Exploring the clinical value of tumor microenvironment in platinum-resistant ovarian cancer

Platinum resistance in epithelial ovarian cancer (OvCa) is rising at an alarming rate, with recurrence of chemo-resistant high grade serous OvCa (HGSC) in roughly 75 % of all patients. Additionally, HGSC has an abysmal five-year survival rate, standing at 39 % and 17 % for FIGO stages III and IV, respectively. Herein we review the crucial cellular interactions between HGSC cells and the cellular and non-cellular components of the unique peritoneal tumor microenvironment (TME). We highlight the role of the extracellular matrix (ECM), ascitic fluid as well as the mesothelial cells, tumor associated macrophages, neutrophils, adipocytes and fibroblasts in platinum-resistance. Moreover, we underscore the importance of other immune-cell players in conferring resistance, including natural killer cells, myeloid-derived suppressive cells (MDSCs) and T-regulatory cells. We show the clinical relevance of the key platinum-resistant markers and their correlation with the major pathways perturbed in OvCa. In parallel, we discuss the effect of immunotherapies in re-sensitizing platinum-resistant patients to platinum-based drugs. Through detailed analysis of platinum-resistance in HGSC, we hope to advance the development of more effective therapy options for this aggressive disease.

Metabolomic credentialing of murine carcinogen-induced urothelial cancer

Bladder cancer (BCa) is the most common malignancy of the urinary system with increasing incidence, mortality, and limited treatment options. Therefore, it is imperative to validate preclinical models that faithfully represent BCa cellular, molecular, and metabolic heterogeneity to develop new therapeutics. We performed metabolomic profiling of premalignant and non-muscle invasive bladder cancer (NMIBC) that ensued in the chemical carcinogenesis N-butyl-N-(4-hydroxybutyl)-nitrosamine (BBN) mouse model. We identified the enriched metabolic signatures that associate with premalignant and NMIBC. We found that enrichment of lipid metabolism is the forerunner of carcinogen-induced premalignant and NMIBC lesions. Cross-species analysis revealed the prognostic value of the enzymes associated with carcinogen-induced enriched metabolic in human disease. To date, this is the first study describing the global metabolomic profiles associated with early premalignant and NMIBC and provide evidence that these metabolomic signatures can be used for prognostication of human disease.

Methane, nitrous oxide and ammonia emissions from an Australian piggery with short and long hydraulic retention-time effluent storage

In the Australian pork industry, manure is the main source of greenhouse gases (GHG). In conventional production systems, effluent from sheds is transferred into open anaerobic ponds where the effluent is typically stored for many months, with the potential of generating large quantities of GHG. The present study measured methane (CH4), nitrous oxide (N2O) and ammonia (NH3) emissions from a conventional anaerobic effluent pond (control), a short hydraulic retention-time tank (short HRT, mitigation) and from the animal housing for a flushing piggery in south-eastern Queensland, over two 30-day trials during summer and winter. Emissions were compared to determine the potential for a short HRT to reduce emissions. Average CH4 emissions from the pond were 452 ± 37 g per animal unit (AU; 1 AU = 500 kg liveweight) per day, during the winter trial and 789 ± 29 g/AU.day during the summer trial. Average NH3 emissions were 73 ± 8 g/AU.day during the winter trial and 313 ± 18 g/AU.day during the summer trial. High emission factors during summer will be temperature driven and influenced by the residual volatile solids and nitrogen (N) deposited in the pond during winter. Average NH3 emissions from the piggery shed were 0.707 ± 0.050 g/AU.day and CH4 emissions were 0.344 ± 0.116 g/AU.day. The N2O concentrations from both the pond and shed were close to, or below, the detection limits. Total emissions from the short HRT during the winter and summer trials, respectively, were as follows: CH4 10.65 ± 0.616 mg/AU.day and 4108 ± 473 mg/AU.day; NH3-N 1.15 ± 0.07 mg/AU.day and 29.8 ± 2.57 mg/AU.day; N2O-N 0.001 ± 0.00052 mg/AU.day and 5.9 ± 0.321 mg/AU.day. On the basis of a conservative analysis of CH4 emissions relative to the inflow of volatile solids, and NH3 and N2O emissions as a fraction of the excreted N, GHG emissions were found to be 79% lower from the short-HRT system. This system provides a potential mitigation option to reduce GHG emissions from conventional pork production in Australia.

