Adapting to the burdens of care: a telehealth program for cancer survivors with ostomies

PURPOSE

An ostomy introduces to cancer survivors new demands for self-care and healthcare resource use. A curriculum that teaches ostomates self-management skills may affect survivors' use of resources.

METHODS

A prospective randomized trial comparing usual care (UC) with an Ostomy Self-Management Training (OSMT) program delivered by telehealth was conducted in patients with ostomies due to cancer. The intervention occurred over 5 weeks with survey administration at baseline, program completion, and 6 months after completion. Quantitative data were analyzed using a mixed-effects logistic model to predict mean values of resource and service use. Responses to the open-ended question were coded and analyzed with directed content analysis.

RESULTS

One hundred and sixty-seven subjects (89 in the OSMT arm and 78 in the UC arm) completed the questionnaire at all time points. The changes in likelihoods of emptying one's ostomy bag > 8 times/week and of incurring any out-of-pocket costs on accessories were 14% greater for the intervention group (p = .029 and p = .063, respectively). Qualitative analysis reveals among the OSMT arm an increase in the proportion of ostomy-specific comments and a decrease in the same metric among the UC arm. Common themes included learning to work with equipment, dealing with gas build-up and finding well-fitting clothing.

CONCLUSIONS

There are some indications that participants in this structured telehealth program are more active in ostomy self-care. The reported ostomy self-care activities, healthcare consumables, and healthcare services reported by both groups illustrate the complexity of survivorship care following ostomy surgery. National Clinical Trial Identifier: NCT02974634.

A Silver Lining? Fewer non-SARS-CoV-2 Respiratory Viruses during the COVID-19 Pandemic

Non-pharmaceutical interventions (NPIs) have “flattened the curve” of the COVID-19 pandemic, however the effect of these interventions on other respiratory viruses is unknown. We used aggregate level case count data for eight respiratory viruses and compared the institutional and statewide case counts before and during the period that NPIs were active. We observed a 61% (IRR 0.39, 95% CI 0.37 to 0.41, P < 0.0001) decrease in non-SARS-CoV-2 respiratory viral infections when NPIs were implemented. This finding, if further verified, should guide future public health initiatives to mitigate viral epidemics.

What the Coronavirus Disease 2019 (COVID-19) Pandemic Has Reinforced: The Need for Accurate Data

The COVID-19 pandemic has challenged the United States’ existing national public health informatics infrastructure. This report details the factors that have contributed to COVID-19 data inaccuracies and reporting delays and their effect on the modeling and monitoring of the COVID-19 pandemic.

pH Method for Determination of Cholinesterase in Whole Blood: Collaborative Study

A collaborative study of an indirect method for determination of cholinesterase activity was conducted with cattle blood. Ten collaborators analyzed 8 samples of varying degrees of cholinesterase inhibition. The sample is diluted with a buffer, and the pH change that results from the hydrolysis of acetylcholine is monitored. Repeatability relative standard deviations (RSDr) ranged from 6.6 to 8.6%, and reproducibility relative standard deviations (RSDR) ranged from 10.7 to 17.3% for mean activities of 0.60-0.40 ΔpH/h. All samples that were completely inhibited were detected. The method was adopted first action by AOAC International for determination of cholinesterase activity in whole bovine blood.

Ostomy telehealth for cancer survivors: Design of the Ostomy Self-management Training (OSMT) randomized trial

PURPOSE

An ostomy adversely affects health-related quality of life (HRQOL) in a diverse population of cancer survivors and their caregivers. Hit-or-miss ostomy care, nurse counseling, and community referral have been the primary modes of self-management education and support in the peri-operative setting. Few evidence-based, systematic ostomy self-management programs are available to ensure optimal post-operative care. This paper describes the study design of a telehealth-based Ostomy Self-management Training (OSMT) program for cancer survivors and their caregivers.

METHODS

The study is a three-year, randomized trial that tests the effectiveness of the OSMT program on survivor activation, self-efficacy, and HRQOL. The intervention integrates goal setting and problem-solving approaches to enhance survivor activation and self-efficacy to carry out ostomy care. The curriculum is delivered via four group sessions administered by trained ostomy certified nurses (WOCNs) and peer ostomates. An additional session is offered to caregivers to address their needs in relation to ostomy care. Telehealth approaches through videoconferencing are used to enhance program delivery to participants in three different geographic areas across two time zones. Participants join sessions via real-time videoconferencing from their homes.

