Detrimental conditions affecting Xestospongia muta across shallow and mesophotic coral reefs off the southwest coast of Puerto Rico

Sponges are fundamental components of coral reef communities and, unfortunately, like other major benthic members, they too have been impacted by epizootic and panzootic events. We report on the prevalence of disease-like conditions affecting populations of the giant barrel sponge Xestospongia muta across shallow and mesophotic coral reefs off La Parguera Natural Reserve (LPNR) and Mona Island Marine Reserve (MIMR) in Puerto Rico. Four different conditions affecting X. muta were observed during our surveys, of which 3 have been previously reported: cyclic spotted bleaching (CSB; apparently non-lethal), Xestospongia-tissue wasting disease (X-TWD; apparently lethal), and sponge orange band disease (SOB; sparsely associated with X-TWD infected individuals). Additionally, we describe a fourth condition, Xestospongia-tissue hardening condition (X-THC), a previously unreported disease recently observed along the insular shelf margin off LPNR and MIMR. Within LPNR, a total of 764 specimens of X. muta were inspected and measured. Of these, 590 sponges (72.2%) had CSB, 25 (3.27%) had signs of X-TWD, 7 (0.92%) had SOB, and the remaining 142 (18.6%) were apparently healthy. Three colonies inhabiting upper mesophotic depths on the LPNR insular shelf showed signs of CSB and X-TWD. At MIMR, video-transect surveys revealed a total of 514 colonies, of which 40 (7.78%) had signs of CSB and/or XTWD, 14 (2.72%) were affected by X-THC, while the remaining 460 (89.5%) showed no external signs of disease and appeared healthy. The presence of 4 concomitant disease-like conditions in barrel sponges of Puerto Rico is alarming, and indicative of the deteriorating status of Caribbean coral reefs.

ALT-803, an IL-15 superagonist, in combination with nivolumab in patients with metastatic non-small cell lung cancer: a non-randomised, open-label, phase 1b trial

BACKGROUND

Immunotherapy with PD-1 or PD-L1 blockade fails to induce a response in about 80% of patients with unselected non-small cell lung cancer (NSCLC), and many of those who do initially respond then develop resistance to treatment. Agonists that target the shared interleukin-2 (IL-2) and IL-15Rβγ pathway have induced complete and durable responses in some cancers, but no studies have been done to assess the safety or efficacy of these agonists in combination with anti-PD-1 immunotherapy. We aimed to define the safety, tolerability, and activity of this drug combination in patients with NSCLC.

METHODS

In this non-randomised, open-label, phase 1b trial, we enrolled patients (aged ≥18 years) with previously treated histologically or cytologically confirmed stage IIIB or IV NSCLC from three academic hospitals in the USA. Key eligibility criteria included measurable disease, eligibility to receive anti-PD-1 immunotherapy, and an Eastern Cooperative Oncology Group performance status of 0 or 1. Patients received the anti-PD-1 monoclonal antibody nivolumab intravenously at 3 mg/kg (then 240 mg when US Food and Drug Administration [FDA]-approved dosing changed) every 14 days (either as new treatment or continued treatment at the time of disease progression) and the IL-15 superagonist ALT-803 subcutaneously once per week on weeks 1-5 of four 6-week cycles for 6 months. ALT-803 was administered at one of four escalating dose concentrations: 6, 10, 15, or 20 μg/kg. The primary endpoint was to define safety and tolerability and to establish a recommended phase 2 dose of ALT-803 in combination with nivolumab. Analyses were per-protocol and included any patients who received at least one dose of study treatment. This trial is registered with ClinicalTrials.gov, number NCT02523469; phase 2 enrolment of patients is ongoing.

FINDINGS

Between Jan 18, 2016, and June 28, 2017, 23 patients were enrolled and 21 were treated at four dose levels of ALT-803 in combination with nivolumab. Two patients did not receive treatment because of the development of inter-current illness during enrolment, one patient due to leucopenia and one patient due to pulmonary dysfunction. No dose-limiting toxicities were recorded and the maximum tolerated dose was not reached. The most common adverse events were injection-site reactions (in 19 [90%] of 21 patients) and flu-like symptoms (15 [71%]). The most common grade 3 adverse events, occurring in two patients each, were lymphocytopenia and fatigue. A grade 3 myocardial infarction occurred in one patient. No grade 4 or 5 adverse events were recorded. The recommended phase 2 dose of ALT-803 is 20 μg/kg given once per week subcutaneously in combination with 240 mg intravenous nivolumab every 2 weeks.

