Low-frequency axial ultrasound velocity correlates with bone mineral density and cortical thickness in the radius and tibia in pre- and postmenopausal women

Axial transmission velocity of a low-frequency first arriving signal (V (LF)) was assessed in the radius and tibia of 254 females, and compared to site-matched pQCT measurements. V (LF) best correlated with cortical BMD, but significantly also with subcortical BMD and cortical thickness. Correlations were strongest for the radius in postmenopausal females.

INTRODUCTION

Ultrasonic low-frequency (LF; 0.2-0.4 MHz) axial transmission, based on the first arriving signal (FAS), provides enhanced sensitivity to thickness and endosteal properties of cortical wall of the radius and tibia compared to using higher frequencies (e.g., 1 MHz). This improved sensitivity of the LF approach has not yet been clearly confirmed by an in vivo study on adult subjects. The aims of the present study were to evaluate the extent to which LF measurements reflect cortical thickness and bone mineral density, and to assess whether an individual LF measurement can provide a useful estimate for these bone properties.

METHODS

Velocity of the LF FAS (V (LF)) was assessed in the radius and tibia shaft by a new ultrasonometer (CV(RMS) = 0.5%) in a cross-sectional study involving 159 premenopausal (20-58 years) and 95 postmenopausal females (45-88 years). Site-matched volumetric total bone mineral density (BMD), cortical bone mineral density (CBMD), subcortical bone mineral density (ScBMD) and cortical thickness (CTh) were assessed using pQCT.

RESULTS

For the postmenopausal females, V (LF) correlated best with CBMD in the radius (R = 0.850, p < 0.001), but significantly also with ScBMD and CTh (R = 0.759 and R = 0.761, respectively; p < 0.001). Similar trends but weaker correlations were observed for the tibia and for the premenopausal women.

CONCLUSIONS

The LF assessment, with an optimal excitation frequency, thus provided good prediction of both cortical thickness and subcortical bone material properties. These results suggest that the LF approach does indeed have enhanced sensitivity for detecting osteoporotic changes that occur deep in the endosteal bone.

Telomerase inhibition strategies by siRNAs against either hTR or hTERT in oral squamous cell carcinoma

Human telomerase RNA (hTR) and human telomerase reverse transcriptase (hTERT) are considered effective molecular targets for current anticancer therapy. In this study, we investigated the therapeutic effects of targeting hTR and hTERT individually or in combination by recombinant adenovirus-delivered small interfering RNA (siRNA) in oral squamous cell carcinoma (OSCC) Tca8113. Further, we screened the optimal strategy for RNA interference. Our results show that these different recombinant adenoviruses specifically reduced the levels of hTR mRNA, hTERT mRNA, hTERT protein and telomerase activity in Tca8113 cells. Moreover, they successfully inhibited xenograft tumor growth in nude mice. The potency of their antitumor activities was ranked as follows: anti-hTR >anti-hTR+anti-hTERT >anti-hTERT. Therefore, we demonstrated that the siRNA-expressing recombinant adenoviruses were an effective anticancer tool for treatment of OSCC. Furthermore, the anticancer effect of solely targeting hTR was more direct and efficient, compared with the effect of targeting hTR and hTERT in combination, or hTERT exclusively. The mechanism of this anticancer effect in OSCC was not only related to the inhibition of cell proliferation and the induction of cell apoptosis, but might also involve the inhibition of tumor angiogenesis.

Movement of the human upper airway during inspiration with and without inspiratory resistive loading

The electromyographic (EMG) activity of human upper airway muscles, particularly the genioglossus, has been widely measured, but the relationship between EMG activity and physical movement of the airway muscles remains unclear. We aimed to measure the motion of the soft tissues surrounding the airway during normal and loaded inspiration on the basis of the hypothesis that this motion would be affected by the addition of resistance to breathing during inspiration. Tagged MR imaging of seven healthy subjects was performed in a 3-T scanner. Tagged 8.6-mm-spaced grids were used, and complementary spatial modulation of magnetization images were acquired beginning ∼200 ms before inspiratory airflow. Deformation of tag line intersections was measured. The genioglossus moved anteriorly during normal and loaded inspiration, with less movement during loaded inspiration. The motion of tissues at the anterior border of the upper airway was nonuniform, with larger motions inferiorly. At the level of the soft palate, the lateral dimension of the airway decreased significantly during loaded inspiration (-0.15 ± 0.09 and -0.48 ± 0.09 mm during unloaded and loaded inspiration, respectively, P < 0.05). When resistance to inspiratory flow was added, genioglossus motion and lateral dimensions of the airway at the level of the soft palate decreased. Our results suggest that genioglossus motion begins early to dilate the airway prior to airflow and that inspiratory loading reduces the anterior motion of the genioglossus and increases the collapse of the lateral airway walls at the level of the soft palate.