CONCLUSIONS

The OSMT program has high potential to make a positive impact on the unique physical, psychological, social, and spiritual needs of cancer survivors living with a permanent ostomy. The study design, process, and telehealth approach contributes to the success of future dissemination efforts of the intervention into diverse clinical and community settings.

RNA-Sequencing Analysis of Messenger RNA/MicroRNA in a Rabbit Aneurysm Model Identifies Pathways and Genes of Interest

BACKGROUND AND PURPOSE

Rabbit aneurysm models are used for the testing of embolization devices and elucidating the mechanisms of human intracranial aneurysm growth and healing. We used RNA-sequencing technology to identify genes relevant to induced rabbit aneurysm biology and to identify genes and pathways of potential clinical interest. This process included sequencing microRNAs, which are important regulatory noncoding RNAs.

MATERIALS AND METHODS

Elastase-induced saccular aneurysms were created at the origin of the right common carotid artery in 6 rabbits. Messenger RNA and microRNA were isolated from the aneurysm and from the control left common carotid artery at 12 weeks and processed by using RNA-sequencing technology. The results from RNA sequencing were analyzed by using the Ingenuity Pathway Analysis tool.

RESULTS

A total of 9396 genes were analyzed by using RNA sequencing, 648 (6.9%) of which were found to be significantly differentially expressed between the aneurysms and control tissues (P < .05; false-discovery rate, <0.01; fold change, >2 or <.5). Of these genes, 614 were mapped successfully, 143 were down-regulated, and 471 were up-regulated in the aneurysms as compared with controls. Using the same criteria for significance, 3 microRNAs were identified as down-regulated and 5 were identified as up-regulated. Pathway analysis associated these genes with inflammatory response, cellular migration, and coagulation, among other functions and pathologies.

CONCLUSIONS

RNA-sequencing analysis of rabbit aneurysms revealed differential regulation of some key pathways, including inflammation and antigen presentation. ANKRD1 and TACR1 were identified as genes of interest in the regulation of matrix metalloproteinases.

Rapid, high-precision measurements of boron isotopic compositions in marine carbonates

RATIONALE

The isotopic composition and elemental abundance of boron (B) in marine carbonates provide a powerful tool for tracking changes in seawater pH and carbonate chemistry. Progress in this field has, however, been hampered by the volatile nature of B, its persistent memory, and other uncertainties associated with conventional chemical extraction and mass spectrometric measurements. Here we show that for marine carbonates, these limitations can be overcome by using a simplified, low-blank, chemical extraction technique combined with robust multi-collector inductively couple plasma mass spectrometry (MC-ICPMS) methods.

METHODS

Samples are dissolved in dilute HNO3 and loaded first onto on a cation-exchange column with the major cations (Ca, Mg, Sr, Na) being quantitatively retained while the B fraction is carried in the eluent. The eluent is then passed directly through an anion column ensuring that any residual anions, such as SO4(2-), are removed. Isotopic measurements of (11)B/(10)B ratios are undertaken by matching both the B concentration and the isotopic compositions of the samples with the bracketing standard, thereby minimising corrections for cross-contamination.

RESULTS

The veracity of the MC-ICPMS procedure is demonstrated using a gravimetrically prepared laboratory standard, UWA24.7, relative to the international reference standard NIST SRM 951 (δ(11)B = 0‰). This gives values consistent with gravimetry (δ(11)B = 24.7 ± 0.3‰ 2sd) for solutions ranging in concentration from 50 to 500 ppb, equivalent to ~2-10 mg size coral samples. The overall integrity of the method for carbonate analysis is demonstrated by measurements of the international carbonate standard JCp-1 (δ(11)B = 24.3 ± 0.34‰ 2sd).

CONCLUSIONS

A streamlined, integrated approach is described here that enables rapid, accurate, high-precision measurements of boron isotopic compositions and elemental abundances in commonly analysed biogenic carbonates, such as corals, bivalves, and large benthic forams. The overall simplicity of this robust approach should greatly facilitate the wider application of boron isotope geochemistry, especially to marine carbonates.

