Adverse psychologic consequences of positive cytologic cervical screening

Cervical cancer is still widely prevalent in the female population. This study explores the relationship of cervical cancer screening, positive versus negative Papanicolaou's test results, and psychologic status among lower-income minority women. All patients were interviewed 3 months after they had received initial test results. One hundred six women with normal Papanicolaou's test results were compared with 118 women who were referred for colposcopic examination for follow-up of positive test results. Women with positive Papanicolaou's-test results showed statistically significant elevations in worries about cancer and impairments in mood, daily activities, sexual interest, and sleep patterns. More fine-grained analyses revealed that the effects of positive results were most pronounced among those women who did not comply with colposcopy (n = 53). These findings suggest that lack of compliance with follow-up may maintain high levels of uncertainty about disease and may interfere with successful psychologic adaptation. Health education targeted to psychologically vulnerable individuals may reduce psychologic distress and enhance compliance.

Dates for the Middle Stone Age of East Africa

Three potassium-argon age determinations on sanidine from crystalrich pantellerite and volcanic ash in the Main Rift Valley of central Ethiopia indicate that the Middle Stone Age of East Africa began prior to 180,000 years ago. This suggests that the technological developments which characterize the Middle Stone Age have a far greater antiquity than previously estimated.

Viable embryos and normal calves after nuclear transfer into Hoechst stained enucleated demi-oocytes of cows

Bovine oocytes were bisected, stained with Hoechst 33342 and observed under a fluorescent microscope to identify nucleated and enucleated demi-oocytes. Other oocytes were bisected but not stained, or bisected and only half of each oocyte stained, and viewed under a fluorescent microscope. The oocytes were then used for nuclear transfer by fusing them with embryonic blastomeres from a 5-6 day bovine embryo. The fusion rate and proportion developing into compact morulae or blastocysts was compared among different types of demi-oocytes. Expt 1 examined the effect of staining and indicated no effect on either fusion rate or embryonic development whether or not the oocytes were stained. In Expt 2, stained and unstained nucleated and enucleated oocytes were compared. As in the first experiment, there were no differences between stained and unstained demi-oocytes. There was no difference between fusion rates of nucleated and enucleated oocytes. However, there was a significant difference in embryonic development between nucleated (10.4%) and enucleated (22.6%) demi-oocytes (P less than 0.05). In a final experiment, stained and unstained enucleated oocytes were used for nuclear transfer and the resulting embryos transferred into recipient cows. There was no difference in pregnancy rates or in the number of normal calves born whether stained or unstained recipient oocytes were used. Results from these experiments indicate that Hoechst staining and fluorescent microscopy can be used to identify enucleated demi-oocytes, and that these can be used for nuclear transfer, and result in viable embryos and normal calves.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of extensive chronic graft-versus-host disease with extracorporeal photochemotherapy

Extracorporeal photochemotherapy (ECP; photopheresis), an immunomodulatory therapy developed for cutaneous T-cell lymphoma, has shown promise in treating chronic graft-versus-host disease (cGvHD) in uncontrolled studies. The purpose of this study was to further examine the effects of ECP on cGvHD. ECP (administered initially 3 times weekly on alternating days) was retrospectively evaluated in 14 patients with extensive cGvHD following allogeneic hematopoietic stem cell transplantation. The median time from transplantation to ECP initiation was 29 months (range, 5-96 months). The median number of concomitant baseline treatments per patient was 3 (range, 0-5). During a median ECP duration of 17 months (range, 3-44 months), 3 patients (21%) achieved a complete cutaneous response (100% improvement), 4 patients (29%) achieved a partial cutaneous response (> or =50% improvement), and 7 patients (50%) had stable skin disease. The median time to response was 6 months (range, 2-15 months), and the median response duration was 5 months (range, 1-31 months). At endpoint, responses were ongoing in 4 patients. Resolution or improvement was noted in arthralgia (5/7 patients), oral changes (3/7), elevated liver enzymes (3/5), dry eyes (2/5), joint stiffness (3/3), pulmonary disease (1/3), and thrombocytopenia (1/1). Because of a favorable response, 11 of 13 patients (85%) who received prednisone at baseline were able to taper (7/13; 54%) or discontinue (4/13; 31%) this medication, and 12 of 14 patients (86%) were able to taper (11/14; 79%) or discontinue (1/14; 7%) ECP. Five-year posttransplantation survival was 77%. Our results suggest that adjunctive ECP improves cutaneous and extracutaneous manifestations of cGvHD and has a steroid-sparing effect.

