Large nipple areolar complex angiofibroma treated with combined surgical debulking and carbon dioxide laser therapy - a case report

Here, we describe single case review of a 14-year-old female who presented with an angiofibroma on the right nipple areolar complex, which was treated successfully with debulking and CO₂ laser. After 8 months of follow up, there has still been no recurrence of disease.

Glucocorticoids improve calcium cycling in cardiac myocytes after cardiopulmonary bypass

BACKGROUND

Glucocorticoids can reduce myocardial dysfunction associated with ischemia and reperfusion injury following cardiopulmonary bypass (CPB) and circulatory arrest. The hypothesis was that maintenance of cardiac function after CPB with methylprednisolone therapy results, in part, from preservation of myocyte calcium cycling.

METHODS

Piglets (5-7 kg) underwent CPB and 120 min of hypothermic circulatory arrest with (CPB-GC) or without (CPB) methylprednisolone (30 mgkg(-1)) administered 6h before and at CPB. Controls (No-CPB) did not undergo CPB or receive glucocorticoids (n=6 per treatment). Myocardial function was monitored in vivo for 120 min after CPB. Calcium cycling was analyzed using rapid line-scan confocal microscopy in isolated, fluo-3-AM-loaded cardiac myocytes. Phospholamban phosphorylation and sarco(endo)plasmic reticulum calcium-ATPase (SERCA2a) protein levels were determined by immunoblotting of myocardium collected 120 min after CPB. Calpain activation in myocardium was measured by fluorometric assay.

RESULTS

Preload recruitable stroke work in vivo 120 min after reperfusion decreased from baseline in CPB (47.4±12 versus 26.4±8.3 slope of the regression line, P<0.05), but was not different in CPB-GC (41±8.1 versus 37.6±2.2, P=0.7). In myocytes isolated from piglets, total calcium transient time remained unaltered in CPB-GC (368±52.5 ms) compared with controls (434.5±35.3 ms; P=0.07), but was prolonged in CPB myocytes (632±83.4 ms; P<0.01). Calcium transient amplitude was blunted in myocytes from CPB (757±168 nM) compared with controls (1127±126 nM, P<0.05) but was maintained in CPB-GC (1021±155 nM, P>0.05). Activation of calpain after CPB was reduced with glucocorticoids. Phospholamban phosphorylation and SERCA2a protein levels in myocardium were decreased in CPB compared with No-CPB and CPB-GC (P<0.05).

CONCLUSIONS

The glucocorticoid-mediated improvement in myocardial function after CPB might be due, in part, to prevention of calpain activation and maintenance of cardiac myocyte calcium cycling.

Aerobic Exercise Adaptations in Trained Adolescent Runners Following a Season of Cross-country Training

Adaptations in aerobic exercise responses as well as the relationship between aerobic exercise responses and running performance were examined in a group of previously trained adolescent runners (n = 9; 15.9 +/- 1.0 years) over the course of a competitive cross-country season. Running economy (RE), submaximal blood lactate concentration [BLa] and VO2max were assessed before and immediately after the season. Five-km race time improved (P < 0.05) from 18.68 +/- 1.10 min at the beginning of the season to 18.16 +/- 1.11 min at the end of the season. Significant increases were observed in peak VO2 (61.6 +/- 3.5 to 65.3 +/- 2.9 mL x kg(-1) x min(-1)) and graded exercise test time (11.32 +/- 1.56 to 12.22 +/- 0.79 min). There was a tendency for RE (P = 0.051) to worsen slightly and for [BLa] (P = 0. 057) to decline as a result of training. At the beginning of the season submaximal [BLa] at 14 km x hr(-1) (r = 0.86) and graded exercise test time (r = -0.87) were significantly related to 5-km time. At the end of the season, RE (r = 0.78) and [BLa] (r = 0.77) at 14 km x hr(-1) and graded exercise test time (r = -0.69) were significantly related to race time. In this well-trained group of runners, further training during the cross-country season increased peak VO2 and improved race time. Submaximal [BLa] and graded exercise test time appear to be the most robust predictors of performance, while RE became a significant predictor of race time at the end of the season.

