The politics of COVID-19: Differences between U.S. red and blue states in COVID-19 regulations and deaths

The study investigated infection variables and control strategies in 2020 and 2021 and their influence on COVID-19 deaths in the United States, with a particular focus on comparing red (Republican) and blue (Democratic) states. The analysis reviewed cumulative COVID-19 deaths per 100,000 by year, state political affiliation, and a priori latent factor groupings of mitigation strategies (lockdown days in 2020, mask mandate days, vaccination rates), social demographic variables (ethnicity, poverty rate), and biological variables (median age, obesity). Analyses first identified possible relationships between all assessed variables using K-means clustering for red, blue, and purple states. Then, a series of regression models were fit to assess the effects of mitigation strategies, social, and biological factors specifically on COVID-19 deaths in red and blue states. Results showed distinct differences in responding to COVID infections between red states to blue states, particularly the red states lessor adoption of mitigation factors leaving more sway on biological factors in predicting deaths. Whereas in blue states, where mitigation factors were more readily implemented, vaccinations had a more significant influence in reducing the probability of infections ending in death. Overall, study findings suggest politicalization of COVID-19 mitigation strategies played a role in death rates across the United States.

Exploratory analysis of medication adherence and social determinants of health among older adults with diabetes

Background

Diabetes is the fifth leading cause of death in the United States (US), affecting approximately 27%, or 15.9 million adults 65 years of age and older. Diabetes is the most expensive chronic condition in the US and accounts for the second largest avoidable healthcare cost. Adherence to long-term medication treatment plans is crucial among patients with diabetes because it decreases risk of developing comorbid conditions and improves quality of life. Greater exposure to adverse social determinants of health (SDOH) over an individual's lifespan can result in worse health outcomes. Hence, it is important to obtain a better understanding of how social determinants of health (SDOH) influence patients' behaviors and affect medication adherence among older adults with diabetes.

Objectives

Identify and prioritize SDOH associated with medication adherence among a nationally representative sample of older adults with diabetes. Secondary objectives were to characterize SDOH, estimate medication adherence, and explain implications for health disparity populations among older adults in the US who have been diagnosed with diabetes.

Methods

This study used a cross-sectional secondary data analysis to examine the National Health and Nutrition Examination Survey database, identifying associations between SDOH and medication adherence among older adults with diabetes in the US.

Results

A total of 1807 respondents' data were included in the analyses. Nearly three-quarters (73.9%) of patients were considered adherent to their oral diabetes medications. Multivariable analysis revealed significant differences in medication adherence based on disability status (p = 0.016), household balanced meals (p = 0.033), and interview language (p = 0.008).

Conclusions

Results revealed those with a disability, those who could not afford a balanced meal, and/or those who spoke English were associated with a higher likelihood of being nonadherent to their diabetes medications in comparison to individuals not in these groups. These findings can assist in developing SDOH-centered medication adherence strategies for pharmacists to implement with older patients with diabetes.

Evaluation of Sexual Side Effects in Patients after Chemoradiation and Brachytherapy for Gynecologic Cancers Involving the Lower Vagina and Bulboclitoris

PURPOSE/OBJECTIVE(S)

Radiation toxicity to the bulboclitoris has not been previously investigated. This retrospective cohort study aims to report sexual side effects of patients who underwent radiotherapy for tumors involving the lower vagina, periurethra, and bulboclitoris (BC).

MATERIALS/METHODS

Patients treated between 2017- 2022 for gynecologic cancer involving the low vagina were included. The high-risk clinical target volume (HR-CTV), bladder, rectum, and urethra were contoured on patient imaging during initial treatment planning. The BC was retrospectively contoured using T2 MRI sequences fused to the pre-treatment and brachytherapy CT simulation. Superiorly, the BC was defined as inferior to the pubic symphysis and attached to the suspensory ligament of the clitoris. Laterally, the crura extend on either side of the corpus. Inferiorly, the vestibular bulbs flank the urethra and vagina on either side, extending posteriorly to mid-vagina. Dosimetric data for the BC, vaginal morbidity using the CTCAE 4.0 for vaginal stenosis, and pain scoring of the BC were obtained via chart review.