INTERPRETATION

ALT-803 in combination with nivolumab can be safely administered in an outpatient setting. The promising clinical activity observed with the addition of ALT-803 to the regimen of patients with PD-1 monoclonal antibody relapsed and refractory disease shows evidence of anti-tumour activity for a new class of agents in NSCLC.

FUNDING

Altor BioScience (a NantWorks company), National Institutes of Health, and Medical University of South Carolina Hollings Cancer Center.

Renal cell carcinoma containing macroscopic fat on CT mimics an angiomyolipoma due to bone metaplasia without macroscopic calcification

We report a case of renal cell carcinoma (RCC) containing foci of macroscopic fat, which were pathologically proven to be areas of osseous metaplasia. The macroscopic fat was not associated with calcification on the pre-operative CT scan. To our knowledge, there are no reported cases of RCC that contain osseous metaplasia without evidence of macroscopic calcification on CT. The finding is significant because standard imaging practice is to classify a renal mass containing intratumoral macroscopic fat that is not associated with calcification, ossification or invasion of perirenal or hilar fat as an angiomyolipoma.

Bortezomib in combination with celecoxib in patients with advanced solid tumors: a phase I trial

Background

COX-2 inhibitors, such as celecoxib, and ubiquitin-proteasome pathway inhibitors, such as bortezomib, can down-regulate NF-κB, a transcription factor implicated in tumor growth. The objective of this study was to determine the maximum tolerated dose and dose-limiting toxicities of bortezomib in combination with celecoxib in patients with advanced solid tumors.

Methods

Patients received escalating doses of bortezomib either on a weekly schedule (days 1, 8, 15, 22, and 29 repeated every 42 days) or on a twice-weekly administration schedule (days 1, 4, 8, and 11 repeated every 21 days), in combination with escalating doses of celecoxib twice daily throughout the study period from 200 mg to 400 mg twice daily.

Results

No dose-limiting toxicity was observed during the study period. Two patients had stable disease lasting for four and five months each, and sixteen patients developed progressive disease.

Conclusion

The combination of bortezomib and celecoxib was well tolerated, without dose limiting toxicities observed throughout the dosing ranges tested, and will be studied further at the highest dose levels investigated.

Trial registration number

NCT00290680.

Lunx is a superior molecular marker for detection of non-small cell lung cancer in peripheral blood [corrected]

The clinical management of non-small cell lung cancer (NSCLC) would benefit greatly by a test that was able to detect small amounts of NSCLC in the peripheral blood. In this report, we used a novel strategy to enrich tumor cells from the peripheral blood of 24 stage I to IV NSCLC patients and determined expression levels for six cancer-associated genes (lunx, muc1, KS1/4, CEA, CK19, and PSE). Using thresholds established at three standard deviations above the mean observed in 15 normal controls, we observed that lunx (10 of 24, 42%), muc1 (5 of 24, 21%), and CK19 (5 of 24, 21%) were overexpressed in 14 of 24 (58%) peripheral blood samples obtained from NSCLC patients. Patients who overexpressed either KS1/4 (n = 2) or PSE (n = 1) also overexpressed either lunx or muc1. Of patients with presumed curable and resectable stage I to II disease (n = 7), at least one marker was overexpressed in three (43%) patients. In advanced stage III to IV patients (n = 17), at least one marker was overexpressed in 11 patients (65%). These results provide evidence that circulating tumor cells can be detected in NSCLC patients by a high throughput molecular technique. Further studies are needed to determine the clinical relevance of gene overexpression.