Impaired intracellular Ca2+ dynamics in live cardiomyocytes revealed by rapid line scan confocal microscopy

Altered intracellular Ca2+ dynamics are characteristically observed in cardiomyocytes from failing hearts. Studies of Ca2+ handling in myocytes predominantly use Fluo-3 AM, a visible light excitable Ca2+ chelating fluorescent dye in conjunction with rapid line-scanning confocal microscopy. However, Fluo-3 AM does not allow for traditional ratiometric determination of intracellular Ca2+ concentration and has required the use of mathematic correction factors with values obtained from separate procedures to convert Fluo-3 AM fluorescence to appropriate Ca2+ concentrations. This study describes methodology to directly measure intracellular Ca2+ levels using inactivated, Fluo-3-AM-loaded cardiomyocytes equilibrated with Ca2+ concentration standards. Titration of Ca2+ concentration exhibits a linear relationship to increasing Fluo-3 AM fluorescence intensity. Images obtained from individual myocyte confocal scans were recorded, average pixel intensity values were calculated, and a plot is generated relating the average pixel intensity to known Ca2+ concentrations. These standard plots can be used to convert transient Ca2+ fluorescence obtained with experimental cells to Ca2+ concentrations by linear regression analysis. Standards are determined on the same microscope used for acquisition of unknown Ca2+ concentrations, simplifying data interpretation and assuring accuracy of conversion values. This procedure eliminates additional equipment, ratiometric imaging, and mathematic correction factors and should be useful to investigators requiring a straightforward method for measuring Ca2+ concentrations in live cells using Ca2+-chelating dyes exhibiting variable fluorescence intensity.

Intracellular Ca2+ measurements in live cells by rapid line scan confocal microscopy: simplified calibration methodology

Altered intracellular Ca2+ dynamics are characteristically observed in cardiomyocytes from failing hearts. Studies of Ca2+ handling in myocytes predominantly use Fluo-3 AM, a visible light excitable Ca2+ chelating fluorescent dye in conjunction with rapid line-scanning confocal microscopy. However, Fluo-3 AM does not allow for traditional ratiometric determination of intracellular Ca2+ concentration and has required use of mathematic correction factors with values obtained from separate procedures to convert Fluo-3 AM fluorescence to appropriate CA2+ concentrations. This study describes methodology to directly measure intracellular Ca2+ levels using inactivated, Fluo-3 AM loaded cardiomyocytes equilibrated with Ca2+ concentration standards. Titration of Ca2+ concentration exhibits a linear relationship to increasing Fluo-3 AM fluorescence intensity. Images obtained from individual myocyte confocal scans were recorded, average pixel intensity values were calculated, and a plot is generated relating the average pixel intensity to known Ca2+ concentrations. These standard plots can be used to convert transient Ca2+ fluorescence obtained with experimental cells to Ca2+ concentrations by linear regression analysis. Standards are determined on the same microscope used for acquisition of unknown Ca2+ concentrations, simplifying data interpretaton and assuring accuracy of conversion values. This procedure eliminates additional equipment, ratiometric imaging, and mathematic correction factors and should be used to investigators requiring a straightforward method for measuring Ca2+ concentrations in live cells using Ca2+-chelating dyes exhibiting variable fluorescence intensity.

Running performance in middle-school runners

AIM

This study examined the relationship of 3-km run time to indices of aerobic and anaerobic ability in 9 male runners (13.4+/-0.6 years, mean+/-SD).

METHODS

Anthropometric measurements were made, and an exercise test to determine running economy at 187 m x min(-1) and (.-)VO(2max) were assessed on a treadmill. On a separate day, 2 55-m sprints followed by a 3-km run were performed on a 200-m indoor track. Capillary blood samples were obtained from a finger tip immediately after the run to determine blood lactate level. Fractional utilization (%(.-)VO(2max) used during the 3-km run) was calculated. Correlations were used to examine the relationship between run time and the physiological measurements.

RESULTS

Mean values for (.-)VO(2), HR and RER at maximal exercise were 61.7+/-4.4 ml x kg(-1)xmin(-1), 198.9+/-6.7 b x min(-1), and 1.16+/-0.04, respectively. The average time to run 3 km was 13.27+/-0.97 min (90.1+/-7.2% of (.-)VO(2max)). Post-run blood lactate level was 8.3+/-3.2 mmol x L(-1) and was significantly related (r=-0.73, p=0.02) to 3-km time. Fractional utilization tended to be related (r=-0.56, p=0.12) to time.