An early regional experience with expansion of Milan Criteria for liver transplant recipients

The Milan Criteria (MC) showed that orthotopic liver transplantation (OLT) was an effective treatment for patients with nonresectable, nonmetastatic HCC. There is growing evidence that expanding the MC does not adversely affect patient or allograft survival following OLT. The adult OLT programs in UNOS Region 4 reached an agreement allowing lesions outside MC (one lesion <6 cm, ≤3 lesions, none >5 cm and total diameter <9 cm-[R4 T3]) to receive the same exception points as MC lesions. Kaplan-Meier curves and log-rank tests were used to compare survival data. Chi-squared and Mann-Whitney U tests were used to compare patient data. A p-value of <0.05 was considered significant. All statistical analyses were performed on SPSS 15 (SPSS, Chicago, IL). Four hundred and forty-five patients were transplanted for HCC (363-MC and 82-R4 T3). Patient demographics were found to be similar between the two groups. Three year patient, allograft and recurrence free survival between MC and R4 T3 were found to be 72.9% and 77.1%, 71% and 70.2% and 90.5% and 86.9%, respectively (all p > 0.05). We report the first regionalized multicenter, prospective study showing benefit of OLT in patients exceeding MC based on preoperative imaging.

Taste does not determine daily intake of dilute sugar solutions in mice

When a rodent licks a sweet-tasting solution, taste circuits in the central nervous system that facilitate stimulus identification, motivate intake, and prepare the body for digestion are activated. Here, we asked whether taste also determines daily intake of sugar solutions in C57BL/6 mice. We tested several dilute concentrations of glucose (167, 250, and 333 mM) and fructose (167, 250, and 333 mM). In addition, we tested saccharin (38 mM), alone and in binary mixture with each of the sugar concentrations, to manipulate sweet taste intensity while holding caloric value constant. In experiment 1, we measured taste responsiveness to the sweetener solutions in two ways: chorda tympani nerve responses and short-term lick tests. For both measures, the mice exhibited the following relative magnitude of responsiveness: binary mixtures > saccharin > individual sugars. In experiment 2, we asked whether the taste measures reliably predicted daily intake of the sweetener solutions. No such relationship was observed. The glucose solutions elicited weak taste responses but high daily intakes, whereas the fructose solutions elicited weak taste responses and low daily intakes. On the other hand, the saccharin + glucose solutions elicited strong taste responses and high daily intakes, while the saccharin + fructose solutions elicited strong taste responses but low daily intakes. Overall, we found that 1) daily intake of the sweetener solutions varied independently of the magnitude of the taste responses and 2) the solutions containing glucose stimulated substantially higher daily intakes than did the solutions containing isomolar concentrations of fructose. Given prior work demonstrating greater postoral stimulation of feeding by glucose than fructose, we propose that the magnitude of postoral nutritive stimulation plays a more important role than does taste in determining daily intake of dilute sugar solutions.

Cytochrome c(2) is not essential for photosynthetic growth of Rhodopseudomonas capsulata

The structural gene for cytochrome c(2) (cycA) of the photosynthetic bacterium Rhodopseudomonas capsulata has been cloned, and the nucleotide and deduced polypeptide sequences have been determined. Compared with the known amino acid sequence of the purified cytochrome c(2), the nucleotide sequence corresponding to the N-terminal part of the cycA gene product indicates the presence of a putative 21 amino acid signal sequence. Thus, cytochrome c(2) may be synthesized as a precursor which is processed during its secretion to the periplasm. Insertion and insertion-deletion mutations were constructed in vitro and the chromosomal cycA(+) allele of a wild-type strain was replaced with these mutations by homologous recombination to yield c(2) (-) mutants of R. capsulata. The c(2) (-) mutants are stable, and they can grow by photosynthesis and by respiration. Since cytochrome c(2) is the primary electron donor to the reaction center during photosynthesis, the ability of these mutants to grow photosynthetically indicates that an alternative way(s) of reducing the oxidized reaction center must exist in R. capsulata. One candidate for this role may be the membrane-bound cytochrome c(1).

Characterization of a ceramic ultrafiltration membrane in different operational states after its use in a heavy-metal ion removal process

In the present study, the atomic force microscopy (AFM) technique has been used to characterize a Carbosep M5 ceramic membrane (MWCO=10kDa, TiO(2)-ZrO(2) active layer). This membrane was previously used in a polymer supported ultrafiltration (PSU) process to recover copper, using partially ethoxylated polyethylenimine as the water-soluble polymer. The membrane was characterized in four different operational states: new, new and cleaned, fouled in a PSU stage and cleaned after a PSU process. The influence of the membrane state on pore opening size distribution and roughness was studied, finding a 16% decrease in the former and a 20% increase in the latter due to foulant deposition upon the membrane active layer. Phase angle distribution was also analyzed to indicate the foulant spreading on the membrane surface. These phase angle measurements can be related to pore opening size and roughness, concluding that the cleaning procedure is not totally effective and that foulant presence on the membrane active layer is not remarkable. Finally, AFM was used to measure the influence of pH on adhesion forces between a silica probe and the membrane active layer. These results can be related to the flux evolution vs pH in PSU experiments, finding both lowest adhesion and highest flux at pH 6.