Tyrosine phosphorylation in human lymphomas

In a previous study, we showed that the high level of protein tyrosine phosphorylation present in lymphomas containing an anaplastic lymphoma kinase (ALK) can be demonstrated in routinely processed paraffin tissue sections using immunolabelling techniques. In the present study we investigated whether oncogenic tyrosine kinase activation also occurs in other categories of lymphoma by staining 145 cases of lymphoma covering those tumours with a range of different subtypes including those with morphological similarity to ALK-positive anaplastic large cell lymphoma (ALCL). Twelve cases of the borderline malignant disorder lymphomatoid papulosis were also studied. Twenty seven of the 28 cases of ALK-positive ALCL showed the extensive cytoplasmic labelling for phosphotyrosine in the neoplastic cells. The remaining case containing moesin-ALK exhibited membrane-associated phosphotyrosine expression. There was no nuclear phosphotyrosine labelling in any of the ALK-positive ALCL, even though ALK was present within the cell nuclei in 23 of the tumours. Variable degrees of phosphotyrosine labelling, usually membrane-restricted, were observed in 7/40 cases of ALK-negative ALCL, 9/29 cases of diffuse large B-cell lymphoma, 3/6 cases of mediastinal B-cell lymphoma, 2/7 cases of Hodgkin's lymphoma, 3/6 cases of peripheral T-cell lymphomas unspecified, 4/6 cases of B-cell chronic lymphocytic leukaemia, 2/6 cases of follicular lymphomas and 2/12 cases of lymphomatoid papulosis studied. However none of these phosphotyrosine-positive cases showed the strong cytoplasmic labelling comparable to that seen in ALK-positive lymphoma. We conclude that activation of a tyrosine kinase is probably not a major oncogenic event in lymphomas other than ALK-positive ALCL.

Lunx is a superior molecular marker for detection of non-small cell lung cancer in peripheral blood [corrected]

The clinical management of non-small cell lung cancer (NSCLC) would benefit greatly by a test that was able to detect small amounts of NSCLC in the peripheral blood. In this report, we used a novel strategy to enrich tumor cells from the peripheral blood of 24 stage I to IV NSCLC patients and determined expression levels for six cancer-associated genes (lunx, muc1, KS1/4, CEA, CK19, and PSE). Using thresholds established at three standard deviations above the mean observed in 15 normal controls, we observed that lunx (10 of 24, 42%), muc1 (5 of 24, 21%), and CK19 (5 of 24, 21%) were overexpressed in 14 of 24 (58%) peripheral blood samples obtained from NSCLC patients. Patients who overexpressed either KS1/4 (n = 2) or PSE (n = 1) also overexpressed either lunx or muc1. Of patients with presumed curable and resectable stage I to II disease (n = 7), at least one marker was overexpressed in three (43%) patients. In advanced stage III to IV patients (n = 17), at least one marker was overexpressed in 11 patients (65%). These results provide evidence that circulating tumor cells can be detected in NSCLC patients by a high throughput molecular technique. Further studies are needed to determine the clinical relevance of gene overexpression.

The role of radiotherapy and chemotherapy for curative management of medically inoperable and stage III nonsmall cell lung cancer, and radiotherapy for palliation of symptomatic disease

Radiotherapy has an expanding role in all phases of treatment of nonsmall cell lung cancer. Evolutions in technique, such as three-dimensional conformal radiotherapy, hold the promise for more effective treatment of patients with early stage disease who are not candidates for surgical intervention. Multimodality therapy for patients with locally advanced disease is evolving rapidly, with evidence accruing as to the optimal schedules and doses of radiotherapy and combination chemotherapy. Palliative dose schedules are being refined that maximize patient comfort while providing substantial symptom relief.

The predictive value of diagnostic imaging for histological lesions of the upper poles in duplex systems with ureteroceles

OBJECTIVE

To compare the diagnostic imaging findings with the histological lesions in upper pole nephrectomy (UPN) specimens of duplex system ureteroceles, using renal ultrasonography (US) and nuclear renal scintigraphy.

PATIENTS AND METHODS

Between 1992 and 2000, 86 patients with a ureterocele in a duplex system underwent surgery. The results from US were reviewed in 84 patients by a radiologist, for echogenicity, parenchymal thinning and hydronephrosis; 77 nuclear renal scans describing the differential function of the upper poles were also reviewed. Fifty-five patients underwent UPN (25 antenatal, 30 postnatal; 18 intravesical, 37 extravesical) and the specimens were available for independent review by a pathologist, describing five histological categories, i.e. chronic interstitial inflammation, fibrosis, tubular atrophy, glomerulosclerosis and dysplasia. Histological lesions were categorized as severe (> 25%) or minimal (<or= 25%). Radiological features and the histology of UPN were then analysed, and correlated using Fisher's exact test and multivariate analysis.