Emissions of nitrous oxide, ammonia and methane from Australian layer-hen manure storage with a mitigation strategy applied

Greenhouse gas and ammonia emissions are important environmental impacts from manure management in the layer-hen industry. The present study aimed to quantify emissions of nitrous oxide (N2O), methane (CH4) and ammonia (NH3) from layer-hen manure stockpiles, and assess the use of an impermeable cover as an option to mitigate emissions. Gaseous emissions of N2O, CH4 and NH3 were measured using open-path FTIR spectroscopy and the emission strengths were inferred using a backward Lagrangian stochastic model. Emission factors were calculated from the relationship between gaseous emissions and stockpile inputs over a 32-day measurement period. Total NH3 emissions were 5.97 ± 0.399 kg/t (control) and 0.732 ± 0.116 kg/t (mitigation), representing an 88% reduction due to mitigation. Total CH4 emissions from the mitigation stockpile were 0.0832 ± 0.0198 kg/t. Methane emissions from the control and N2O emissions (control and mitigation) were below detection. The mass of each stockpile was 27 820 kg (control) and 25 120 kg (mitigation), with a surface area of ~68 m2 and a volume of ~19 m3. Total manure nitrogen (N) and volatile solids (VS) were 25.2 and 25.8 kg/t N, and 139 and 106 kg/t VS for the control and mitigation stockpiles respectively. Emission factors for NH3 were 24% and 3% of total N for the control and mitigation respectively. Methane from the mitigation stockpile had a CH4 conversion factor of 0.3%. The stockpile cover was found to reduce greenhouse gas emissions by 74% compared with the control treatment, primarily via reduced NH3 and associated indirect N2O emissions.

Accuracy of radiological staging in identifying high-risk colon cancer patients suitable for neoadjuvant chemotherapy: a multicentre experience

AIM

A pilot study was undertaken to determine the accuracy of computed tomography (CT) staging in identifying patients with high-risk colon cancers who would be considered as candidates for a neoadjuvant therapy trial (FOxTROT) and those at low risk (T1/T2) who would be excluded.

METHOD

Participating radiologists from 19 centres attended workshops for standardization of image interpretation according to previously defined prognostic criteria: good prognosis tumours, including, T1/T2; intermediate prognosis, T3 < 5 mm tumour invasion beyond the muscularis propria (MP); and poor prognosis tumours, including T3 with tumour extension ≥ 5 mm beyond the MP or T4. The CT findings were compared with histopathology as the reference standard.

RESULTS

Of 94 patients with radiological and pathological data, 71% were categorized by CT as having a poor prognosis. The sensitivity and specificity of CT in identifying these tumours were 87% (95% CI, 74-94) and 49% (95% CI, 33-65). Sensitivity and specificity for tumour infiltration beyond the MP (T3/T4 vs T1/T2) were 95% (95% CI, 87-98) and 50% (95% CI, 22-77), respectively. Including all CT-staged T3 and T4 patients in the trial would have increased the proportion eligible for entry to 89% (n = 84) without affecting the false-positive rate of 7%. Some 20% of T3/T4 patients would have been ineligible for FOxTROT because of synchronous metastases.

CONCLUSION

In a multicentre setting, CT scanning identified high-risk (T3/4) colon cancers with minimal overstaging of T1/T2 tumours, thus establishing the feasibility of radiologically guided neoadjuvant chemotherapy.