Coral calcifying fluid pH dictates response to ocean acidification

Ocean acidification driven by rising levels of CO₂ impairs calcification, threatening coral reef growth. Predicting how corals respond to CO₂ requires a better understanding of how calcification is controlled. Here we show how spatial variations in the pH of the internal calcifying fluid (pH_cf) in coral (Stylophora pistillata) colonies correlates with differential sensitivity of calcification to acidification. Coral apexes had the highest pH_cf and experienced the smallest changes in pH_cf in response to acidification. Lateral growth was associated with lower pH_cf and greater changes with acidification. Calcification showed a pattern similar to pH_cf, with lateral growth being more strongly affected by acidification than apical. Regulation of pH_cf is therefore spatially variable within a coral and critical to determining the sensitivity of calcification to ocean acidification.

Light enhanced calcification in Stylophora pistillata: effects of glucose, glycerol and oxygen

Zooxanthellate corals have long been known to calcify faster in the light than in the dark, however the mechanism underlying this process has been uncertain. Here we tested the effects of oxygen under controlled pCO₂ conditions and fixed carbon sources on calcification in zooxanthellate and bleached microcolonies of the branching coral Stylophora pistillata. In zooxanthellate microcolonies, oxygen increased dark calcification rates to levels comparable to those measured in the light. However in bleached microcolonies oxygen alone did not enhance calcification, but when combined with a fixed carbon source (glucose or glycerol), calcification increased. Respiration rates increased in response to oxygen with greater increases when oxygen is combined with fixed carbon. ATP content was largely unaffected by treatments, with the exception of glycerol which decreased ATP levels.

Telemedicine, telehealth, and mobile health applications that work: opportunities and barriers

There has been a spike in interest and use of telehealth, catalyzed recently by the anticipated implementation of the Affordable Care Act, which rewards efficiency in healthcare delivery. Advances in telehealth services are in many areas, including gap service coverage (eg, night-time radiology coverage), urgent services (eg, telestroke services and teleburn services), mandated services (eg, the delivery of health care services to prison inmates), and the proliferation of video-enabled multisite group chart rounds (eg, Extension for Community Healthcare Outcomes programs). Progress has been made in confronting traditional barriers to the proliferation of telehealth. Reimbursement by third-party payers has been addressed in 19 states that passed parity legislation to guarantee payment for telehealth services. Medicare lags behind Medicaid, in some states, in reimbursement. Interstate medical licensure rules remain problematic. Mobile health is currently undergoing explosive growth and could be a disruptive innovation that will change the face of healthcare in the future.

Testing a top-down strategy for establishing a sustainable telemedicine program in a developing country: the Arizona telemedicine program-US Army-Republic of Panama Initiative

OBJECTIVE

Many developing countries have shown interest in embracing telemedicine and incorporating it into their healthcare systems. In 2000, the U.S. Army Yuma Proving Ground (YPG) initiated a program to assist the Republic of Panama in establishing a demonstration Panamanian rural telemedicine program. YPG engaged the Arizona Telemedicine Program (ATP) to participate in the development and implementation of the program.

MATERIALS AND METHODS

The ATP recommended adoption of a "top-down" strategy for creating the program. Early buy-in of the Panamanian Ministry of Health and academic leaders was regarded as critical to the achievement of long-term success.

RESULTS

High-level meetings with the Minister of Health and the Rectors (i.e., Presidents) of the national universities gained early program support. A telemedicine demonstration project was established on a mountainous Indian reservation 230 miles west of Panama City. Today, three rural telemedicine clinics are linked to a regional Ministry of Health hospital for teleconsultations. Real-time bidirectional videoconferencing utilizes videophones connected over Internet protocol networks at a data rate of 768 kilobits per second to the San Felix Hospital. Telepediatrics, tele-obstetrics, telepulmonology, teledermatology, and tele-emergency medicine services became available. Telemedicine services were provided to the three sites for a total of 1,013 cases, with numbers of cases increasing each year. These three demonstration sites remained in operation after discontinuation of the U.S. involvement in September 2009 and serve as a model program for other telemedicine initiatives in Panama.

CONCLUSIONS

Access to the assets of a partner-nation was invaluable in the establishment of the first model telemedicine demonstration program in Panama. After 3 years, the Panamanian Telemedicine and Telehealth Program (PTTP) became self-sufficient. The successful achievement of sustainability of the PTTP after disengagement by the United States fits the Latifi-Weinstein model for establishing telemedicine programs in developing countries.