RESULTS

Patients underwent external beam radiotherapy (IMRT) to the pelvis and bilateral inguinal region (45 Gy in 25 fractions) followed by High Dose Rate Ir-192 interstitial brachytherapy in 5 fractions for a total dose of 25 Gy (22.5 - 27.5 Gy). Patients had a median age of 65 years (49-73) with tumors located in the lower vagina, near the BC and urethra. At the time of brachytherapy, in order to cover the HR-CTV, interstitial brachytherapy needles were placed within the BC structure with 58% (33% - 77%) of total interstitial needles placed within the bulbs of the BC. The mean pre-treatment volume of the BC was 16.6 cc (11.9 - 20.9 cc) and at brachytherapy was 12.66 cc (7.3 - 22.1 cc) with Table 1 summarizing radiation doses. At a median follow up of 19.6 months, all patients had a complete local response, with one patient deceased of metastatic disease. In the acute period, all patients reported severe pain in the clitoral glans region and dysuria that completely resolved after 2 years. Grade 1-2 vaginal stenosis occurred in all patients despite vaginal dilator usage. One patient reported decreased clitoral sensitivity and inability to achieve clitoral-mediated orgasm 5 months after radiotherapy.

CONCLUSION

This study demonstrates that the BC receives a significant radiation dose during vaginal brachytherapy treatment which can cause clitoral pain and dysfunction. Further studies are needed to evaluate the dose response of the BC as well as explore methods to spare the organ during radiation therapy in order to minimize toxicity and preserve sexual function.

Thriving during COVID-19: Predictors of psychological well-being and ways of coping

COVID-19 has led to global dramatic shifts in daily life. Following the biopsychosocial model of health, the goal of the current study was to predict people's psychological well-being (PWB) during the initial lockdown phase of the pandemic and to investigate which coping strategies were most common among people with low and high PWB. Participants were 938 volunteers in the United States who responded to an online survey during the lockdown in April 2020. The main findings were that all three groups of variables, biological, psychological, and socio-economic, significantly contributed to PWB explaining 53% variance. Social loneliness and sense of agency were the strongest predictors. PWB was significantly predicted by physical health (not gender nor age); by spirituality, emotional loneliness, social loneliness, and sense of agency; by job security (not income, nor neighborhood safety, nor hours spent on social media). Comparing the coping strategies of participants, results show more intentional coping in the high-PWB group and more passive coping in the low-PWB group. During this unprecedented pandemic, the findings highlight that ability to sustainably cope with the global shifts in daily life depends on actively and intentionally attending to PWB by being one's own agent for physical health, spiritual health, and social connection.

Preliminary Assessment of Microbial Community Structure of Wind-Tidal Flats in the Laguna Madre, Texas, USA

Aside from two samples collected nearly 50 years ago, little is known about the microbial composition of wind tidal flats in the hypersaline Laguna Madre, Texas. These mats account for ~42% of the lagoon's area. These microbial communities were sampled at four locations that historically had mats in the Laguna Madre, including Laguna Madre Field Station (LMFS), Nighthawk Bay (NH), and two locations in Kenedy Ranch (KRN and KRS). Amplicon sequencing of 16S genes determined the presence of 51 prokaryotic phyla dominated by Bacteroidota, Chloroflexi, Cyanobacteria, Desulfobacteria, Firmicutes, Halobacteria, and Proteobacteria. The microbial community structure of NH and KR is significantly different to LMFS, in which Bacteroidota and Proteobacteria were most abundant. Twenty-three cyanobacterial taxa were identified via genomic analysis, whereas 45 cyanobacterial taxa were identified using morphological analysis, containing large filamentous forms on the surface, and smaller, motile filamentous and coccoid forms in subsurface mat layers. Sample sites were dominated by species in Oscillatoriaceae (i.e., Lyngbya) and Coleofasciculaceae (i.e., Coleofasciculus). Most cyanobacterial sequences (~35%) could not be assigned to any established taxa at the family/genus level, given the limited knowledge of hypersaline cyanobacteria. A total of 73 cyanobacterial bioactive metabolites were identified using ultra performance liquid chromatography-Orbitrap MS analysis from these commu nities. Laguna Madre seems unique compared to other sabkhas in terms of its microbiology.

New sonographic marker of borderline ovarian tumor: microcystic pattern of papillae and solid components

OBJECTIVE

To describe and evaluate the utility of a new sonographic microcystic pattern, which is typical of borderline ovarian tumor (BOT) papillary projections, solid component(s) and/or septa, as a new ultrasound marker that is capable of distinguishing BOT from other adnexal masses, and to present/obtain histologic confirmation.