Spontaneous lupus-like syndrome in HLA-DQ2 transgenic mice with a mixed genetic background

To investigate the role of HLA-DQ2 in the pathogenesis of associated immune disorders, we generated transgenic mice that expressed HLA-DQ2 in the absence of endogenous murine class II molecules (AE(0)DQ2). These AE(0)DQ2 mice with a mixed genetic background spontaneously developed skin lesions on their ears, whereas control AE(0)DQ6 genotype control mice (also with a mixed genetic background) did not. The skin lesions were characterized by deep subepidermal blistering with hydropic degeneration and lymphoid infiltration in the subepidermal area as determined by histopathology. Immunofluorescence analysis revealed thick band-like granular deposition of IgG, IgM, and a thin band of IgA deposition along the basement membrane. AE(0)DQ2 mice also developed significant and progressive hematuria and proteinuria as compared with the AE(0)DQ6 mice (p < 0.05). Histopathology showed immune complex deposits in the glomeruli of AE(0)DQ2 mice. Immunofluorescence analysis showed progressive mesangial and capillary wall deposition of IgA, IgM, IgG and C1q in the kidney. With electron microscopy, the deposits showed a 'fingerprint' substructure; and tubuloreticular structures were identified within endothelial cells. Conversely, these changes were not observed in AE(0)DQ6 mice. Serum anti-double stranded (ds)DNA IgM and IgG levels were also significantly elevated among AE(0)DQ2 mice compared with AE(0)DQ6 mice (p < 0.001). In conclusion, AE(0)DQ2 mice spontaneously develop an autoimmune lupus-like syndrome and are useful model for this disease. It remains to be determined whether genetic admixture played a role in the development of this systemic lupus erythematosus-like syndrome in HLA-DQ2 transgenic mice. Lupus (2010) 19, 815-829.

Integrating regional and community lung cancer services to improve patient care

Lung cancer is the leading cause of cancer death in Canada. The organization of health care services is central to the delivery of accessible, high-quality medical care and may be one factor that influences patient outcome. An exciting opportunity arose for clinicians to initiate the redesign of lung cancer services provided by three institutions in the Greater Toronto Area. This qualitative report describes the integrated lung cancer network that they developed, the innovation it has facilitated, and the systematic approach being taken to evaluate its impact. Available clinical resources were deployed to restructure services along patient-centred lines and to provide greater access to the specialist lung cancer team. A non-hierarchical clinical network was established that consolidates the lung cancer team. A multi-institutional and multidisciplinary tumour board and comprehensive thoracic oncology clinics are at its core. This innovative organizational paradigm considers all of the available services at each facility and aims to fully integrate specialists across the three institutions, thereby maximizing resource utilization. We believe that this paradigm may have wider applicability. The network is currently working to complete a current program of further service improvements and to objectively assess its impact on patient outcome.

The confused cancer patient: a case of 5-fluorouracil-induced encephalopathy

The fluorinated pyrimidine 5-fluorouracil (5-fu) is an anticancer agent used in most adjuvant and palliative treatment regimens for colorectal cancer. Neurotoxicities are considered extremely rare side effects of 5-fu. Here, we report a case of 5-fu–induced encephalopathy, manifesting as seizures and delirium, in an era of oxaliplatin-containing chemotherapy. If ammonia levels are elevated, lactulose may be considered in the initial management of neuropsychiatric complications from 5-fu.

Cellular Location and Expression Pattern of NHERF1 in Human Breast Cancer and the Impact of NHERF1 on the Growth of Breast Cancer Cells