X-ray linear dichroism dependence on ferroelectric polarization

X-ray absorption spectroscopy and photoemission electron microscopy are techniques commonly used to determine the magnetic properties of thin films, crystals, and heterostructures. Recently, these methods have been used in the study of magnetoelectrics and multiferroics. The analysis of such materials has been compromised by the presence of multiple order parameters and the lack of information on how to separate these coupled properties. In this work, we shed light on the manifestation of dichroism from ferroelectric polarization and atomic structure using photoemission electron microscopy and x-ray absorption spectroscopy. Linear dichroism arising from the ferroelectric order in the PbZr0:2Ti0:8O3 thin films was studied as a function of incident x-ray polarization and geometry to unambiguously determine the angular dependence of the ferroelectric contribution to the dichroism. These measurements allow us to examine the contribution of surface charges and ferroelectric polarization as potential mechanisms for linear dichroism. The x-ray linear dichroism from ferroelectric order revealed an angular dependence based on the angle between the ferroelectric polarization direction and the x-ray polarization axis, allowing a formula for linear dichroism in ferroelectric samples to be defined.

Live tissue imaging shows reef corals elevate pH under their calcifying tissue relative to seawater

The threat posed to coral reefs by changes in seawater pH and carbonate chemistry (ocean acidification) raises the need for a better mechanistic understanding of physiological processes linked to coral calcification. Current models of coral calcification argue that corals elevate extracellular pH under their calcifying tissue relative to seawater to promote skeleton formation, but pH measurements taken from the calcifying tissue of living, intact corals have not been achieved to date. We performed live tissue imaging of the reef coral Stylophora pistillata to determine extracellular pH under the calcifying tissue and intracellular pH in calicoblastic cells. We worked with actively calcifying corals under flowing seawater and show that extracellular pH (pHe) under the calicoblastic epithelium is elevated by ∼0.5 and ∼0.2 pH units relative to the surrounding seawater in light and dark conditions respectively. By contrast, the intracellular pH (pHi) of the calicoblastic epithelium remains stable in the light and dark. Estimates of aragonite saturation states derived from our data indicate the elevation in subcalicoblastic pHe favour calcification and may thus be a critical step in the calcification process. However, the observed close association of the calicoblastic epithelium with the underlying crystals suggests that the calicoblastic cells influence the growth of the coral skeleton by other processes in addition to pHe modification. The procedure used in the current study provides a novel, tangible approach for future investigations into these processes and the impact of environmental change on the cellular mechanisms underpinning coral calcification.

Cognitive effects of memantine in postmenopausal women at risk of dementia: a pilot study

BACKGROUND

To determine the effects of memantine on cognition in a normal population of postmenopausal women with putative risk factors for Alzheimer's disease (AD) using a built-in control for the genetic risk factor for AD (apoE-epsilon4 status).

METHODS

A prospective, open-label, 6-month pilot medication trial with memantine and follow-up after discontinuance conducted at the Center for Neuroscience in Women's Health, Stanford University School of Medicine. Neuropsychological data were collected on 22 community-dwelling postmenopausal women (11 apoE-epsilon4 carriers and 11 apoE-epsilon4 non-carriers) with at least one putative risk factor for AD.

RESULTS

ApoE-epsilon4 status was not a significant predictor of change in neuropsychological performance. Changes associated with memantine treatment for entire sample included significant declines in some variables associated with verbal learning and memory that improved upon medication withdrawal. A positive medication effect was noted with executive functions and possibly category fluency. Trend-level improvements were seen in motor dexterity of the non-dominant hand and maintained even after drug discontinuance.

CONCLUSIONS

Treatment with memantine appeared to have differential effects on cognitive performance in a population of women with putative risk factors for AD. ApoE-epsilon4 carrier status did not account for observed changes in cognition.