METHODS

In this retrospective study, we identified women with a histologic diagnosis of BOT following surgical resection who had undergone preoperative transvaginal ultrasound (TVS) examination. All images were reviewed for presence or absence of thin-walled, fluid-filled cluster(s) of 1-3-mm cystic formations, associated with solid component(s), papillary projections and/or septa. From the same cases, histopathologic slides of each BOT were examined for presence of any of these microcystic features which had been identified on TVS. To confirm that the microcystic TVS pattern is unique to BOTs, we also selected randomly from our ultrasound and surgical database 20 cases of epithelial ovarian cancer and 20 cases of benign cystadenoma, for review by the same pathologists. To confirm the novelty of our findings, we searched PubMed for literature published in the English language between 2010 and 2018 to determine whether the association between microcystic tissue pattern and BOT has been described previously.

RESULTS

Included in the final analysis were 62 patients (67 ovaries) with preoperative TVS and surgically confirmed BOT on pathologic examination. The mean patient age at surgery was 39.8 years. The mean BOT size at TVS was 60.7 mm. Of the 67 BOTs, 47 (70.1%) were serous, 15 (22.4%) were mucinous and five (7.5%) were seromucinous. We observed on TVS a microcystic pattern in the papillary projections, solid component(s) and/or septa in 60 (89.6%) of the 67 BOTs, including 46 (97.9%) of the 47 serous BOTs, 11 (73.3%) of the 15 mucinous BOTs and three (60.0%) of the five seromucinous BOTs. On microscopic evaluation, 60 (89.6%) of the 67 samples had characteristic 1-3-mm fluid-filled cysts similar to those seen on TVS. In seven cases there was a discrepancy between sonographic and histologic observation of a microcystic pattern. The 20 cystadenomas were mostly unilocular and/or multilocular and largely avascular. None of them or the 20 epithelial ovarian malignancies displayed microcystic characteristics, either on TVS or at histology. On review of 23 published articles in the English medical literature, containing 163 sonographic images of BOT, we found that, while all images contained it, there was no description of the microcystic tissue pattern.

CONCLUSION

We report herein a novel sonographic marker of BOT, a 'microcystic pattern' of BOT papillary projections, solid component(s) and/or septa. This was seen in the majority of both serous and mucinous BOT cases. Importantly, based on comparison of sonographic images and histopathology of benign entities and malignancies, the microcystic appearance seems to be unique to BOTs. No similar description has been published previously. Utilization of this new marker should help to identify BOT correctly, discriminating it from ovarian cancer and benign ovarian pathology, and should ensure appropriate clinical and surgical management. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

The use of near peer teachers in the radiography program at Monash University

INTRODUCTION

This research investigated the perceptions of fourth year students as near peer (NP) teachers, and second year NP learners during a pathology unit in the Bachelor of Medical Imaging and Radiation Sciences at Monash University.

METHODS

A systematic review of literature was undertaken to inform the research design. Semi-structure pre- and post-teaching interviews were conducted with four NP teachers. An online survey was conducted with 50 second year NP learners. Quantitative data was analysed using Microsoft Excel. Interview data and 64 free text comments in the online survey were analysed using NVivo.

RESULTS

NP students felt there were significant benefits being involved in the NP program, including an explanation of concepts and complementary teaching to lecturers. Three of the free text comments outlined a negative perception, although in each case the comment related to the student's individual learning style rather than being negative against the program.

CONCLUSION

The benefits to learners in a pathology course was consistent to those identified within the literature. Students perceived benefits in terms of content delivery, interaction and communication. Recommendations were made about the organisation and design for future cohorts.

'When he's up there he's just happy and content': Parents' perceptions of therapeutic horseback riding

Background

There is limited global and South African research on parents’ perceptions of therapeutic horseback riding (THR), as well as their perceptions of the effect of the activity on their children with disabilities.

Objective

To explore and describe parents’ perceptions and experiences of THR as an activity for their children with disabilities.

Method

Twelve parents whose children attend THR lessons at the South African Riding for the Disabled Association in Cape Town were asked to participate in a semi-structured interview. The qualitative data obtained from the interviews were first transcribed and then analysed using thematic analysis to establish parents’ perceptions of the THR activity.