BACKGROUND: The Na+/H+ exchange regulatory factor 1 (NHERF1) is an adapter protein that, when present in the cytoplasmic region, regulates trafficking and signaling of several G protein-coupled receptors (GPCRs). However, it has been recently suggested that, when located in the nucleus of cells, NHERF1 may have an oncogenic role in cancer. Recent work has shown that NHERF1 may be involved in the progression of certain solid tumours including breast cancer. The aim of the current study were: first to evaluate the spatial and cellular location of the NHEREF1 protein in mammary tissues, mammary epithelial and cancer cells, second to determine the expression pattern of the NHERF1 transcript in human breast cancer and deduce a possible association with clinical and pathological factors and, finally, to investigate the cellular impact of NHERF1 expression on breast cancer cells.MATERIALS AND METHODS: Expression of NHERF1 was examined in a cohort of breast tissue samples. The protein levels and distributions were assessed using immunohistochemical staining (IHC) and imaging analysis tools. The distribution of the NHERF1 protein in nucleus and cytoplasm was calculated using the protein staining intensity ratio between the two compartments. The transcript level was determined using quantitative real time-PCR. Constructed ribozyme transgenes were used to knock-down NHERF1 in MCF-7 cells, and the effect this had on in vitro cell growth was examined using in vitro methods.RESULTS: NHERF1 protein staining was seen in both normal epithelial cells and cancer cells in tissues. However, the staining pattern in cancer cells and normal epithelial cells was different. The protein was seen at a higher level in the nucleaus of cancer cells, as shown by a higher nuclear/cytoplasmic ratio of NHERF1 staining in breast cancer cells when compared with that in normal mammary epithelial cells (p=0.038). NHERF1 expression was increased in high grade tumours compared with low grade tumours (p=0.0016, grade-3 vs grade-1). Quantitative analysis of the NHERF1 transcript revealed a higher level expression in samples from patients with poor prognosis and that this was linked to the long term survival: mean survival for patients with high NHERF1 was 102 (55-148.8, 95%CI) months compared with 136 (126.6-145.9) months for patients with low NHERF1 transcripts. Using human breast cancer cell line, MCF7, we created NHERF1 knockdown subline. Loss of NHERF1 in the MCF-7 subline resulted in an increase in the growth rate, in vitro.CONCLUSION: This study shows that NHERF1 influences the growth of breast cancer cells. However, the effect of NHERF1 is dependent upon the levels of expression of NHERF1 in breast cancer tissues and most importantly determined by the cellular location of this protein in cancer cells.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3155.

Transforming Acidic Coiled-Coil-Containing Protein 2 (TACC2) in Human Breast Cancer, Expression Pattern and Clinical/Prognostic Relevance

BACKGROUND: TACC2 is a member of the transforming acidic coiled-coil-containing protein family and is associated with the centrosome-spindle apparatus during cell cycling. In vivo, the TACC2 gene is expressed in various splice forms predominantly in postmitotic tissues, including heart, muscle, kidney, and brain. Recent work has shown that members of this family, including TACC2, may be involved in the progression of certain solid tumours. The aim of the current study was to identify the role of TACC2 in breast cancer and to establish if a prognostic relevance exists.MATERIALS AND METHODS: Fresh frozen primary human breast cancer tissues (n = 120) and non-neoplastic mammary tissues (n = 32) were used. The distribution and location of TACC2 was assessed using immunohistochemical staining (IHC) and imaging analysis tools. The transcript levels of TACC2 were determined using quantitative real time-PCR. The results were analyzed against the clinical, pathological and follow-up (10 years) data. Statistical analysis was by Mann-Whitney U test and Kaplan-Meier method. Shown are median transcript level.RESULTS: TACC2 protein staining was seen in both normal epithelial cells and cancer cells in mammary tissues. Increased staining of TACC2 was seen in most of the breast tumours examined when compared with normal breast tissues. Quantitative analysis of the TACC2 transcript also revealed a higher level expression in tumours compared with normal tissues (p=0.027, tumours vs normal). TACC2 expression was significantly increased in higher grade tumours compared to those in lower grade tumours (grade-3 vs grade-1, p=0.046). Using the Nottingham Prognostic Index (NPI), TACC2 transcript was significantly higher in tumours from patients with a moderate prognosis than from those with a good prognosis (p = 0.019). The expression in samples from patients with poor clinical outcome (with metastasis, recurrence and breast cancer related death) was significantly higher than that from patients who remained disease free (median (IQR) 33.8 (3.0-110.2) copies vs 6 (1.6-28.9) copies, p=0.038). This was reflected by the shorter disease-free survival for patients with high TACC2 (107 (91-122.8, 95% CI) months compared with 137 (125-150.6) months for patients with low TACC2 transcripts (p=0.019).CONCLUSION: This study shows that increased expression of TACC2 correlates with poor prognosis in patients with breast cancer. This suggests that TACC2 mediates an oncogenic effect on breast cancer cells. The findings also suggest that TACC2 may be a potential therapeutic target.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3159.

A transdermal nicotine patch is not effective for postoperative pain management in smokers: a pilot dose-ranging study

BACKGROUND

Nicotine has an antinociceptive effect in animal models. The analgesic effect in humans has been examined, but studies have had mixed results. A proposed etiology is variability in chronic nicotine exposure because of differences in tobacco smoking rates and second-hand smoke exposure. In this study, we examined the postoperative analgesic effect of a transdermal nicotine patch in smokers in a parallel design to a previous study in nonsmokers.

METHODS

We conducted a randomized, double-blind, prospective, placebo-controlled trial of 28 patients undergoing abdominal or pelvic surgery who required patient-controlled analgesia and an overnight hospital stay. Before anesthetic induction, a transdermal nicotine patch was applied (0, 5, 10, or 15 mg). The primary outcome variable was postoperative pain reported over the first hour and over the next 5 days using a standard numerical rating scale. Secondary outcome variables were pain medication use, hemodynamic values, nausea, and sedation.