Worldwide incidence and prevalence of pediatric onset systemic lupus erythematosus

Compilation of worldwide data regarding the incidence and prevalence of pediatric-onset systemic lupus erythematosus (SLE) is needed in order to evaluate the scope of the disease in the pediatric population. A literature review was performed to unify the current data available on the global incidence and prevalence of pediatric-onset SLE. We examined 13 available epidemiological studies concentrated on the incidence and prevalence of pediatric-onset SLE. The available reports were predominantly from North America, Europe and Asia. The limited amount of studies available highlights the need for more epidemiological research in order to better comprehend the global scope of this disease.

Benchmarking circumferential resection margin (R1) resection rate for rectal cancer in the neoadjuvant era

AIM

Circumferential resection margin (CRM) involvement (R1) is used to audit rectal cancer surgical quality. However, when downsizing chemoradiation (dCRT) is used, CRM audits both dCRT and surgery, its use reflecting a high casemix of locally advanced tumours. We aimed to evaluate predictors of R1 and benchmark R1 rates in the dCRT era, and to assess the influence of failure of steps in the multidisciplinary team (MDT) process to CRM involvement.

METHOD

A retrospective analysis of prospectively collected rectal cancer data was undertaken. Patients were classified according to CRM status. Uni- and multivariate analysis was undertaken of risk factors for R1 resection. The contribution of the steps of the MDT process to CRM involvement was assessed.

RESULTS

Two hundred and ten rectal cancers were evaluated (68% T3 or T4 on preoperative staging). R1 (microscopic) and R2 (macroscopic) resections occurred in 20 (10%) and 6 patients (3%), respectively. Of several factors associated with R1 resections on univariate analysis, only total mesorectal excision (TME) specimen defects and threatened/involved CRM on preoperative imaging remained as independent predictors of R1 resections on multivariate analysis. Causes of R1 failure by MDT step classification found that less than half were associated with and only 15% solely attributable to a suboptimal TME specimen.

CONCLUSION

Total mesorectal excision specimen defects and staging-predicted threatened or involved CRM are independent strong predictors of R1 resections. In most R1 resections, the TME specimen was intact. It is important to remember the contribution of both the local staging casemix and dCRT failure when using R1 rates to assess purely surgical competence.

A predictive model for local recurrence after transanal endoscopic microsurgery for rectal cancer

BACKGROUND

The outcome of local excision of early rectal cancer using transanal endoscopic microsurgery (TEM) lacks consensus. Screening has substantially increased the early diagnosis of tumours. Patients need local treatments that are oncologically equivalent to radical surgery but safer and functionally superior.

METHODS

A national database, collated prospectively from 21 regional centres, detailed TEM treatment in 487 subjects with rectal cancer. Data were used to construct a predictive model of local recurrence after TEM using semiparametric survival analyses. The model was internally validated using measures of calibration and discrimination.

RESULTS

Postoperative morbidity and mortality were 14.9 and 1.4 per cent respectively. The Cox regression model predicted local recurrence with a concordance index of 0.76 using age, depth of tumour invasion, tumour diameter, presence of lymphovascular invasion, poor differentiation and conversion to radical surgery after histopathological examination of the TEM specimen.

CONCLUSION

Patient selection for TEM is frequently governed by fitness for radical surgery rather than suitable tumour biology. TEM can produce long-term outcomes similar to those published for radical total mesorectal excision surgery if applied to a select group of biologically favourable tumours. Conversion to radical surgery based on adverse TEM histopathology appears safe for p T1 and p T2 lesions.