Results

The main themes that emerged included parental perceived effects of THR on children, parents’ personal experiences of the services, and parents’ perceived reasons for improvements in the children. The participating parents indicated that THR had had a positive psychological, social and physical effect both on the children participating in the riding, as well as on the parents themselves.

Conclusion

According to parents, THR plays an important role in the lives of children with various disabilities and in the lives of their parents. The results of the study address the gap in the literature regarding parents’ perceptions of THR.

ART in South Africa: The price to pay

In developing countries especially in Sub-Saharan Africa, human immunodeficiency virus (HIV) infection -together with limited resources adds to the hindrances in becoming a parent. Although the South African's Bill of Rights proclaim that South Africans can "make decisions concerning reproduction"; access to and the use of Assisted Reproduction Technology (ART) are viewed in general as excessively expensive, accessible only to the privileged few. A dissection of cost-drivers within an ART laboratory, such as procedures; sperm preparations; laboratory supplies including embryo culture media and cryopreservation are discussed in the current overview. Subject to the nature of an ART practice, i.e. private vs. public/tertiary, the structure of a unit will vary with regards to patient demographics, costs and services offered. The average fees per procedure for 20 practices in the private sector in South Africa are: (i) IUI: € 542 ± €159, (ii) IVF: € 3,255 ± € 576 and (iii) ICSI: €3,302 ± € 625. Laboratory costs can contribute between 35 and 48% of ART fees payable in the private sector. Low-cost public ART services are available to citizens of the country at a few tertiary academic units. Some private practices also cater specifically for middle-income citizens. ART procedures need not be propelled towards the must-have and cannot-do without approach, but providers should also reflect on the validity of the techniques and equipment, without compromising treatment virtue.

Phase II study of bevacizumab with liposomal doxorubicin for patients with platinum- and taxane-resistant ovarian cancer

BACKGROUND

Suppression of neoangiogenesis and pegylated liposomal doxorubicin (PLD) each contribute to the management of platinum-resistant/refractory ovarian cancer. The aim of this study is to test the combination of bevacizumab and PLD in women with resistant or refractory ovarian cancer.

METHODS

Eligibility criteria were no more than two prior treatments with platinum-containing regimens and one additional regimen, without anthracyclines. Treatment was administered every 3 weeks (bevacizumab 15 mg/kg beginning on cycle 2 and PLD 30 mg/m(2)). The primary end point was progression-free survival (PFS) at 6 months; the secondary end points included side-effects, overall response rates (ORR) and survival (OS).

RESULTS

Forty-six patients were enrolled. The average number of courses administered was 7. The median PFS was 6.6 months (range 1-24.6 months) according to Gynecologic Cancer Intergroup Committee (GCIC) criteria and 7.8 months (range 2-13.3 months) according to Response Evaluation Criteria in Solid Tumors (RECIST). The median OS was 33.2 months (range 3-37.5+ months). The ORR was 30.2% [95% confidence interval (CI) 17.2-46.1] and the clinical benefit rate (CBR) was 86.1% (95% CI 72.1-94.7). Adverse events included mucosal and dermal erosions (30% grade 3) and asymptomatic cardiac dysfunction. Additional toxic effects included hypertension, headache, renal dysfunction and proteinuria, wound healing delay, and one episode each of central nervous system (CNS) ischemia and hemolytic uremic syndrome.

CONCLUSION

PLD with bevacizumab has improved activity in recurrent ovarian cancer with increased toxicity.

16. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010

This chapter summarises the results of the preceding sections, which estimate the fraction of cancers occurring in the UK in 2010 that can be attributed to sub-optimal, past exposures of 14 lifestyle and environmental risk factors. For each of 18 cancer types, we present the percentage of cases attributable to one or all of the risk factors considered (tobacco, alcohol, four elements of diet (consumption of meat, fruit and vegetables, fibre, and salt), overweight, lack of physical exercise, occupation, infections, radiation (ionising and solar), use of hormones, and reproductive history (breast feeding)).Exposure to less than optimum levels of the 14 factors was responsible for 42.7% of cancers in the UK in 2010 (45.3% in men, 40.1% in women)--a total of about 134,000 cases.Tobacco smoking is by far the most important risk factor for cancer in the UK, responsible for 60, 000 cases (19.4% of all new cancer cases) in 2010. The relative importance of other exposures differs by sex. In men, deficient intake of fruits and vegetables (6.1%), occupational exposures (4.9%) and alcohol consumption (4.6%) are next in importance, while in women, it is overweight and obesity (because of the effect on breast cancer)--responsible for 6.9% of cancers, followed by infectious agents (3.7%).Population-attributable fractions provide a valuable quantitative appraisal of the impact of different factors in cancer causation, and are thus helpful in prioritising cancer control strategies. However, quantifying the likely impact of preventive interventions requires rather complex scenario modelling, including specification of realistically achievable population distributions of risk factors, and the timescale of change, as well as the latent periods between exposure and outcome, and the rate of change following modification in exposure level.