RESULTS

Patients treated with nicotine reported higher pain scores than those treated with placebo over the first hour after surgery (P < 0.01, average numerical rating scale increase = 0.67) and there was no difference between groups in the subsequent 5 days (P > 0.05). There was no significant dose effect. Diastolic blood pressure in the first hour was higher in the placebo group compared with the nicotine-treated group (P < 0.01, average increase = 11 mm Hg). There was no difference in nausea or sedation.

CONCLUSIONS

Transdermal nicotine, 5-15 mg, failed to relieve postoperative pain or reduce opioid use in smokers.

Model collaboration between hospitals and public health system to improve tuberculosis control in China

OBJECTIVE

Hospitals provide clinical care to many tuberculosis (TB) patients, but limited linkage with public health programmes is contributing to low TB case detection and rising TB drug resistance. We evaluated a hospital-public health collaboration to improve the follow-up of TB patients initially seen in hospitals.

DESIGN

In nine counties in eastern China, we evaluated a collaboration with three interventions: hospitals carried out internet-based reporting and patient referral to the local Center for Disease Control (CDC). The CDC regularly checked on hospital reporting and referrals and performed active follow-up of reported patients, and a government coordinating group facilitated implementation of collaborative activities.

RESULTS

Compared to the pre-intervention period, the percentage of TB suspects and patients needing referral from the hospitals who arrived in the CDC increased from 59.3% to 83.2% (P < 0.001). This increase was a result of improved hospital reporting (42.5% to 95.3%, P < 0.001), improved referral from hospitals (48.1% to 83.3%, P < 0.001), active CDC follow-up of 82.5% of reported patients who did not attend CDC by themselves, and successful tracing of 60.8% of these patients. This contributed to a 33% increase in reported smear-positive pulmonary TB cases.

CONCLUSION

This model collaboration successfully improved the follow-up of TB patients seen by hospitals, and contributed to an increase in TB case detection.

Synthesis, Characterization, and Microwave Absorption Property of the SnO2Nanowire/Paraffin Composites

In this article, SnO2nanowires (NWs) have been prepared and their microwave absorption properties have been investigated in detail. Complex permittivity and permeability of the SnO2NWs/paraffin composites have been measured in a frequency range of 0.1-18 GHz, and the measured results are compared with that calculated from effective medium theory. The value of maximum reflection loss for the composites with 20 vol.% SnO2NWs is approximately -32.5 dB at 14 GHz with a thickness of 5.0 mm.

Effects of a low-frequency sound wave therapy programme on functional capacity, blood circulation and bone metabolism in frail old men and women

Objective: To evaluate the effects of a low-frequency sound wave therapy programme on functional capacity, blood circulation and bone metabolism of the frail elderly.

Design: Single-blind, randomized, controlled trial.

Setting: Two senior service centres.

Subjects: Forty-nine volunteers (14 males and 35 females) aged 62—93 years with up to 12 diagnosed diseases were allocated in either the intervention group (n = 30) or control group (n = 19).

Intervention: The intervention group underwent sound wave therapy, 3—5 times a week for 30 minutes per session over a period of 6 months. The control group received no intervention.

Main measurements: Blood pressure, functional capacity, mobility, bone density, biochemical markers, isometric muscle strength, balance, and skin surface temperature.

Results: Compared with the control group, the intervention group’s mobility and the amount of self-reported kilometres walked per week increased by 3 km (P<0.05), while levels of cholesterol (4.97 (0.72) to 4.52 (0.65) mmol/L, P =0.019), low-density lipoprotein (2.82 (0.72) to 2.45 (0.61) mmol/L, P =0.022), bone markers of total osteocalcin (11.0 (6.5) to 10.3 (5.9) ng/mL, P =0.048)) and tartrate-resistant acid phosphatase isoform 5b (2.50 (1.0) to 2.41 (1.1) IU/L, P =0.021)) decreased. The average skin surface temperature was significantly higher during active sessions at the end of the intervention than in the beginning (P = 0.004). No change was found during placebo sessions.

Conclusions: Low-frequency sound wave therapy may have the potential to promote well-being of frail elderly subjects via improved functional capacity, especially in subjects who are too frail to undertake exercise.

Effects of strength training on work capacity and parasympathetic heart rate modulation during exercise in physically inactive men

This study was designed to assess the effects of strength training on work capacity and parasympathetic heart rate modulation during exercise in physically inactive men. Seventy-four men aged 20-45 were randomly assigned to training (n=52) and control (n=22) groups. Training groups underwent 10-weeks of progressive strength training. Body composition, one-repetition maximum half-squat and maximal oxygen uptake were measured before and after the intervention. Respiratory gases, heart rate and blood lactate were recorded during a VO2max test on a cycle ergometer. Parasympathetic heart rate modulation was analyzed based on the standard deviation of instantaneous beat-to-beat R-R interval variability (SD1) and its normalized unit (SD1n). Muscle strength and lean body mass increased in the training group. Compared to the control group, time to exhaustion increased significantly in the training group (p<0.05). SD1 and SD1n were elevated in the training group at submaximal exercise intensities (100 W, p<0.05). Blood lactate decreased at submaximal intensities when compared to the control group. Strength training increased exercise capacity, and improved vagal modulation of heart rate at submaximal exercise intensities. These changes may have favourable cardiovascular health implications for sedentary men during normal daily activities.