Functional correlates of the interleukin-1 receptor antagonist gene polymorphism in the colonic mucosa in ulcerative colitis

Association studies have identified the interleukin-1 receptor antagonist gene allele 2(IL-1RN*2) as a marker of susceptibility in ulcerative colitis (UC). This study investigated the significance of the IL-1RN genotype with respect to protein and mRNA expression in the colonic mucosa. Homogenates of rectal biopsies from 99 UC and 54 controls were assayed for cytokines IL-1ra, IL-1a and IL-1b using ELISA. IL1RN, IL1A and IL1B genotypes were determined using restriction-enzyme analysis. The ability of the two IL1RN alleles to generate steady-state mRNA accumulation was assessed in the colonic mucosa of seven heterozygous patients. Stepwise linear regression demonstrated that IL-1RN genotype (P=0.001), diagnosis (P<0.0001) and treatment (P<0.03) were independent factors associated with the IL-1ra protein level whilst IL1RN genotype (P=0.005) and macroscopic inflammatory grade (P<0.0001) were associated with the IL-1ra/ total IL-1 ratio. The IL1RN*2 correlated with reduced IL-1ra and IL-1ra/IL-1 ratio with a gene dosage effect. In heterozygous UC patients the ratio of allele 1 mRNA / allele 2 steady state mRNA was always greater than 1 (range: 1.2-3.1) (P=0.018). The IL-1RN*2 is associated with reduced levels of IL-1ra protein and IL-1RN mRNA in the colonic mucosa, providing a biologically plausible explanation for the observed association of the allele with the disease.

How could pathologists improve the initial diagnosis of colitis? Evidence from an international workshop

BACKGROUND

The taking of multiple colorectal biopsies is in widespread use although there is little research into their benefit for the pathological diagnosis of inflammatory bowel disease. There is also still debate about appropriate morphological criteria for interpreting these biopsies.

AIMS

To determine the effect of single versus multiple biopsies on the accuracy of diagnosis and to study the accuracy and reproducibility of the different criteria used in the diagnosis of multiple biopsies by expert and non-expert pathologists.

METHOD

Thirteen expert and 12 non-expert international diagnostic histopathologists attended a workshop. Sixty cases with full follow up were viewed, blinded, in two rounds. Diagnoses were made on rectal biopsies and then full colonoscopic series.

RESULTS

Experts correctly identified 24% of Crohn's disease cases (non-experts, 12%) from the rectal biopsies. This improved to 64% (non-experts, 60%) with the full series. The accuracy of the diagnosis of ulcerative colitis also improved slightly with the full series from 64% to 74% overall. Experts had a similar (moderate) level of agreement and accuracy to non-experts. For Crohn's disease, the likelihood ratios (LR) for the most important individual features were 12.4 for granulomas and 3.3 for focal or patchy inflammation. Features favouring ulcerative colitis were diffuse crypt architectural irregularity (LR, 3.4), general crypt epithelial polymorphs (LR, 3.7), and reduced crypt numbers (LR, 2.9).

CONCLUSIONS

A full colonoscopic series gave more accurate diagnosis than a rectal biopsy. Accurate pathologists used the same evidence based criteria for multiple biopsies as for single biopsies.

The personal construction of death in anorexia nervosa

This paper reports a study concerned with an attempt to understand the manner in which individuals at high objective risk of death through their own behaviour, understand the phenomenon of death, and their own death. It is an extension of an earlier empirical study (Warren et al., 1994) which in turn, set out to test a hypothesis advanced by Jackson and Davidson (1986) that disturbed death ideation was aetiologically significant in anorexia nervosa; and an extension of earlier work on death constructions, and death education (Warren, 1984, 1989). Constructs were elicited from a sample of hospitalized sufferers of anorexia nervosa. These participants also completed the provided construct, Death Threat Index. Repertory grids were analysed for the information they yield concerning death constructions in sufferers of anorexia nervosa. Various quantitative measures were also derived and compared with similar measures from a control group.

Diversion colitis--new light through old windows

Diversion proctocolitis is an iatrogenic disorder caused by surgical diversion of the faecal stream away from the colorectal mucosa. Such surgery may be necessary in cases of tumour, trauma or inflammatory conditions of the colorectum. Histopathological change is characterized by a chronic lymphoplasmacytic inflammatory infiltrate, and the hallmark feature, lymphoid follicular hyperplasia. Histological appearances are determined by the disease state of the colonic mucosa prior to faecal diversion. Macroscopic appearances may vary considerably, but often include aphthoid ulceration. The exact pathogenesis of the condition remains unclear, but the removal of short-chain fatty acids, present in the faecal stream, is considered an important aetiological factor. Current research areas, including the microbiology and cellular kinetics of diversion colitis, are discussed along with clinical features and treatments.