RESULTS

Severe histological lesions were reported in 38 specimens (69%) and minimal lesions in 17 UPN specimens (31%). Severe parenchymal thinning was associated with a severe pathological lesion (P < 0.02). There was no correlation with the echogenicity or degree of hydronephrosis. Dysplasia, found in 64% of specimens, did not correlate with increased echogenicity. Minimally functioning upper poles on nuclear renal scan (<or= 4% overall function) were significantly associated with severe histological lesions (P = 0.01). There was no correlation between diagnostic imaging features and the mode of presentation or type of ureterocele.

CONCLUSIONS

Multivariate analysis, severe parenchymal thinning on renal US and minimal function on nuclear renal scan can be used to predict the severity of histological lesions of the upper pole. These results may be helpful in the making therapeutic decisions for patients with ureteroceles in duplex systems.

Evaluation of the efficacy of lambda-cyhalothrin applied as ultra-low volume and thermal fog for emergency control of Aedes aegypti in Honduras

An extended-duration formulation of lambda-cyhalothrin (Demand CS) applied as either an ultra-low volume (ULV) or thermal fog spray from a new handheld sprayer (Terrier) against Aedes aegypti was evaluated in Honduras. Spray applications were made at the front door for 1 min or to each room for 15 sec, both for the ULV and thermal fog applications to houses in separate blocks for each treatment. The efficacy and duration of effectiveness of the spray was determined from sentinel caged mosquito mortality and collection of mosquitoes within houses with a backpack power aspirator. Sentinel caged mosquito mortality in both open and sequestered locations was 97-100% for all spray treatments, with control mortality less than 2%. Both ULV applications (front door and each room) provided 4 wk of significant control (P < 0.01) based on adult Ae. aegypti house collections.

Effects of withdrawal of inhaled steroids in men with severe irreversible airflow obstruction

Inhaled corticosteroid therapy has proven efficacy for asthmatics, but the benefit for patients with chronic obstructive pulmonary disease (COPD) is less well supported. We hypothesized that withdrawal of inhaled steroids in elderly patients with severe irreversible airway obstruction would not lead to a deterioration in respiratory function. We designed a prospective, double-blind, randomized, placebo-controlled, crossover study to follow spirometry, quality of life questionnaire, six-minute (6-min) walk test, and sputum markers of inflammation during a 6-wk placebo treatment period and a 6-wk treatment period with beclomethasone dipropionate (BDP), 336 microg/d. There were 24 men receiving BDP who entered the study; 15 completed the study. Their mean age was 66.9 +/- 1.9 yr, and mean FEV(1) was 1.61 +/- 0.1 L (47% of predicted). There was a significant decrease in the mean FEV(1 )while using the placebo inhaler (1.70 L versus 1.60 L, baseline versus placebo: 95% CI, 0.002 to 0.195; p < 0.05). There was a decrease in the mean percentage change in FEV(1) for the study subjects during the placebo treatment period as compared with the BDP treatment period (-6.28 versus 5.03%, placebo versus BDP: 95% CI, -23.38 to 0.76; p = 0.06). Six-minute walk test results and sputum analysis for cell count and differential were not significantly different during placebo and BDP treatment periods. Borg scale assessment of dyspnea after exercise was increased while using the placebo inhaler as compared with baseline, and decreased during the BDP treatment period. Chronic Respiratory Disease Questionnaire (CRQ) scores revealed no significant difference between placebo and BDP. This study has demonstrated that in elderly patients with severe irreversible airway obstruction, withdrawal of inhaled corticosteroid therapy leads to a deterioration in ventilatory function and increased exercise-induced dyspnea.