The folic acid endophenotype and depression in an elderly population

OBJECTIVES

Folate status and/or genes have been linked to depression in a number of studies. This may be via a direct action (or actions) on neuronal membranes or indirect effects through the metabolism of methyl groups involved in neurotransmitter synthesis. This study examines folate and related thiol metabolism that might underpin either phenomenon.

DESIGN

Cohort study describing the relationship between several genetic and nutritional aspects of folic acid homeostasis and depression assessed by the HADS psychometric index in an elderly cohort.

SETTING

New South Wales (Australia) retirement village.

PARTICIPANTS

118 elderly participants (age 65-90 years).

RESULTS

Stepwise multiple regression was used to determine the best statistical model to predict depression; C677T-MTHFR (p=0.0103) was found to be positively associated with depression, while the thiol dipeptide Cys-Gly was negatively associated (p=0.0403). The statistical models used accounted for the major folate related indices (genetic and biochemical) that are most often evaluated in the context of health and disease. When only genetic data were examined for interactions, C677T-MTHFR was found to be negatively associated with the HADS Depression Index Score (p=0.0191).

CONCLUSION

The potential influence of Cys-Gly on this phenotype is novel, and of considerable interest given that it has been linked to altered spontaneous activity and sedation in an animal model. Cys-Gly is a recognised ligand at the N-methyl-D-aspartatic acid (NMDA) subclass of glutamate receptor, a system associated with depression. In addition, the C677T-MTHFR association adds further support to existing findings underscoring the potential role of folate in depression.

Pegylated liposomal doxorubicin (PLD) with bevacizumab (B) in second-line treatment of ovarian cancer (OC): Pharmacokinetics (PK), safety, and preliminary outcome results

5548

Background: PLD activity in platinum-resistant OC is modest. B, with its activity in platinum(Plat)-sensitive and Plat-resistant patients (pts), has not been combined with PLD. PLD intratumoral concentrations, if affected by B, might be reflected in PLD PK. This phase II study of PLD + B was started in 2007 to accrue 48 pts, unless 4 serious (> grade 3) adverse events (AEs) supervened. Methods: Improvement in progression-free survival (PFS) at 6 m from 25 to 40% at 6 m in Plat-resistant OC is primary endpoint. PK of PLD alone at 1h, d 7 and d 21 (cycle 1) vs with B (cycle 2), safety, and response rates (RECIST and CA125 criteria) were secondary endpoints. Dosing: PLD 30 mg/m2 followed by B 15 mg/kg on cycles 2–7 (with option to continue) d 1 every 3 w. Pts recurring within 6 m of platinum-based treatment for OC after < 3 prior regimens (but no PLD or B) were eligible. Exclusions: bowel obstruction, prior perforation, uncontrolled hypertension, or vascular disease. Hematologic, mucocutaneous and renal toxicities were evaluated prior to each cycle, MUGA scans every third cycle; disease status by CA125 and/or RECIST every third cycle. Results: 21 of 24 pts enrolled to date are evaluable. Median age is 65, range 52–83; most had 2 prior chemotherapy regimens. Median 6 (range 3–12) cycles were given with 6 off study with progression at 3–7 cycles. RECIST and CA125 responses are under review; in 11 pts with baseline CA125 of > 40 IU/mL, median increase was 31% by cycle 2; later falling to -57%. AEs did not exceed grade 3; hand-foot syndrome led to PLD dose reduction in 8 pts (33%); asymptomatic decreases in left ventricular ejection fraction (LVEF) >10% in 3 pts were noted, with treatment discontinuation in 1. The mean (±SEM) secondary PK parameter estimates for Cmax, AUC, and elimination half life were 4.5 ± 0.5 ug/mL, 651.7 ± 61 ug/mL x h, and 93.3 ± 19.7 h, respectively. Conclusions: Cycles 1 and 2 PLD PK do not differ. PLD + B is tolerable with PLD dose modifications. Declines in LVEF in 1 institution have uncertain causality. Midway into the trial, safety and time on study encourage completion for study primary endpoint.