Effect of carbohydrate substrate availability on ratings of perceived exertion during prolonged running

The purpose of this study was to investigate the effects of carbohydrate substrate availability on ratings of perceived exertion (RPE) during prolonged submaximal running. Thirty marathon runners were recruited as subjects. A double-blind study design was used in which subjects performed an experimental trial that consisted of a 2.5-hr treadmill run at 75-80% VO2max. During the experimental trial, the subjects in the carbohydrate feeding group ingested a 6% glucose and fructose solution at a rate of approximately 60 g.hr, whereas subjects in the placebo group consumed an equal volume of artificially flavored placebo. Statistical analysis of RPE, respiratory exchange ratio, fat and carbohydrate oxidation rate, and blood glucose concentrations indicated that increased carbohydrate substrate availability attenuated the intensity of exertional perceptions during the later stages of prolonged running at 75-80% VO2max in marathon runners.

Death themes in anorexia nervosa: dimensions for a reply to Jackson et al

OBJECTIVE

To provide a critical, theoretical response to some ideas argued initially by Jackson and Davidson (Int J Eat Dis, 5, 821-835, 1986). Those ideas developed an understanding of anorexia nervosa in terms of disturbed death ideation and the notion of the anorexia nervosa sufferer as a "survivor." This paper was intended to broaden the frame of reference for a consideration of the relationship between eating disorders and death ideation.

METHOD

The approach is a reflection on three domains of thinking about death and destructiveness, two within psychology, the third a perspective provided by philosophy. Specifically, early post-Freudian work, personal construct psychology, and the philosophical tradition that makes death generally significant in human life, that is, Existentialism, are discussed in terms of their illumination of the ideas under review.

RESULTS

The result is a series of speculative observations that constitute an argument that these three domains together provide a strong countercritical position to the idea of a universal, even a general significance of death, particularly etiologically, in anorexia nervosa.

DISCUSSION

The discussion suggests that the particular significance of death ideation in a multidimensional condition like anorexia nervosa must be derived in each particular case where it will sometimes be more, sometimes less significant, and, importantly, will mean something different to each individual sufferer.

Pigbel-like syndrome in a vegetarian in Oxford

Enterocolitis necroticans or pigbel is a rare condition characteristically affecting chronically malnourished people who abruptly increase their intake of protein. The classic presentation of the disease as seen in the highlands of Papua New Guinea is that of a necrotising enterocolitis after the ritual ingestion of contaminated pork. In this context, the presentation of the same disease in a well nourished white vegetarian in Oxford was all the more intriguing.

Heart rate response during handball singles match-play and selected physical fitness components of experienced male handball players

Limited information is available concerning the exercise response during handball (HB) singles match-play. Also, few studies exist that have examined VO2 peak and body composition of HB players. The purpose of this study was to examine the heart rate (HR) response during match play and peak physiologic responses and relative fat in twelve experienced HB players. Peak physiologic responses were measured during treadmill running and body composition was assessed via hydrodensiotometry. During HB match-play, HR was measured and stored every five seconds using a Polar Vantage XL heart watch. Physical characteristics and peak physiologic responses included the following: Age (yrs) 47.2; BW (kg) 78.0; height (cm) 178.9; % fat 18.9; VO2 peak (ml.kg-1.min-1) 48.0; RER peak 1.03; HR peak (bpm) 183.1 and lactic acid peak (mmol.l-1) 10.3. During HB match-play, HR averaged 85% of peak during one hour of play. Moreover, 67% of match-play time, HR was > 80% of peak. When HR responses were examined over one hour of match-play (twelve, five minute blocks) only the first five minutes were significantly different (lower) than the other 55 minutes. The exercise intensity and the relatively stable HR response observed during HB suggests that this activity appears to be appropriate for meeting the American College of Sports Medicine guidelines to develop and maintain cardiorespiratory fitness.