Telemedicine and telepresence for trauma and emergency care management

The use of telemedicine is long-standing, but only in recent years has it been applied to the specialities of trauma, emergency care, and surgery. Despite being relatively new, the concept of teletrauma, telepresence, and telesurgery is evolving and is being integrated into modern care of trauma and surgical patients. This paper will address the current applications of telemedicine and telepresence to trauma and emergency care as the new frontiers of telemedicine application. The University Medical Center and the Arizona Telemedicine Program (ATP) in Tucson, Arizona have two functional teletrauma and emergency telemedicine programs and one ad-hoc program, the mobile telemedicine program. The Southern Arizona Telemedicine and Telepresence (SATT) program is an inter-hospital telemedicine program, while the Tucson ER-link is a link between prehospital and emergency room system, and both are built upon a successful existing award winning ATP and the technical infrastructure of the city of Tucson. These two programs represent examples of integrated and collaborative community approaches to solving the lack of trauma and emergency care issue in the region. These networks will not only be used by trauma, but also by all other medical disciplines, and as such have become an example of innovation and dedication to trauma care. The first case of trauma managed over the telemedicine trauma program or "teletrauma" was that of an 18-month-old girl who was the only survival of a car crash with three fatalities. The success of this case and the pilot project of SATT that ensued led to the development of a regional teletrauma program serving close to 1.5 million people. The telepresence of the trauma surgeon, through teletrauma, has infused confidence among local doctors and communities and is being used to identify knowledge gaps of rural health care providers and the needs for instituting new outreach educational programs.

Integrating telemedicine and telehealth: putting it all together

Telemedicine and telehealth programs are inherently complex compared with their traditional on-site health care delivery counterparts. Relatively few organizations have developed sustainable, multi-specialty telemedicine programs, although single service programs, such as teleradiology and telepsychiatry programs, are common. A number of factors are barriers to the development of sustainable telemedicine and telehealth programs. First, starting programs is often challenging since relatively few organizations have, in house, a critical mass of individuals with the skill sets required to organize and manage a telemedicine program. Therefore, it is necessary to "boot strap" many of the start-up activities using available personnel. Another challenge is to assemble a management team that has time to champion telemedicine and telehealth while dealing with the broad range of issues that often confront telemedicine programs. Telemedicine programs housed within a single health care delivery system have advantages over programs that serve as umbrella telehealth organizations for multiple health care systems. Planning a telemedicine program can involve developing a shared vision among the participants, including the parent organizations, management, customers and the public. Developing shared visions can be a time-consuming, iterative process. Part of planning includes having the partnering organizations and their management teams reach a consensus on the initial program goals, priorities, strategies, and implementation plans. Staffing requirements of telemedicine and telehealth programs may be met by sharing existent resources, hiring additional personnel, or outsourcing activities. Business models, such as the Application Service Provider (ASP) model used by the Arizona Telemedicine Program, are designed to provide staffing flexibility by offering a combination of in-house and out-sourced services, depending on the needs of the individual participating health care organizations. Telemedicine programs should perform ongoing assessments of activities, ranging from service usage to quality of service assessments, to ongoing analyses of financial performance. The financial assessments should include evaluations of costs and benefits, coding issues, reimbursement, account receivables, bad debt and network utilization. Long-range strategic planning for a telemedicine and telehealth program should be carried out on an on-going basis and should include the program's governing board. This planning process should include goal setting and the periodic updating of the program's vision and mission statements. There can be additional special issues for multi-organization telemedicine and telehealth programs. For example, authority management can require the use of innovative approaches tailored to the realities of the organizational structures of the participating members. Inter-institutional relations may introduce additional issues when competing health care organizations are utilizing shared resources. Branding issues are preferably addressed during the initial planning of a multi-organizational telemedicine and telehealth program. Ideally, public policy regarding telemedicine and telehealth within a service region will complement the objectives of telemedicine and telehealth programs within that service area.

Oxygen consumption in unfertilized salmonid eggs: an indicator of egg quality?

A negative correlation between oxygen consumption and fertility was observed in both steelhead and chinook salmon eggs. However, this relationship was attributed to bacterial growth. Elimination of samples with bacterial growth resulted in no significant relationship between the rate of oxygen consumption (VO2) and fertility. VO2 of unfertilized eggs of both steelhead and chinook salmon was measured over a storage period of up to 24 days (d). Despite declines in fertility during storage, VO2 did not significantly change throughout storage. The average respiration rate for steelhead eggs was 3.4 nmol O2 per egg per h, and was 4.3 nmol O2 per egg per h for chinook salmon eggs. Treatment of chinook salmon eggs with uncouplers of mitochondrial respiration, 2,4-dinitrophenol (2,4-DNP) and carbonyl cyanide 4-trifluoro-methoxyphenylhydrazone (FCCP), resulted in an increase in VO2 to 12.9 and 11.5 nmol O2 per egg per h, respectively. Treatment with the putative uncoupler, clove oil, resulted in no change in VO2, while KCN, an inhibitor of oxidative phosphorylation, reduced oxygen consumption to zero. Copper caused an increase in oxygen consumption, even in the absence of eggs, suggesting a need for caution in interpreting changes in respiration rates as a result of metal exposure. Thus, unfertilized salmonid eggs demonstrated submaximal VO2, which was not correlated with fertility.