[Table: see text]

National Hand Hygiene Campaigns in Europe, 2000-2009

Hand hygiene represents the single most effective way to prevent healthcare-associated infections. The World Health Organization, as part of its First Global Patient Safety Challenge, recommends implementation of multi-faceted strategies to increase compliance with hand hygiene. A questionnaire was sent by the European Centre for Disease Prevention and Control to 30 European countries, regarding the availability and organisation of their national hand hygiene campaigns. All countries responded. Thirteen countries had organised at least one national campaign during the period 2000-2009 and three countries were in the process of organising a national campaign. Although the remaining countries did not have a national campaign, several reported regional and local hand hygiene activities or educational resources on national websites.

National hand hygiene campaigns in Europe, 2000-2009

Hand hygiene represents the single most effective way to prevent healthcare-associated infections. The World Health Organization, as part of its First Global Patient Safety Challenge, recommends implementation of multi-faceted strategies to increase compliance with hand hygiene. A questionnaire was sent by the European Centre for Disease Prevention and Control to 30 European countries, regarding the availability and organisation of their national hand hygiene campaigns. All countries responded. Thirteen countries had organised at least one national campaign during the period 2000-2009 and three countries were in the process of organising a national campaign. Although the remaining countries did not have a national campaign, several reported regional and local hand hygiene activities or educational resources on national websites.

Contralateral cerebellar damage impairs imperative planning but not updating of aimed arm movements in humans

The specific motor control processes supported by the cerebellum and impaired with cerebellar damage remain unclear. The cerebellum has been implicated in both planning and updating of accurate movements. Previously, we used a statistical model to parcel aiming performance that was constrained by a timed-response paradigm into contributions attributed to a specified plan and feedforward updating. Here, we apply this procedure to determine the putative role of the cerebellum in planning and updating goal-directed aiming by comparing the performance of subjects with unilateral cerebellar stroke to controls. Subjects rapidly moved to targets in predictable or unpredictable conditions and cerebellar subjects used the contralesional limb to control for ipsilesional motor execution deficits. Displacement-derived movement velocity was used in the statistical model to determine the effect of planning and updating on accuracy. Compared to controls, the cerebellar group demonstrated errors in final position that were primarily determined by planning deficits. This finding is manifest in four ways: Cerebellar subjects (1) were less accurate than controls in both predictable and unpredictable conditions; (2) they showed minimal benefit from increased preparation time for target amplitude specification; (3) with ample time to plan direction, wrong direction response frequency was greater; and (4) final position was minimally determined by the plan. Because these deficits were found contralesional to the moving limb, the cerebellum's role in planning is not lateralized to one hemisphere but rather our findings suggest that cerebellar output affects motor planning for both upper limbs. Indeed, a lesion analysis showed that the dentate nucleus, an area implicated in planning motor strategies and the primary cerebellar output nucleus, was the only common region affected by our patient group with contralateral cerebellar strokes.

Comparative effects of phytosterol oxides and cholesterol oxides in cultured macrophage-derived cell lines

The cytotoxicity of cholesterol and a mixture of beta-sitosterol/campesterol (50%/40%) and their oxides was examined in a cultured-derived macrophage cell line, C57BL/6. Cell numbers, lactate dehydrogenase (LDH) leakage, protein content, lipid uptake, and mitochondria dehydrogenase activity were determined after exposure of cell mononlayers to sterols and sterol oxides at a concentration of 200 microg/mL for up to 120 h. Results indicate that the oxides of cholesterol, beta-sitosterol, and campesterol exhibited similar patterns of toxicity as indicated by LDH leakage, cell viability, and mitochondria dehydrogenase activity. Greatest cell damage was associated with treatments containing 5 alpha,6 alpha-epoxide or cholesterol oxides, followed by beta-sitosterol/campesterol oxides, cholesterol, and beta-sitosterol. The oxides of beta-sitosterol/campesterol caused less LDH leakage and less of an effect on protein content. Results of this study demonstrate that phytosterols contained in vegetable oils, when subjected to frying conditions, do oxidize and may cause cellular damage in an in vitro cell line similar to cholesterol oxides, although less severe.