Cerebral venous infarction during a high altitude expedition

Bilateral venous infarction of the brain due to thrombosis of the deep cerebral venous system is relatively rare, accounting for approximately 3-8 percent of all cases of cerebral venous thrombosis (CVT). Known risk factors include the use of oral contraceptives, pregnancy, puerperium, malignancy and thrombophilic states. CVT, in the setting of acute mountain sickness (AMS), has rarely been reported. We present an unusual occurrence of bilateral deep subcortical venous infarction in a previously-well, 39-year-old woman, who developed AMS during a high altitude expedition in Nepal. The possible mechanisms responsible for this unfortunate event include dehydration with resultant relative polycythaemia and raised intracranial pressure at high altitudes. CVT should be considered in mountain climbers presenting with progressive neurological deterioration that is not solely attributable to AMS.

Deformation crossover: from nano- to mesoscale

In situ synchrotron and neutron diffraction were used to study deformation mechanisms in Ni over a broad range of grain sizes. The experimental data show that unlike in coarse-grained metals, where the deformation is dominated by dislocation slip, plastic deformation in nanocrystalline Ni is mediated by grain-boundary activities, as evidenced by the lack of intergranular strain and texture development. For ultrafine-grained Ni, although dislocation slip is an active deformation mechanism, deformation twinning also plays an important role, whose propensity increases with the grain size.

TRANSURETHRAL PROSTATECTOMY USING VISTATMBIPOLAR RADIOFREQUENCY SYSTEM: COMPARISON WITH CONVENTIONAL TRANSURETHRAL RESECTION OF THE PROSTATE

To assess the efficacy and safety of transurethral prostatectomy using Vista system, between 2002 and 2004, patients with symptomatic BPH without suspected cancer were treated using the Vista device. The therapeutic effect was retrospective studied compared with patients who were received by TURP. Bipolar resection using the Vista device exhibits a statistically difference in maximum urinary flow rate, RUV, IPSS and QOL(P < .05) 3 and 6 months after operation, and no transurethral resection syndrome occurred. TURP also exhibits a statistically difference in maximum urinary flow rate, RUV, IPSS and QOL(P < .05), but TURS occurred in 2 patients. Compared with TURP, the Vista device shows a statistically less blood loss (P < .05), and longer operation time in prostate enlarged III(0)(P < .05). The Vista system seems to be effective and safe, and especially fit the patients who have a bigger prostate and high risk factors. It appears to be an effective treatment for BPH. Long-term results should be evaluated.

A sense of urgency: Evaluating the link between clinical trial development time and the accrual performance of CTEP-sponsored studies

CRA6509

Background: Post-activation barriers to oncology clinical trial accruals are well documented; however, potential barriers prior to trial opening are not. We investigate one such barrier: trial development time. Methods: National Cancer Institute Cancer Therapy Evaluation Program (NCI-CTEP) sponsored trials for all therapeutic, non-pediatric phase I,I/II, II, and III studies activated in an eight year period (2000–2007) were investigated (n=553). Successful trials were those achieving 100% of minimum accrual goal. Time to open a study was the calendar time from initial CTEP submission to trialactivation. Multivariable logistic regression analysis was used tocalculate unadjusted and adjusted odds ratios, controlling for study phase and size of expected accruals. Results: 40.0 percent (n=221) of CTEP-approved oncology trials failed to achieve minimum accrual goals, with 49.2 percent (n=30) of phase III trials failing to achieve at least 25 percent of accrual goals. A total of 8,723 patients (17.0% of accruals) accrued to those studies that were unable to achieve the projected minimum accrual goal. Trials requiring 9–12 months development were significantly more likely to achieve accrual goals (odds ratio, 1.94; 95% CI, 1.06 to 3.52, P=0.031) than trials requiring the median time (15–18 months); trials that exceeded 27 months of development time were significantly less likely of achieving accrual goals (odds ratio, 0.14; 95% CI, 0.04 to 0.54, P=0.004). Conclusions: A large percentage of oncology clinical trials do not achieve minimum projected accruals. Trial development time appears to be one important predictor of the likelihood of successfully achieving the minimum accrual goals.

[Table: see text]

No significant financial relationships to disclose.

A sense of urgency: Evaluating the link between clinical trial development time and the accrual performance of CTEP-sponsored studies

CRA6509

The full, final text of this abstract will be available in Part II of the 2009 ASCO Annual Meeting Proceedings, distributed onsite at the Meeting on May 30, 2009, and as a supplement to the June 20, 2009, issue of the Journal of Clinical Oncology.

No significant financial relationships to disclose.