Active immunization of beef heifers against luteinizing hormone: III. Evaluation of dose and longevity

Objectives were to evaluate the dose (Exp. 1) and purity of LH preparations (Exp. 2) on the anti-LH antibody response in heifers. Experiment 3 evaluated the longevity of LH immunization on sterility in heifers. In Exp. 1, 115 crossbred heifers were injected every 3 wk for 6 wk with .1, .33, 1.0, 3.0 or 9.0 mg of LH-ovalbumin. Concentrations of anti-LH antibodies generated were quantified by determining the percentage of binding of [125I]LH in serum. Mena LH binding over wk 0 to 12 was greater in heifers immunized with 1.0 mg conjugate than in heifers immunized with other doses (P less than .05). In Exp. 2, LH-ovalbumin conjugates were made from either LH-1, LH-2 or LH-3, which had relative immunological potencies of 2.1, 1.5 and 1.2 x NIH-LH-S1 units/mg, respectively. Forty-eight crossbred beef heifers were immunized against one of these three LH-ovalbumin conjugates, against LH conjugated without ovalbumin (LH-LH), or against ovalbumin alone (Oval). Estrous cycle activity was monitored by measuring serum progesterone concentration. Potency of the LH preparation used in the LH-ovalbumin conjugate was correlated (r = .94) with its ability to produce LH antibodies. In Exp.3, heifers were injected with 1 mg antigen every 2 wk for 10 wk. Five LH-1 heifers and five control heifers were slaughtered for examination of ovaries 10 wk after the last booster injection. The remaining five LH-I and five control animals were placed with a bull 8 wk after the last booster. All five control heifers conceived by 4 +/- 1 wk after placement with the bull whereas the LH-immunized heifers remained acyclic for 42 to 96 wk.

Haemoglobin disorders in Australia: where are we now and where will we be in the future?

Inherited disorders of haemoglobin (Hb), such as thalassaemia and sickle cell disease (SCD) are common and responsible for significant morbidity and mortality on a global scale. As Australia becomes increasingly ethnically diverse, their prevalence will increase. However, we lack important demographic and epidemiological data to manage these disorders and their consequences and to support affected individuals and communities. Thalassaemia and SCD are lifelong conditions. Affected individuals have reduced life expectancies, poorer quality of life and complex healthcare needs. Treatment strategies currently focus on prenatal diagnosis, red blood cell transfusion, iron chelation, management of iron-related complications, haemopoietic stem cell transplantation (HSCT) and hydroxyurea. Currently, the only curative therapy is HSCT; however, gene therapy offers the possibility of cure and trials are currently underway. These therapies are associated with significant complications and substantial costs; there is also evidence of variation in approaches to diagnosis and care. Optimal strategies for many aspects of management are not yet defined and more research is necessary to inform clinical care and health service delivery.

Response to a growth hormone-releasing hormone analog in heifers treated with recombinant growth hormone

Sixteen pregnant Holstein heifers (430kg) were used to determine the effect of long-term administration of a bovine growth hormone (bGH) made by recombinant DNA technology on the ability of a bolus injection of a growth hormone-releasing hormone analog (Ac-His-1, D-Ala-2, Nle-27, GHRH(1-29 NH2) to increase serum GH. Eight heifers received a daily intramuscular injection of bGH (50 mg/day) for 5 months while the other half received a daily injection of physiological saline (control) over the same period. On the last day of bGH treatment and 1, 5, 10 and 25 days after the cessation of bGH treatment, five heifers from each group were challenged with GHRH analog and the response to this releasing hormone analog was measured. Basal GH concentrations were elevated on the last day of treatment in bGH-treated heifers and declined to concentrations similar to control heifers by 1 day after cessation of treatment. Response to GHRH analog was impaired by bGH during the last day of treatment and one day later. Responsiveness returned to a level similar to controls by 5 days after the end of bGH treatment. Response to GHRH analog was lessened during the period of bGH treatment but there were no long term effects on the animals' ability to respond to the releasing hormone.

