrophage activation by IL-2 both in vitro and in vivo. They also suggest a mechanism for some of the immunoregulatory and toxic effects of IL-2 based immunotherapy regimens.

Interleukin-1 and tumor necrosis factor production by tumor-associated mononuclear leukocytes and peripheral mononuclear leukocytes in cancer patients

The production of interleukin-1 (IL-1) and tumor necrosis factor (TNF) by tumor-associated mononuclear leukocytes (TAML) and peripheral mononuclear leukocytes (PMBL) from 9 otherwise untreated patients with a variety of malignancies (lung, sarcoma, stomach, renal) was assessed. Cells were cultured for 24 hr in vitro in the presence or absence of lipopolysaccharide (LPS), and IL-1 and TNF levels were measured in culture supernatants. TNF production was comparable between TAMLs and PBMLs. However, a striking defect in IL-1 production by TAMLs was noted. There was no basal production of IL-1 and LPS-stimulated TAMLs produced only 1% the amount of IL-1 produced by LPS-stimulated PBMLs.

Menarche: the beginning of menstrual life

Menarche represents a developmental milestone in a woman's life. This paper reviews current knowledge about the physiological aspects of menarche and its place in the sequence of pubertal development. Hypotheses regarding the mechanisms that trigger menarche are presented, as is our current understanding of the influence of hormones, genetic factors, nutrition, exercise, and illness. Also discussed are the ways in which the changes of puberty and menarche affect the adolescent girl's psychosocial development, the unique problems of the early maturing girl, and the kind of preparation for menarche that is needed.

Recollections of menarche and women's subsequent experiences with menstruation

Seventy college women aged 18 to 22 and 67 older women aged 30 to 45 completed a questionnaire comprised of multiple choice and open-ended questions covering recollections of menarche, preparation for menstruation, menstrual symptoms, and current attitude. The hypothesis that menarche was a significant developmental event that would be readily recalled by a majority of women regardless of age was confirmed. Almost all of the women remembered their first menstruation and the early experiences described by both groups were similar. Most women felt they were adequately prepared and a significant relationship was found between adequacy of preparation and positive reaction to menarche among the college women. Both groups reported a similar incidence of menstrual pain, bleeding, and amenorrhea. However, the incidence of menstrual symptoms in adult women was not significantly related to preparation for menstruation or to whether or not menarche was a positive event.

Premenstrual and menstrual mood changes in adolescent women

One hundred fifty-eight female subjects aged 15-16 years completed the Menstrual Distress Questionnaire and reported the actual date of onset of the next two menstrual periods. These female high school students and their male classmates were later given The Depression Adjective Check List and the State-Trait Anxiety Inventory twice, 2 weeks apart, in an unrelated classroom setting. This study assessed the magnitude of anxiety and depression experienced by the 29 adolescents who were tested within 4 days preceding the onset of menstruation and the 23 adolescents who were tested during the first 4 days of menstruation. Premenstrual and menstrual test scores were compared with those obtained during the intermenstrual phase of the cycle. No significant differences in mood attributable to cycle phase were found. A control group of males also showed no significant difference in mood. Adolescent women appear to be different from women over 30 who have been reported to show significantly increased state anxiety and depression during the premenstrual phase of the menstrual cycle.

Premenstrual and menstrual mood changes in adolescent women

One hundred fifty-eight female subjects aged 15-16 years completed the Menstrual Distress Questionnaire and reported the actual date of onset of the next two menstrual periods. These female high school students and their male classmates were later given The Depression Adjective Check List and the State-Trait Anxiety Inventory twice, 2 weeks apart, in an unrelated classroom setting. This study assessed the magnitude of anxiety and depression experienced by the 29 adolescents who were tested within 4 days preceding the onset of menstruation and the 23 adolescents who were tested during the first 4 days of menstruation. Premenstrual and menstrual test scores were compared with those obtained during the intermenstrual phase of the cycle. No significant differences in mood attributable to cycle phase were found. A control group of males also showed no significant difference in mood. Adolescent women appear to be different from women over 30 who have been reported to show significantly increased state anxiety and depression during the premenstrual phase of the menstrual cycle.

The effect of premenstrual anxiety and depression on cognitive function

The Depression Adjective Check List, State-Trait Anxiety Inventory, and a battery of factor analytically derived cognitive tests sensitive to anxiety or depression were administered to 50 women between the ages of 30 and 45 during the 4 days prior to the onset of menstruation and again 2 weeks later. Testing sessions were scheduled on the basis of a previously completed Menstrual Distress Questionnaire. There were significant increases in anxiety and depression during the premenstruum. However, no statistically significant differences were found in cognitive test performance, and correlation data failed to support any consistent relationship between premenstrual mood and cognitive function. Moreover, no significant correlations were found between premenstrual complaints on the Menstrual Distress Questionnaire and either cognitive test performance or mood scores obtained during the premenstrual testing sessions. It was concluded that the magnitude of the premenstrual mood change was not great enough to affect intellectual function. Alternative explanations of the absence of decrements in performance are discussed.

The effect of premenstrual anxiety and depression on cognitive function

The Depression Adjective Check List, State-Trait Anxiety Inventory, and a battery of factor analytically derived cognitive tests sensitive to anxiety or depression were administered to 50 women between the ages of 30 and 45 during the 4 days prior to the onset of menstruation and again 2 weeks later. Testing sessions were scheduled on the basis of a previously completed Menstrual Distress Questionnaire. There were significant increases in anxiety and depression during the premenstruum. However, no statistically significant differences were found in cognitive test performance, and correlation data failed to support any consistent relationship between premenstrual mood and cognitive function. Moreover, no significant correlations were found between premenstrual complaints on the Menstrual Distress Questionnaire and either cognitive test performance or mood scores obtained during the premenstrual testing sessions. It was concluded that the magnitude of the premenstrual mood change was not great enough to affect intellectual function. Alternative explanations of the absence of decrements in performance are discussed.

The magnitude of premenstrual anxiety and depression

The magnitude of premenstrual mood changes in 50 parous adult women between the ages of 30 and 45 was assessed using standardized measures of depression and anxiety. Premenstrual test scores were compared with those obtained during the intermenstrual phase of the cycle and with normative data. Premenstrual state anxiety and depression mean scores were significantly higher than those obtained midcycle, but were much lower than those of patients with psychiatric disorders. Trait anxiety scores were low and were not significantly correlated with premenstrual depression and anxiety scores.