Carbon dioxide and pH affect sperm motility of white sturgeon(Acipenser transmontanus)

Maintenance of sperm at pH values less than approximately 7.5 inhibited the onset of motility when sperm were subsequently diluted with water; maintenance at pH values above approximately 8.2 was associated with maximal motility upon dilution with water. Within 5∼min of exposure to low pH buffer (pH 6.9),there was a 50% decline in sperm motility upon dilution with water suggesting that exposure to low pH interferes with motility within a time frame that may affect fertilization. In most instances, maintenance of sperm under CO2 at a pressure of 4-5 kPa almost completely blocked their capacity for motility. Furthermore, exposing semen to increasing partial pressures of CO2 up to about 1 kPa resulted in a marked decrease in semen pH. These observations are consistent with the findings that the buffering capacity of semen is particularly low at physiological pH, and that this low buffering capacity corresponds to the highest pH sensitivity of the capacity for sperm motility. The low seminal buffering capacity may represent a physiological adaptation in the control of sperm function. It may also represent a vulnerability to environmental hypercapnia or metabolic acidosis.

Sample preparation for the analysis of flavors and off-flavors in foods

Off-flavors in foods may originate from environmental pollutants, the growth of microorganisms, oxidation of lipids, or endogenous enzymatic decomposition in the foods. The chromatographic analysis of flavors and off-flavors in foods usually requires that the samples first be processed to remove as many interfering compounds as possible. For analysis of foods by gas chromatography (GC), sample preparation may include mincing, homogenation, centrifugation, distillation, simple solvent extraction, supercritical fluid extraction, pressurized-fluid extraction, microwave-assisted extraction, Soxhlet extraction, or methylation. For high-performance liquid chromatography of amines in fish, cheese, sausage and olive oil or aldehydes in fruit juice, sample preparation may include solvent extraction and derivatization. Headspace GC analysis of orange juice, fish, dehydrated potatoes, and milk requires almost no sample preparation. Purge-and-trap GC analysis of dairy products, seafoods, and garlic may require heating, microwave-mediated distillation, purging the sample with inert gases and trapping the analytes with Tenax or C18, thermal desorption, cryofocusing, or elution with ethyl acetate. Solid-phase microextraction GC analysis of spices, milk and fish can involve microwave-mediated distillation, and usually requires adsorption on poly(dimethyl)siloxane or electrodeposition on fibers followed by thermal desorption. For short-path thermal desorption GC analysis of spices, herbs, coffee, peanuts, candy, mushrooms, beverages, olive oil, honey, and milk, samples are placed in a glass-lined stainless steel thermal desorption tube, which is purged with helium and then heated gradually to desorb the volatiles for analysis. Few of the methods that are available for analysis of food flavors and off-flavors can be described simultaneously as cheap, easy and good.

Patterns of use and satisfaction with a university-based teleradiology system

The Radiology Department at the University of Arizona has been operating a teleradiology program for almost 2 years. The goal of this project was to characterize the types of cases reviewed, to assess radiologists' satisfaction with the program, and to examine case turnaround times. On average, about 50 teleradiology cases are interpreted each month. Computed tomography (CT) cases are the most common type of case, constituting 65% of the total case volume. Average turnaround time (to generate a "wet read" once a case is received) is about 1.3 hours. Image quality was rated as generally good to excellent, and the user interface as generally good. Radiologists' confidence in their diagnostic decisions is about the same as reading films in the clinical environment. The most common reason for not being able to read teleradiology images is poor image quality, followed by lack of clinical history and not enough images.

Analysis of fumonisin B1 in rodent feed by CE with fluorescence detection of the FMOC derivative

A fast, simple, and environmentally friendly method has been developed for the analysis of fumonisin B1 (FB1) in rodent feed using CE. FB1 is the major fumonisin metabolite produced by the fungus Fusarium moniliforme and has been implicated in human and animal diseases. FB1 was extracted from rodent feed with acetonitrile/water (50/50) (vol/vol) and cleaned up with a C18 Sep-Pak Vac cartridge (Waters Corp., Milford, MA, U.S.A.). FB1 was quantitated after elution from the column using capillary electrophoresis with a 25-mM sodium borate buffer (pH 9.0) containing 10% acetonitrile and fluorescence detection of the (9-fluorenylmethyl) chloroformate (FMOC) derivative. The minimum detectable amount in rodent feed was 0.5 pmm. Recovery values in spiked rodent feed averaged more than 87% over the 2-20 ppm range.