Combined utility of p16 and BRAF V600E in the evaluation of spitzoid tumors: Superiority to PRAME and correlation with FISH

BACKGROUND

Spitzoid melanocytic neoplasms are diagnostically challenging; criteria for malignancy continue to evolve. The ability to predict chromosomal abnormalities with immunohistochemistry (IHC) could help select cases requiring chromosomal evaluation.

METHODS

Fluorescence in situ hybridization (FISH)-tested spitzoid neoplasms at our institution (2013-2021) were reviewed. p16, BRAF V600E, and preferentially expressed antigen in melanoma (PRAME) IHC results were correlated with FISH.

RESULTS

A total of 174 cases (1.9F:1M, median age 28 years; range, 5 months-74 years) were included; final diagnoses: Spitz nevus (11%), atypical Spitz tumor (47%), spitzoid dysplastic nevus (9%), and spitzoid melanoma (32%). Sixty (34%) were FISH positive, most commonly with absolute 6p25 gain (RREB1 > 2). Dermal mitotic count was the only clinicopathologic predictor of FISH. Among IHC-stained cases, p16 was lost in 55 of 134 cases (41%); loss correlated with FISH positive (p < 0.001, Fisher exact test). BRAF V600E (14/88, 16%) and PRAME (15/56, 27%) expression did not correlate with FISH alone (p = 0.242 and p = 0.359, respectively, Fisher exact test). When examined together, however, p16-retained/BRAF V600E-negative lesions had low FISH-positive rates (5/37, 14%; 4/37, 11% not counting isolated MYB loss); all other marker combinations had high rates (56%-75% of cases; p < 0.001).

CONCLUSIONS

p16/BRAF V600E IHC predicts FISH results. "Low-risk" lesions (p16⁺ /BRAF V600E^- ) uncommonly have meaningful FISH abnormalities (11%). PRAME may have limited utility in this setting.

OUP accepted manuscript

Background

Antimicrobial stewardship programmes (ASPs) have been widely implemented in medical practice to improve antimicrobial prescribing and reduce selection for multidrug-resistant pathogens.

Objectives

To implement different antimicrobial stewardship intervention packages in 135 veterinary practices and assess their impact on antimicrobial prescribing.

Methods

In October 2018, general veterinary clinics were assigned to one of three levels of ASP, education only (CON), intermediate (AMS1) or intensive (AMS2). De-identified prescribing data (1 October 2016 to 31 October 2020), sourced from VetCompass Australia, were analysed and a Poisson regression model fitted to identify the effect of the interventions on the incidence rates of antimicrobial prescribing.

Results

The overall incidence rate (IR) of antimicrobial prescribing for dogs and cats prior to the intervention was 3.7/100 consultations, which declined by 36% (2.4/100) in the implementation period, and by 50% (1.9/100) during the post-implementation period. Compared with CON, in AMS2 there was a 4% and 6% reduction in the overall IR of antimicrobial prescribing, and a 24% and 24% reduction in IR of high importance antimicrobial prescribing, attributable to the intervention in the implementation and post-implementation periods, respectively. A greater mean difference in the IR of antimicrobial prescribing was seen in high-prescribing clinics.

Conclusions

These AMS interventions had a positive impact in a large group of general veterinary practices, resulting in a decline in overall antimicrobial use and a shift towards use of antimicrobials rated as low importance, with the greatest impact in high-prescribing clinics.