Complications and effectiveness of gastrostomy feedings in pediatric cancer patients

PURPOSE

The objective of this study was to assess the complications and efficacy of gastrostomy (GT) feedings in pediatric cancer patients.

PATIENTS AND METHODS

We reviewed the medical records of 33 pediatric cancer patients who received enteral nutrition via a GT.

RESULTS

Median age was 9.4 years (range, 1-19.8 years), and 28 of the 33 patients had solid tumors. Seventeen patients had a significant weight loss (median, 8.5%) and therapy-related weight loss was anticipated in 16 patients. The GT device was placed an average of 5.5 months after diagnosis. Twenty-five patients were fed via a tube and eight via a button device. The tube was placed surgically in 21 cases (including all eight button types) and endoscopically in 12. Nutritional support lasted a median of 9.5 months. One or more complications occurred in 30 patients and were categorized as (a) insertion site reactions (inflammation, 23; infection/colonization, 14; exuberant granulation tissue, 6); (b) mechanical problems (leaking, 3; obstruction, 2; breakage, 1; accidental dislodgement, 2); (c) insertion site bleeding, 8; and (d) feeding intolerance, 12. Only one insertion site cellulitis progressed to a systemic infection. All eight patients with a button GT experienced insertion site complications, with local infection occurring significantly more often in patients with the button than in those with the tube GT. There were no significant associations between insertion technique and type of complication. Twenty-seven patients (82%) achieved or maintained ideal body weight with this intervention.

CONCLUSIONS

GT feeding was associated with minor complications, but permitted effective nutritional support for pediatric cancer patients.

Guidelines for the optimal management of chemotherapy-induced nausea and vomiting: a consensus

Nausea and vomiting are the most frequently reported adverse effects of cancer chemotherapy and have a significant impact on patients' daily functioning, quality of life and compliance with chemotherapy. Summarized in this article are the recommendations for the optimal management of nausea and vomiting developed by a multidisciplinary group of health care professionals. Issues relating to chemotherapy-induced nausea and vomiting are discussed; general principles of treatment are reviewed; treatment algorithms based on emetogenicity and types of chemotherapy are presented; and the importance of issues including non-pharmacological approaches, patient education and pharmacoeconomic perspectives are considered. The goal of antiemetic therapy should be no episodes of vomiting or retching and minimal or no nausea. Data from clinical trials support the clear superiority of 5-HT3 receptor antagonists in a variety of clinical situations. Their cost must be considered not only as an isolated item from the institutional perspective, but also from the perspective of the impact of successful therapy on the patient.

Comparison of a simulated 16.1-km time trial, VO2max and related factors in cyclists with different ventilatory thresholds

Differences in cycling performance have been observed in cyclists with similar VO2max values yet different lactate thresholds. The purpose of the current study was to compare a simulated 16.1-km cycling time trial, VO2max and related factors in cyclists who significantly varied in ventilatory threshold. From an original group of 18 category III or IV cyclists, two groups of 6 cyclists were formed based on ventilatory threshold values as high (77 +/- 4% of VO2max-Group H) or low (68 +/- 2.8% - Group L). VO2max and a 16.1-km time trial were completed on a Velodyne trainer. No significant difference (p > or = 0.05) was noted between groups in VO2max (Group H 4.00 +/- 0.281.min-1, Group L 4.15 +/- 0.671.min-1), however significant differences (p < or = 0.05) were found in ventilatory threshold and time trial scores. Group H completed the time trial in 16.29 +/- 2.08 min while Group L averaged 20.93 +/- 3.03 min. Group H completed the time trial 28% more quickly by working at a significantly higher percentage of VO2max, a higher power output and a faster pedal rate than Group L. From a battery of physiologic and body composition parameters, the ventilatory threshold expressed as VO2 (l.min-1) was the best predictor (r = -0.76) of time trial performance in the 12 cyclists. The findings of this study indicate that the ventilatory threshold was superior to VO2max in discerning performance differences in a 16.1-km cycling time trial, and was the best predictor of the simulated time trial performance.