Nanoparticles and 3D sponge-like porous networks of manganese oxides and their microwave absorption properties

Hydrohausmannite nanoparticles (approximately 10 nm) were prepared by the hydrothermal method at 100 degrees C for 72 h. Subsequent annealing was done in air at 400 degrees C and 800 degrees C for 10 h, Mn(3)O(4) nanoparticles (approximately 25 nm) and 3D Mn(2)O(3) porous networks were obtained, respectively. The products were characterized by XRD, TEM, SAED and FESEM. Time-dependent experiments were carried out to exhibit the formation process of the Mn(2)O(3) networks. Their microwave absorption properties were investigated by mixing the product and paraffin wax with 50 vol%. The Mn(3)O(4) nanoparticles possess excellent microwave absorbing properties with the minimum reflection loss of -27.1 dB at 3.1 GHz. In contrast, the Mn(2)O(3) networks show the weakest absorption of all samples. The absorption becomes weaker with the annealing time increasing at 800 degrees C. The attenuation of microwave can be attributed to dielectric loss and their absorption mechanism was discussed in detail.

Reversible encephalopathy after cardiac transplantation: histologic evidence of endothelial activation, T-cell specific trafficking, and vascular endothelial growth factor expression

Reversible encephalopathy after transplantation is well recognized. The condition is commonly thought to be related to immune suppression, and a characteristic brain imaging pattern is typically recognized with vasogenic edema in the parietal and occipital regions, typically termed posterior reversible encephalopathy syndrome (PRES). We report the case of a patient with reversible encephalopathy after cardiac transplantation with brain biopsy evidence of endothelial activation, selective intravascular/perivascular T-cell trafficking, and VEGF expression in astrocytes, neurons, and the endothelium.

Reduction in asthma morbidity following a community-based asthma self-management programme in Tonga

BACKGROUND

The Tonga Asthma Self-management Project assessed whether the introduction of an asthma self-management plan would reduce asthma morbidity.

METHODS

The project involved a 'before and after' trial, with each participant serving as his/her own control. Asthma patients used the self-management plan to manage their asthma medication or obtain medical help based on their peak expiratory flow (PEF) rate and/or asthma symptoms.

RESULTS

The 110 participants initially had relatively high asthma morbidity: 68% had had an emergency medical visit for asthma in the previous 12 months. Ninety-two (84%) completed the 12-month programme. Emergency doctor visits fell from 66% in the previous 12 months to 18% (P < 0.001) in the following 12 months. Other measures also improved, including hospital admissions (from 19% to 3%, P = 0.001), having 14 days or more 'out of action' (from 29% to 4%, P < 0.001), waking > or = 2 nights a week (from 40% to 13%, P < 0.001), severe asthma attacks (from 54% to 18%, P < 0.001) and mean PEF rates (from 341 l/min to 417 l/min, a 22% increase, P < 0.001).

CONCLUSIONS

The potential benefits of asthma self-management plans and community-based asthma education are supported by the findings of the Tonga study. Their implementation is essential in the resource-scarce Pacific health setting.

Recurrent orbital myositis with radiological feature mimicking thyroid eye disease in a patient with Crohn's disease

Orbital myositis is an extremely rare extra-intestinal manifestation of Crohn's disease. Herein we describe a patient with self-limiting episodes of episcleritis and uveitis prior to the diagnosis of Crohn's disease, and subsequent development of recurrent orbital myositis with radiological features mimicking thyroid eye disease.

Pott's puffy tumor in a premature neonate: the new youngest case reported in the post-antibiotic era

An extreme premature infant born at 25 weeks post menstrual age (PMA) presented at PMA of 32 weeks with non-multiresistant methicillin resistant Staphylococcus aureus (MRSA) Pott's puffy tumor (PPT) involving both orbital and intracranial extension is described here. This is the youngest case of PPT ever reported in the antibiotic era.

Unilateral penile swelling: an unusual presentation of primary syphilis?

Summary:

Primary syphilis is characterized by a solitary, painless, indurated ulcer (chancre) at the site of inoculation, with associated inguinal lymph nodes that are enlarged, rubbery, painless and discrete. We report a case of syphilis that presented with penile swelling associated with tender lymphadenopathy and review the literature concerning this unusual presentation of early syphilis.

Genetic profile of ischemic cerebrovascular disease and carotid stenosis

OBJECTIVES

Carotid artery stenosis (CS) is a major risk factor for ischemic cerebrovascular disease (ICVD) and is therefore of interest in genetic investigating. Here we report the distribution of 100 polymorphisms in 47 suspected susceptibility genes for ICVD and its risk factors.

MATERIALS AND METHODS

Previously published markers in suspected susceptibility genes were genotyped in ICVD patients and controls (928/602). Genotyping was performed using multiplex polymerase chain reaction (PCR) and linear immobilized probe array assays. ICVD cases were subtyped according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) or subdivided into CS and non-CS patients by ultrasonography in a separate analysis.