Analogs of growth hormone-releasing hormone induce release of growth hormone in the bovine

Biological potencies of three 29 amino acid growth hormone-releasing hormone analogs (GHRH[1-29]) were determined in the bovine and compared to synthetic human GHRH (44 amino acids; hGHRH[1-44]NH2) for their ability to increase serum growth hormone (GH) concentrations. Four prepubertal Holstein heifers (179 +/- 10 kg) received hGHRH(1-44)NH2 or analogs (D-Ala2, Nle27, Agm29 GHRH[1-29], [JG-73]; D-N-MeAla2, Nle27, Agm29 GHRH[1-29], [JG-75]; and desamino-Tyr1, D-Ala2, Nle27, Agm29 GHRH[1-29], [JG-77]) at the following doses: 0, 6.25, 25, 100 and 400 micrograms/animal. All treatment-dose combinations were administered to each heifer with at least a 1-d interval between treatments. Sixteen blood samples were collected via jugular cannulas 20 min before and up to 6 h after treatment injection. There was a linear dose-dependent GH release in response to hGHRH(1-44)NH2 and the three analogs. Growth hormone peak amplitudes for the three analogs were similar to those observed after administration of the hGHRH(1-44)NH2 (P greater than .05). However, when total area under the GH response curves for each treatment was averaged over all the doses, JG-73 stimulated greater GH release than hGHRH(1-44)NH2 (P less than .05) Heifers injected with the 400-microgram dose of hGHRH(1-44)NH2 or the three analogs showed a primary release of GH followed by a secondary release 1 h later. At all other doses, only a primary GH release was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Utilization at Regional Hospitals

Introduction

Transfusion medicine is unique to lab medicine. While it still involves testing and reporting of results, it is one of the few areas where the laboratory is providing treatment. The risk of providing a blood product must be weighed against the benefit before the decision is made to transfuse a patient. Our study looked at blood utilization at our regional hospitals to assess if there were areas where we need to improve this decision process.

Methods

Chart reviews were performed for patients who received packed red blood cells (RBCs) in the regional hospitals over a 2-month period. Using the AABB and Choosing Wisely recommendations, we created two screening criteria: hemoglobin (Hb) >8 g/dL or greater than 1 unit RBC ordered when Hb is >6 g/dL to screen for outliers among RBC orders. A more in-depth chart review including information on clinical diagnosis, indications, bleeding status, and blood loss during surgery was performed on cases that met these criteria. Using this information, a decision was made on the appropriateness of the transfusion.

Results

In total, 1,592 RBC units were screened at eight regional hospitals. Sixty-eight (4%) were flagged as inappropriate, 57 (83.8%) due to multiple units, and 11 (16.2%) for an Hb >8 g/dL. The percentage of inappropriate transfusions at a hospital ranged from 5.2% to 13.6%. However, all hospitals except one were under 5.5%.

Discussion

In general, regional physicians are transfusing RBCs appropriately. When a unit is ordered inappropriately, it is most likely due to ordering multiple units upfront. To further improve blood utilization, these data were presented to hospital administration and a new alert in the EMR was created. A repeat study will be performed to see if the alerts and awareness of these data has had an effect on blood utilization.

Cutaneous symplastic hemangioma: A series of four cases

Symplastic hemangiomas (SH) are benign vascular lesions that show atypia in vascular smooth muscle and interstitial cells with sparing of endothelial cells. We present four cases of this rare tumor. The patients (two males; two females) ranged in age from 57 to 83 years (median 74); lesions were located on the leg (n = 3) and back (n = 1), and ranged from 6 to 8 mm. SH were well-circumscribed and dermal-based, often with an epidermal collarette (3/4). They were characterized by the presence of variably atypical, hyperchromatic/pleomorphic epithelioid to spindled cells within vascular walls (3/4) and/or perivascular stroma (4/4). Atypical multinucleated cells were present in three of four cases. The overall mitotic rate was low (0-2 mitotic figures per 10 HPFs; mean 0.75 per 10 HPFs), but atypical mitotic figures were seen in two of four cases. Atypical cells were negative for SMA (0/2), desmin (0/2), AE1/3 (0/2), and CAM5.2 (0/1). ERG, CD31, and CD34 stains were positive in endothelial cells but negative in atypical cells (4/4). Lesional cells and vessels were negative for podoplanin (3/3). Symplastic hemangioma is a benign tumor with bizarre atypia that may be mistaken for malignancy. We present four cases of this rare entity to increase awareness of this tumor and discuss the differential diagnosis.