Illiteracy among Medicaid recipients and its relationship to health care costs

Poor literacy is associated with poor health status, but whether illiteracy is also linked to higher medical care costs is unclear. We characterized the literacy skills of 402 randomly selected adult Medicaid enrollees to determine if there was an association between literacy skills and health care costs. Each subject's literacy skills were measured with a bilingual (English/Spanish) reading-assessment instrument. We also reviewed each subject's health care costs over the same one-year period. The mean reading level of this Medicaid population was at grade 5.6. Mean annual health care costs were $4,574 per person. There was no significant relationship between literacy and health care costs. While there are compelling reasons to improve poor reading skills among Medicaid enrollees, illiteracy in this population does not appear to contribute to the high cost of providing government-sponsored care.

[Promoting positive relations between parents and child--a counseling service for families with infants and young children in Sydney]

The "Early Intervention Programme" (EIP) in Sydney, Australia, is a home-based service for distressed families with children 0-3 years of age. It is funded as a child abuse prevention unit. The concept is based on the work of Selma Fraiberg (1980), who developed the first infant mental health program in Michigan, USA. The goal of the EIP is to strengthen the relationship between parents and child through developmental guidance, psychotherapy and/or provision of active help. The child is seen as an important partner in the intervention process.

Role of serology in monitoring treatment for Helicobacter pylori infection in elderly patients

Fifteen elderly patients with type B gastritis caused by Helicobacter pylori infection were treated with triple therapy consisting of colloidal bismuth subcitrate, amoxycillin and metronidazole. All were followed up every 6 weeks for 3 months. After triple therapy, eradication of the infection was confirmed in 12 patients (85%) by histology and bacteriology. In this group, a significant reduction in IgG antibody levels against H. pylori was detected (p < 0.001). In a control group of 15 patients with type B gastritis who received no antibacterial treatment, the specific IgG antibody titre remained unchanged during 3 months of follow-up. We conclude that this simple and noninvasive serological test would be suitable for follow-up after treatment of H. pylori infection in elderly patients.

Helicobacter pylori infection in elderly people: correlation between histology and serology

A hundred elderly dyspeptic patients were studied to assess the prevalence of Helicobacter pylori infection and the correlation between histological and serological findings. Eighty-one per cent of the patients with gastritis and 63% with gastric ulcer were H. pylori positive. All patients who had H. pylori negative gastritis and gastric ulcers were on nonsteroidal anti-inflammatory drugs (NSAIDs). There were 24 patients who had evidence of H. pylori infection and were on NSAIDs. H. pylori positive patients had more dyspeptic symptoms in comparison with those who were H. pylori negative. In patients who were taking NSAIDs, the presence of severe active gastritis seemed to correlate with the presence of H. pylori but not with the use of NSAIDs. Serology had a sensitivity of 90% and a specificity of 93% with a negative predictive value of 86%. There was a significant correlation between IgG titre and the degree of inflammation and H. pylori infection. We conclude that H. pylori gastritis is the commonest histopathological finding in elderly dyspeptic patients. H. pylori infection may be an important risk factor in elderly patients who take NSAIDs, increasing their risk of gastric ulcer. H. pylori serology in elderly people has a high sensitivity and specificity comparable with those in young age groups.