Fumonisin B1 analysis with capillary electrophoresis-electrospray ionization mass spectrometry

Fumonisin B1, a mycotoxin produced by a common fungal contaminant of corn, Fusarium moniliforme, was analyzed by capillary electrophoresis-electrospray ionization mass spectrometry. System performance was maximal with uncoated columns. System efficiencies of approximately 44,000 plates/m and reproducible analysis times of about 13 min were obtained. System efficiency with methyl-coated columns was approximately 24,000 plates/m. Reproducible analysis times of about 3.5 min were obtained with these columns. With uncoated columns, the concentration limit of detection was 156 ppb with a s/n ratio of approximately 10. The estimated injected mass at 156 ppb was 1.1 pg. Repeated injections of extracts containing constant fumonisin B1 concentrations showed that peak areas were slightly inconsistent, although generally similar to variations encountered with liquid chromatography-electrospray ionization mass spectrometry. The source of this inconsistency was traced to sample solubility, errors inherent in electrophoresis injections, and electrospray instability. Minimizing these problem areas will produce a technique with peak area reproducibilities comparable to liquid chromatography-electrospray ionization mass spectrometry, but with potentially greater resolving power.

Inhibition of 7,12-dimethylbenzanthracene-induced rat mammary tumor growth by 2,3,7,8-tetrachlorodibenzo-p-dioxin

2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) and related compounds inhibit diverse estrogen-induced responses in the rodent uterus and human breast cancer cells. The effects of a single non-toxic dose of TCDD (10 micrograms/kg) on the development of mammary tumors was investigated in female Sprague-Dawley rats treated with an oral dose of 7,12-dimethylbenzanthracene (DMBA) (20 mg). In rats which developed mammary tumors, subsequent treatment with corn oil (vehicle) resulted in a 3.9-fold increase in mammary tumor volume after 21 days. In contrast, a second group of rats with mammary tumors were treated with a non-toxic dose of TCDD (10 micrograms/kg) and after 21 days, the mean tumor volumes decreased from 89.7 +/- 53 mm3 to 24.9 +/- 28.5 mm3. Moreover, these results demonstrate the antitumorigenic activity of TCDD in female Sprague-Dawley rats.

Determination of aflatoxins in food products by chromatography

Several chromatographic methods for the determination of aflatoxins in agricultural and food products are reviewed. During the past two decades, identification and determination of aflatoxins were done by thin-layer chromatography (TLC) because it was easy, fast and inexpensive. However, high-performance liquid chromatography (HPLC) using fluorescence detection is now the method of choice for determining aflatoxins and is also growing in popularity for their identification. The reasons for selecting HPLC over TLC can be summarized as the ability to analyze for a wide variety of compounds, including compounds that are easily degraded by heat, light or air, the ease of adaptation to confirmatory procedures, the potential for automation and the dramatic improvement in instrumentation, including the development of increasingly sensitive fluorescence and electrochemical detectors and short, high-resolution, reversed-phase columns.

Characterization of iodine derivatives of aflatoxin B1 and G1 by thermospray mass spectrometry

Thermospray mass spectrometry (TSMS) was used to identify the derivatives formed when iodine is reacted with aflatoxins B1 and G1 at approximately 70 degrees C to enhance fluorescence. It was found that stable derivatives were formed by addition of an iodine atom and a methoxy group across the double bond located on the furan ring of the aflatoxin B1 and G1 molecules. TSMS and TSMS/MS daughter spectra of the reaction products of aflatoxin B1 and G1 with iodine provide evidence of the addition of each moiety to produce the iodo-methoxy derivative. The addition of an iodine atom to one carbon and a methoxy group to the other carbon of the furan ring provided molecular weights of 470 and 486 for the products of aflatoxin B1 and G1, respectively.

Effect of electrocautery on wound healing in midline laparotomy incisions

The effect of electrocautery on midline fascial wound healing was studied in 108 Sprague-Dawley rats. Midline wound tensile strength was significantly reduced in fascia incised with the coagulation current compared with the cutting current or scalpel. In addition, tissue necrosis and inflammation as well as adhesion formation between the incision and abdominal viscera were more extensive in animals with incisions made using coagulation current. The results of the study indicate that the use of electrocautery coagulation current is associated with increased tissue damage and a significant reduction in the tensile strength of healing wounds. The contribution of electrocautery to wound complications in patients needs further evaluation.