Visual expertise in the perception of action

Within the exercise and the sports sciences, various "expert observers" rely on visual assessments of movement. Strengths and limitations of unaided observation are outlined based on the biological motion perception literature and related work. The concepts of coordination, control, and action are used to propose an "action prototype" for pattern recognition.

Fossiliferous Lana'i deposits formed by multiple events rather than a single giant tsunami

Giant tsunamis, generated by submarine landslides in the Hawaiian Islands, have been thought to be responsible for the deposition of chaotic gravels high on the southern coastal slopes of the islands of Lana'i and Moloka'i, Hawaii. Here we investigate this hypothesis, using uranium-thorium dating of the Hulopoe gravel (on Lana'i) and a study of stratigraphic relationships, such as facies changes and hiatuses, within the deposit. The Hulopoe gravel contains corals of two age groups, representing marine isotope stages 5e and 7 (approximately 135,000 and 240,000 years ago, respectively), with significant geographical and stratigraphic ordering. We show that the Hulopoe gravel was formed by multiple depositional events, separated by considerable periods of time, thus invalidating the main premise of the 'giant wave' hypothesis. Instead, the gravels were probably deposited during interglacial periods (when sea level was relatively high) by typical Hawaiian shoreline processes such as seasonal wave patterns, storm events and possibly 'normal' tsunamis, and reached their present height by uplift of Lana'i.

Exercise and Children's Health: A Little Counseling Can Pay Lasting Dividends

Regular exercise is an important health maintenance strategy for children and adolescents: It facilitates weight control, helps strengthen bones, and can improve cardiovascular risk factors. Mental health may also benefit. An active childhood may also lay the groundwork for a lifetime of fitness. Physicians are in an important position to assess children's weight status and activity levels during a routine physical exam. And, with some simple recommendations to children and parents, they can play a key role in helping young patients find and maintain activities they enjoy, while keeping the risk of injury to a minimum.

Women's experience and satisfaction with emergency contraception

CONTEXT

If any new contraceptive technology is to become a viable option for decreasing unintended pregnancies, women must be willing to use the method and find it acceptable. However, because emergency contraceptive pills have not been widely used, very little is known about this method's acceptability.

METHODS

Telephone interviews were conducted with 235 women who had received emergency contraceptive pills through a demonstration project at 13 Kaiser Permanente medical offices in San Diego to assess women's experience and satisfaction with the pills.

RESULTS

More than two-thirds of the women (70%) were using a contraceptive method prior to their need for emergency contraception, and 73% of these users were relying on condoms. When asked about the situation that led to unprotected intercourse, 45% reported that their condom broke or slipped, while 23% said they had had unplanned sex. More than three-quarters of the sample (81%) experienced at least one side effect. The overwhelming majority were satisfied with emergency contraceptive pills (91%) and would recommend them to friends and family members (97%). Just one-quarter of the sample (28%) believed that emergency contraceptive pills should be dispensed over the counter, and an even lower proportion agreed that they should be available from vending machines (6%).

CONCLUSIONS

Because women were overwhelmingly accepting of emergency contraceptive pills, found them easy to use and did not intend to substitute them for regular contraceptive use, this new method is an important addition to the contraceptive options available to women, providing a way to prevent pregnancy after unprotected intercourse or method failure.

Exercise during pregnancy: safe and beneficial for most

Regular, moderate exercise does not significantly affect length of gestation or birth weight, and it may ease pregnancy and labor. Active pregnant women should maintain adequate hydration and nutrition, avoid hyperthermia, and take precautions if obstetric or medical complications are present. Supine exercise, contact sports, high-altitude exertion, and scuba diving should be avoided, and some women, including those who lift weights or do high-impact exercise, may need to modify their routines. Most women can begin or continue to exercise during pregnancy.