Association of protein kinase C activation with induction of ornithine decarboxylase in murine but not human keratinocyte cultures

The goal of this study was to compare the response of mouse epidermal keratinocytes (MEKs) and human epidermal keratinocytes (HEKs) to 12-O-tetradecanoylphorbol-13-acetate (TPA) with respect to the activation and downregulation of protein kinase C (PKC), the expression of c-jun and c-fos, and the expression and induction of ornithine decarboxylase (ODC) activity. Keratinocytes from adult CD-1 mice and from discarded adult human skin were grown in primary culture in a high-calcium serum-free medium that supported proliferation and differentiation. Immunoblotting of freshly isolated and cultured MEKs and HEKs for isozymes of protein kinase C revealed that fresh HEKs contained PKC alpha, PKC beta, and PKC delta; no PKC gamma, PKC epsilon, or PKC zeta were detected. In fresh MEKs, PKC alpha, PKC beta, PKC delta, and PKC zeta were observed, but not PKC gamma or PKC epsilon. After 2 wk in culture, the isozyme profiles of MEKs and HEKs were similar except that PKC gamma was noticeably present in HEK cultures. Activation of partially purified total PKC by TPA was similar in freshly isolated and cultured MEKs and HEKs, indicating that the two species were similar in this regard and that 2 wk of culture did not alter this characteristic. When MEK and HEK cultures were treated with TPA for 3 h, less than 30% of the control level of PKC activity was detected, indicating that TPA-induced downregulation of PKC was similar in MEKs and HEKs. After treatment with TPA, MEK cultures produced a large induction of both c-jun and c-fos mRNA by 60 min, as determined by northern blot analysis, and a large induction of ODC mRNA and enzyme activity by 6 h. TPA treatment of cultured HEKs, however, did not induce ODC activity; in fact, less activity, compared with that of control cultures, was observed. Northern blot analysis also revealed no increase in c-jun, c-fos, and ODC mRNA in HEKs. However, c-jun and c-fos mRNA and both ODC mRNA and enzyme activity were induced in HEKs fed growth factors after several days of deprivation. This suggests that the lack of ODC induction by TPA in HEKs is probably due to species differences in downstream steps in PKC signal transduction.

Developing National Guidelines for Nurse Practitioner Education: An Overview of the Product and the Process

In 1988, the National Organization of Nurse Practitioner Faculties appointed an ad hoc education committee (AHEC) to review existing nurse practitioner (NP) education curricula and to formulate national guidelines. An overview of the new NP guidelines are presented along with the philosophy, content, objectives, and competencies that are viewed as the foundation for NP education today. The guidelines are presented within the structure outlined in Brykczynski's (1985) research about NP practice. Thus, as a "product" of the Advanced Nursing Practice: Nurse Practitioner Curriculum Guidelines (NPCG), a new NP graduate for the 1990s could be described as one who demonstrates beginning competencies in primary health care theory and research within the five domains of practice identified by Brykczynski.

Ceftriaxone (Rocephin) in abdominal trauma

A prospective study was undertaken to evaluate the use of ceftriaxone in patients with abdominal trauma admitted to our hospital over a period of 6 months. Because of the large trauma load and an unacceptable waiting period before surgery combined with the fact that many patients on 6-hourly antibiotic regimes often did not receive their second and third doses, it was decided to use ceftriaxone because of its long half-life with maintenance of fluid and tissue concentrations for 24-48 hours. Because ceftriaxone is not reliably effective against anaerobic organisms such as Bacteroides fragilis, it was decided to add metronidazole as a combined initial dose. Two hundred ninety patients were entered in this trial, of which there were 259 stab wounds (89.3%), 20 missile injuries (6.9%), and 11 blunt injuries (3.8%). It was found that the mean delay between injury and initial dosage of ceftriaxone was 9.1 hours, with a range of 1-126 hours, and the mean delay between antibiotic therapy and operation 6.3 hours, with a range of 0-39 hours. The organs most frequently injured were the small bowel, the large bowel, the stomach, and the liver. Wound infection developed in only 4 patients (1.4%); intra-abdominal sepsis did not occur; and 35 patients (12%) developed respiratory infections. There were no deaths. We conclude that ceftriaxone, because of its 24-hour dosage was not only convenient but also adequate to prevent intra-abdominal sepsis and there was no difference in cost between this product and our previous protocol of 6-hourly antibiotic regime.