Antibiotic irrigation and the formation of intraabdominal adhesions

The efficacy of antibiotic peritoneal lavage in the prevention of postoperative infection is controversial. The role of intraperitoneally administered cefazolin and tetracycline in the formation of adhesions was studied in the rodent model. Thirty-two rats were divided into 3 groups. Group 1 underwent midline laparotomy with instillation of 10 ml of normal saline solution. Group 2 and Group 3 underwent the same procedure with instillation of 0.2 percent saline solutions of cefazolin or tetracycline, respectively. Animals were sacrificed after 2 weeks. Intraabdominal adhesions were graded and samples of parietal peritoneum were processed for histologic data. Group 2 and Group 3 had significantly higher adhesion scores compared with Group 1 (p less than 0.001). Histologic appearance of both antibiotic-irrigated groups showed mesothelial thickening with presence of fibroblasts and collagen. Cefazolin and tetracycline irrigation of the abdominal cavity contributes to the formation of peritoneal adhesions in the rat model.

Development and validation of in vitro induction assays for toxic halogenated aromatic mixtures: a review

Halogenated aromatic industrial compounds, typified by the polychlorinated dibenzo-p-dioxins (PCDDs), dibenzofurans (PCDFs) and biphenyls (PCBs) have been identified as residues in almost every component of the global ecosystem. Risk assessment of the complex mixtures of halogenated aromatics found in environmental samples is complicated by analytical problems and the lack of toxicological information on individual compounds and mixtures. Research in our laboratory has focused on the development and vadidation of the in vitro aryl hydrocarbon hydroxylase (AHH) induction assay in rat hepatoma H-4-II E cells in culture for quantitating individual toxic halogenated aryl hydrocarbons and their mixtures. For several PCB, PCDD, PCDF congeners, their mixed bromo/chloro analogs and reconstituted mixtures there was an excellent linear correlation between their -log ED50 values for AHH induction in rat hepatoma cells and their -log ED50 values for in vivo hepatic microsomal AHH induction, inhibition of body weight gain and thymic atrophy in the rat. It has also been shown for selected compounds that there was a good correlation between their in vitro AHH induction potencies and their effects in guinea pigs (AHH induction, inhibition of body weight gain) and mice (immunotoxicity). This assay system has been utilized to quantitative the "2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) equivalents" present in extracts from diverse sources including fly ash from a municipal incinerator and pyrolyzed brominated flame retardants which contain a complex mixture of halogenated dibenzo-p-dioxins and dibenzofurans.

Biologic and toxic effects of polychlorinated dibenzo-p-dioxin and dibenzofuran congeners in the guinea pig. Quantitative structure-activity relationships

The dose-response effects of 2,3,7,8-tetrachorodibenzo-p-dioxin, 1,3,7,8-tetrachlorodibenzo-p-dioxin, 1,2,4,7,8-pentachlorodibenzo-p-dioxin, 2,3,4,7,8-, 1,2,3,7,9-, and 2,3,4,7,9-pentachlorodibenzofuran on body weight loss and hepatic microsomal aryl hydrocarbon hydroxylase (AHH) and ethoxyresorufin O-deethylase (EROD) induction were determined in the immature male guinea pig. The ED50 values for each compound were measured for the three in vivo responses. The quantitative structure-activity relationships clearly illustrated that the most toxic congeners were substituted in the lateral 2, 3, 7 and 8 positions, and removal of a lateral chlorine group substantially reduced the potency of the resulting compound. The most toxic congener in this series was 2,3,7,8-tetrachlorodibenzo-p-dioxin in which the in vivo ED50 values for AHH and EROD induction and body weight loss were 2.8 X 10(-10), 9.3 X 10(-11) and 5.6 X 10(-9) mol/kg. The structure-activity relationships observed in this study were comparable to those previously reported in rats and rat hepatoma H-4-II E cells in culture. Moreover, there was an excellent linear correlation between in vivo -log ED50 values for body weight loss, AHH and EROD induction and the corresponding in vitro -log EC50 data for AHH induction in rat hepatoma cells [S. Safe, Chemosphere 16, 791 (1987)].