Mismatch repair gene defects contribute to the genetic basis of double primary cancers of the colorectum and endometrium

Hereditary non-polyposis colorectal cancer (HNPCC) is a dominantly inherited cancer syndrome caused by germline defects of mismatch repair (MMR) genes. Endometrial cancer is the most common extracolonic neoplasm in HNPCC and is the primary clinical manifestation of the syndrome in some families. The cumulative incidence of endometrial cancer among HNPCC mutation carriers is high, estimated to be from 22 to 43%. We hypothesized that women with double primary cancers of the colorectum and endometrium are likely to be members of HNPCC families. In order to determine how frequently HNPCC manifests in the context of double primary cancers, we examined alterations of two MMR genes, hMSH2 and hMLH1, in 40 unrelated women affected with double primary cancers. These cases were identified using hospital-based and population-based cancer registries in Ontario, Canada. MMR gene mutations were screened by single-strand conformation polymorphism analysis and confirmed by direct sequencing. Eighteen percent (seven of 40) were found to harbor mutations of one of the two MMR genes. Analysis of colorectal and/or endometrial tumors of mutation-negative probands found microsatellite instability in seven of 20 cases. Six of seven mutation-positive probands had strong family histories suggestive of HNPCC. First degree relatives of mutation-positive probands had a very high relative risk (RR) of colorectal cancer (RR = 8.1, CI 3. 5-15.9) and endometrial cancer (RR = 23.8, CI 6.4-61.0). The relative risk of mutation-negative cases was 2.8 (CI 1.7-4.5) for colorectal cancer and 5.4 (CI 2.0-11.7) for endometrial cancer. We recommend that all double primary patients with cancers at these sites should have a genetic evaluation, including molecular analysis for HNPCC where appropriate.

Exercising with diabetes: tips, strategies, and precautions

If you have diabetes, one of the best things you can do for yourself is to stay-or begin to be-active. A regular exercise program can help stabilize your blood sugar, reduce your need for insulin and medication, and keep your weight under control. Diabetes increases the risk of heart disease, but exercise can lower it. Best of all, exercise helps you get more out of life.

Exercise in diabetes management: maximizing benefits, controlling risks

Exercise is a recommended component of diabetes management. In both type 1 and type 2 diabetes mellitus, exercise can increase insulin sensitivity, lower blood glucose, and have positive psychological effects. More markedly in type 2 than in type 1, regular physical activity improves glycemic control, reduces hypertension, and normalizes lipids. Adjustments in insulin dosage, careful blood glucose monitoring, and attention to diet around the time of exercise will help prevent hypoglycemia and hyperglycemia, which are common hazards of exercise in type 1 diabetes. Special precautions are necessary for those who have diabetic complications such as retinopathy or peripheral neuropathy.

Exercise and the bottom line: promoting physical and fiscal fitness in the workplace: a commentary

One important way that physicians can promote regular exercise by patients is to encourage employers to establish exercise facilities and programs in the workplace. Physicians can also help design such programs. Employers who offer exercise opportunities may benefit from reduced healthcare costs, absenteeism, injury rates, and turnover and improved job performance, productivity, and morale.

Emergency contraception: preliminary report of a demonstration and evaluation project

Kaiser Permanente Southern California and the Pacific Institute for Women's Health began a demonstration and evaluation project on emergency contraceptive pills (ECPs) in the summer of 1996 with the goal of evaluating the feasibility and acceptability of ECPs in a large health maintenance organization and developing institutional templates, provider training and patient education materials that could be used to replicate the project. The ECP program had six components: repackaging of oral contraceptives in an ECP "kit," development of provider education materials, development of patient education materials, in-service training, making ECPs kits available in convenient locations, and development of materials to support replication of the project inside and outside Kaiser Permanente. Although data are still being analyzed, preliminary results are promising. The success of the project within this relatively conservative, but well-established medical care organization provides a model for others. The development of a standard set of educational materials and approaches to implementation should facilitate dispensing ECPs in other settings.

Exercise for midlife women

Exercise is good for everyone, but it's more important than ever when you reach midlife. While regular exercise may not eliminate symptoms like hot flushes, it can improve your general well-being and increase your strength and stamina in daily life. If you want to lose fat or maintain a healthy weight, exercise is far more effective than diet alone. A physically active lifestyle, along with good nutrition and estrogen therapy, will also help protect you against heart disease, overweight, and osteoporosis.