RESULTS

Three polymorphisms located in the lipoprotein lipase (LPL), angiotensinogen (AGT) and guanine nucleotide-binding protein beta-3 (GNB3) genes were significantly associated with ICVD after correction for age and gender. The strongest association was found for the protective LPL Ser447Term polymorphism. All the significant markers showed varying frequencies in different subphenotypes of ICVD. Factor VII, apolipoprotein E and two renin polymorphisms were differentially frequent in patients with evidence of CS compared with non-CS patients.

CONCLUSIONS

We have found that some previously described susceptibility polymorphisms are weakly associated with ICVD and that subdivision of patients into CS and non-CS groups may help to identify new candidate polymorphisms.

Models of the pulsatile hydrodynamics of cerebrospinal fluid flow in the normal and abnormal intracranial system

Images obtained from magnetic resonance imaging have helped to ascertain that both the cerebrospinal fluid (CSF) and brain move in a pulsatile manner within the cranium. However, these images are not able to reveal any quantitative information on the physiological forces that are associated with pulsatile motion. Understanding both the pressure and velocity flow field of CSF in the ventricles is important to help understand the mechanics of hydrocephalus. Four separate fluid structure interaction models of the ventricular system in the sagittal plane were created for this purpose. The first model was of a normal brain. The second and third models were pathological brain models with aqueductal stenosis at various locations along the fluid pathway. The fourth model was of a hydrocephalic brain. Results revealed the hydrodynamics of CSF pulsatile flow in the ventricles of these models. Most importantly, it has also revealed the different changes in CSF pulsatile hydrodynamics caused by the various locations of fluid flow obstructions.

Movement of the tongue during normal breathing in awake healthy humans

Electromyographic (EMG) activity of the airway muscles suggest that genioglossus is the primary upper airway dilator muscle. However, EMG data do not necessarily translate into tissue motion and most imaging modalities are limited to assessment of the surfaces of the upper airway. In this study, we hypothesized that genioglossus moves rhythmically during the respiratory cycle and that the motion within is inhomogeneous. A 'tagged' magnetic resonance imaging technique was used to characterize respiratory-related tissue motions around the human upper airway in quiet breathing. Motion of airway tissues at different segments of the eupnoeic respiratory cycle was imaged in six adult subjects by triggering the scanner at the end of inspiration. Displacements of the 'tags' were analysed using the harmonic phase method (HARP). Respiratory timing was monitored by a band around the upper abdomen. The genioglossus moved during the respiratory cycle. During expiration, the genioglossus moved posteriorly and during inspiration, it moved anteriorly. The degree of motion varied between subjects. The maximal anteroposterior movement of a point tracked on the genioglossus was 1.02 +/- 0.54 mm (mean +/- s.d.). The genioglossus moved over the geniohyoid muscle, with minimal movement in other muscles surrounding the airway at the level of the soft palate. Local deformation of the tongue was analysed using two-dimensional strain maps. Across the respiratory cycle, positive strains within genioglossus reached peaks of 17.5 +/- 9.3% and negative strains reached peaks of -16.3 +/- 9.3% relative to end inspiration. The patterns of strains were consistent with elongation and compression within a constant volume structure. Hence, these data suggest that even during respiration, the tongue behaves as a muscular hydrostat.

Risk factors for symptoms of childhood asthma, allergic rhinoconjunctivitis and eczema in the Pacific: an ISAAC Phase III study

BACKGROUND AND METHODS

Phase III of the International Study of Asthma and Allergies in Childhood (ISAAC) was conducted in eight Pacific countries, five of which (Samoa, Fiji, Tokelau, French Polynesia and New Caledonia) collected environmental questionnaire (EQ) data. We report the findings of the EQ analyses below.

RESULTS

The major factors associated with current wheeze were regular margarine consumption (prevalence odds ratio [POR] 1.19, 95%CI 1.01-1.40), paracetamol use (POR 1.35, 95%CI 1.11-1.64), electric cooking (POR 1.42, 95%CI 1.11-1.80), regular exercise (POR 1.44, 95%CI 1.18-1.75) and maternal smoking (POR 1.16, 95%CI 1.01-1.33). Protective factors included having older siblings (two or more POR 0.69, 95%CI 0.58-0.82; one POR 0.86, 95%CI 0.71-1.05), and being born in the country of the survey (POR 0.74, 95%CI 0.63-0.87). Risk factors for rhinoconjunctivitis included regular consumption of meat, butter, margarine and nuts, regular exercise, regular television viewing, paracetamol use and passive smoking. Eczema was associated with regular meat, pasta and butter consumption, regular television viewing, paracetamol use and passive smoking.

CONCLUSIONS

Regular meat and margarine consumption, paracetamol use, electric cooking and passive smoking are risk factors for symptoms of asthma, rhinoconjunctivitis and eczema in the Pacific. However, most of these associations were weak, and account for only a small proportion of cases.