Malaria diagnosis by dipstick assay in a Honduran population with coendemic Plasmodium falciparum and Plasmodium vivax

A Plasmodium lactate dehydrogenase dipstick designed to separately detect P. falciparum and P. vivax malaria was evaluated in two Honduran populations where both species are endemic. The dipstick was compared to thick film microscopy; the polymerase chain reaction (PCR) was used to analyze discordant results. The dipstick had a sensitivity of 100% and a specificity of 95% compared with microscopy in the diagnosis of Plasmodium infections in a hospital population; the mean parasite density was approximately 590/mm3. In a field sample of mostly asymptomatic volunteers, the sensitivity of the dipstick for Plasmodium infection varied with parasite density. Additionally, the sensitivity and specificity of the dipstick was similar to thick film microscopy in the diagnosis of vivax malaria compared with the PCR. The dipstick was unable to detect P. vivax in the presence of P. falciparum because of cross-reactivity in the pan-specific band. Accurate species identification in mixed infections remains a problem in malaria diagnosis.

Exercise and menopause: a time for positive changes

Exercise may help control a number of physical and psychological problems and changes associated with menopause and midlife, including depression, weight gain, loss of muscle mass and bone density, the risk of coronary artery disease, and possibly vasomotor symptoms. The basic prescription of aerobic exercise (20 to 60 minutes 3 to 5 days per week) and strength training (2 to 3 days per week) should be adapted to the patient's medical condition, fitness level, motivation, experience, and preferences. Exercise effects can be supplemented by estrogen therapy, a low-fat diet, and adequate calcium and vitamin D intake.

Trial of a community-based intervention to decrease infestation of Aedes aegypti mosquitoes in cement washbasins in El Progreso, Honduras

Washbasins and metal drums are important sources of Aedes aegypti mosquitoes in much of Latin America. When manual cleaning was found to be ineffective in eliminating mosquito larvae in a community-based control programme in El Progreso, Honduras, it was decided to develop and evaluate an improved method of removing mosquito eggs based on commonly-available materials. The method, named La Untadita ('The Little Dab', in English), consists of five steps: mixing chlorine bleach and detergent to make a paste, applying the mixture to the walls of the container, waiting 10 min, scrubbing with a brush, and finally rinsing with water. A field trial of the Untadita was conducted in 13 peri-urban neighbourhoods. At the first post-intervention survey, in spite of high levels of exposure to the community-based intervention, high levels of knowledge regarding the Untadita and high levels of its reported use, little or no impact was discernable on mosquito larvae and pupae. The method was then modified by increasing the recommended quantities of bleach and detergent and simplifying the instructions. In the second post-intervention survey, knowledge of the steps and their order increased further; the intervention neighbourhoods had significantly fewer algae on washbasin walls, an indicator of more effective cleaning; and numbers of pupae and 3rd and 4th instar larvae were significantly lower than in untreated neighbourhoods. Effective promotion of the Untadita should be able to control mosquito infestation in many washbasins, especially those in frequent use, thus reducing the need for chemical and biological larvicides that may be either more costly or less acceptable to householders.

Exercise for asthma patients: little risk, big rewards

The standard exercise recommendation -20 to 30 minutes at 60% to 85% of maximum heart rate four or five times a week- should be part of asthma management. Not only will patients benefit in a general way, but improved fitness is likely to reduce airway reactivity and medication use. The capacity to exercise, however, requires good general control of asthma, including use of inhaled corticosteroids and avoidance of triggers. In addition, patients must be taught to prevent exercise-induced bronchoconstriction by using inhaled medications and strategies like avoiding cold-weather exercise.

Your guide to exercising with asthma

Years ago, everyone thought strenuous physical activity was dangerous if you had asthma, but now we know better. Exercise is not only safe if done properly, it's an integral part of treatment. Regular workouts will make you stronger and more energetic and reduce your risk of heart disease, diabetes, and other health problems. What's more, your asthma is likely to improve. Studies have shown that physically fit people have fewer attacks, need less medication, and lose less time from work or school.

Development of an indicator to evaluate the impact, on a community-based Aedes aegypti control intervention, of improved cleaning of water-storage containers by householders

Householders in a community-based programme to control dengue in El Progreso, Honduras, are being encouraged to improve the cleaning of the water-storage containers in which many of the vectors thrive. The objective of the present study was to develop an indicator of the change occurring in human behaviour. Traditional Aedes aegypti larval indices do not differentiate between containers in which all the immature stages are present and those which hold only first- and second-instar larvae. However, it is not essential to prevent all larval development to limit transmission of pathogens by the adults; if the Ae. aegypti in the containers only manage to develop to young larvae before the containers are cleaned, then control of the vector in these containers will be effective. In field trials, sampling of third- and fourth-instar larvae in washbasins by taking five dips (quick immersions to a standard depth) with a hand-held net was found to be sufficient for estimating the true population size of that same cohort. This sampling method was then included in a large-scale survey of households, conducted for programme monitoring. An index was then developed as a summary measure of the degree of infestation of a washbasin by Ae. aegypti. This index was the sum of four variables assessed in the survey: presence of any immature stages (larvae and/or pupae); presence of pupae; detection of third-fourth-instar larvae in a five-dip sample; and a log-transformation of the number of larvae recovered. Based on this new index, the 884 washbasins encountered in the survey were classified as infestation-free (76.2%), or with low-(6.7%), medium-(14.9%) or high-level (2.2%) infestation. Application of the same procedure to 240 drums encountered in the survey showed that 66.3% were infestation-free and 9.2%, 17.1% and 7.4% had low-, medium- and high-level infestations, respectively. Compared with the traditional indices, this new index should be more sensitive to changes in human behaviour resulting from a control programme exposure than a simple, dichotomous variable (i.e. positive/negative for presence of immature stages). The use of such an index could make the control programme more efficient, allowing the greatest efforts to be targeted at households that have medium-high levels of infestation.

Low-pressure workouts for hypertension

Regular exercise is a central part of your program for controlling hypertension (high blood pressure). For most people who have hypertension, a few sessions of moderate physical activity each week will reduce blood pressure significantly and lower the risk of stroke and heart attack. If your blood pressure is just mildly elevated, exercise (along with a healthy diet and lifestyle) may be enough to bring it down to normal. If you need medication, exercise probably will make it more effective, and possibly allow you to take a lower dose.

Active control of hypertension

Hypertension is common, and even slight elevations in blood pressure can be associated with health risks. Regular aerobic exercise helps prevent hypertension. In patients who already have hypertension, such exercise has been shown to lower systolic and diastolic blood pressure by a mean of 10 mm Hg. For mild or labile hypertension, lifestyle modification that includes at least a half hour of moderate aerobic exercise at least 3 days a week should be tried before using drug therapy. If medication is needed, one that is not likely to impede the patient's ability to exercise should be considered.

La Untadita: a procedure for maintaining washbasins and drums free of Aedes aegypti based on modification of existing practices

Chlorine bleach and detergent are routinely used by householders in El Progreso, Honduras in the process of cleaning washbasins and drums, the two most important larval habitats of Aedes aegypti in the city. The efficacy of these materials in eliminating eggs, larvae, and pupae of Ae. aegypti was assessed under controlled conditions. The promising results obtained led to trials using a combination of chlorine bleach and detergent to apply to the walls of washbasins and drums as a method for eliminating eggs. The bleach maintained its ovicidal properties when mixed with detergent, and the detergent gave the mixture consistency so that it could be applied as a thin film to the walls. This new procedure was named the little dab (Untadita in Spanish) and allows households to direct their efforts against a stage of the mosquito life cycle that has been ignored in the past: the egg.

Osteoporosis: the role of exercise in optimal management

Physical activity promotes increases in bone mineral density or reductions in bone loss in young, premenopausal, and postmenopausal women, making exercise a key strategy for preventing and treating osteoporosis. Alongside weight-bearing exercise and resistance training, treatment may also include therapy with estrogen, alendronate, or calcitonin, adequate calcium and vitamin D intake, and measures to prevent falls.

Exercise for osteoporosis

For patients who have osteoporosis, exercise is an essential part of treatment. Just as regular workouts build muscle, they also maintain and may even increase bone strength. By strengthening your muscles and bones and improving your balance, exercise can reduce the risk of falls and resulting fractures. Exercise works well with estrogen or other medications that increase bone density and strength. Exercise, medication, and proper diet combat osteoporosis more effectively together than any one treatment alone could do. Remember that you're never too old to exercise.