CONCLUSIONS

In this age group the ability to run at a high percentage of (.-)VO(2max) and tolerate a high blood lactate appear to be important determinants of running performance in young male runners.

Calcineurin/NFAT coupling participates in pathological, but not physiological, cardiac hypertrophy

Calcineurin (PP2B) is a calcium/calmodulin-activated, serine-threonine phosphatase that transmits signals to the nucleus through the dephosphorylation and translocation of nuclear factor of activated T cell (NFAT) transcription factors. Whereas calcineurin-NFAT signaling has been implicated in regulating the hypertrophic growth of the myocardium, considerable controversy persists as to its role in maintaining versus initiating hypertrophy, its role in pathological versus physiological hypertrophy, and its role in heart failure. To address these issues, NFAT-luciferase reporter transgenic mice were generated and characterized. These mice showed robust and calcineurin-specific activation in the heart that was inhibited with cyclosporin A. In the adult heart, NFAT-luciferase activity was upregulated in a delayed, but sustained manner throughout eight weeks of pathological cardiac hypertrophy induced by pressure-overload, or more dramatically following myocardial infarction-induced heart failure. In contrast, physiological hypertrophy as produced in two separate models of exercise training failed to show significant calcineurin-NFAT coupling in the heart at multiple time points, despite measurable increases in heart to body weight ratios. Moreover, stimulation of hypertrophy with growth hormone-insulin-like growth factor-1 (GH-IGF-1) failed to activate calcineurin-NFAT signaling in the heart or in culture, despite hypertrophy, activation of Akt, and activation of p70 S6K. Calcineurin Abeta gene-targeted mice also showed a normal hypertrophic response after GH-IGF-1 infusion. Lastly, exercise- or GH-IGF-1-induced cardiac growth failed to show induction of hypertrophic marker gene expression compared with pressure-overloaded animals. Although a direct cause-and-effect relationship between NFAT-luciferase activity and pathological hypertrophy was not proven here, our results support the hypothesis that separable signaling pathways regulate pathological versus physiological hypertrophic growth of the myocardium, with calcineurin-NFAT potentially serving a regulatory role that is more specialized for maladaptive hypertrophy and heart failure.

Calcium dynamics in the failing heart: restoration by beta-adrenergic receptor blockade

Changes in calcium (Ca2+) regulation contribute to loss of contractile function in dilated cardiomyopathy. Clinical treatment using beta-adrenergic receptor antagonists (beta-blockers) slows deterioration of cardiac function in end-stage heart failure patients; however, the effects of beta-blocker treatment on Ca2+ dynamics in the failing heart are unknown. To address this issue, tropomodulin-overexpressing transgenic (TOT) mice, which suffer from dilated cardiomyopathy, were treated with a nonselective beta-receptor blocker (5 mg. kg-1. day-1 propranolol) for 2 wk. Ca2+ dynamics in isolated cardiomyocytes of TOT mice significantly improved after treatment compared with untreated TOT mice. Frequency-dependent diastolic and Ca2+ transient amplitudes were returned to normal in propranolol-treated TOT mice and but not in untreated TOT mice. Ca2+ kinetic measurements of time to peak and time decay of the caffeine-induced Ca2+ transient to 50% relaxation were also normalized. Immunoblot analysis of untreated TOT heart samples showed a 3.6-fold reduction of sarco(endo)plasmic reticulum Ca2+-ATPase (SERCA), whereas Na+/Ca2+ exchanger (NCX) concentrations were increased 2.6-fold relative to nontransgenic samples. Propranolol treatment of TOT mice reversed the alterations in SERCA and NCX protein levels but not potassium channels. Although restoration of Ca2+ dynamics occurred within 2 wk of beta-blockade treatment, evidence of functional improvement in cardiac contractility assessed by echocardiography took 10 wk to materialize. These results demonstrate that beta-adrenergic blockade restores Ca2+ dynamics and normalizes expression of Ca2+-handling proteins, eventually leading to improved hemodynamic function in cardiomyopathic hearts.

The influence of exercise test protocol on perceived exertion at submaximal exercise intensities in children

This study examined ratings of perceived exertion (RPE) using Borg's 6-20 scale at 50 W, 80 W, and ventilatory threshold (VT) in 10-year-old children (n = 15) during two different graded exercise tests. Power output was increased by 10 W.min(-1) in one protocol and by 30 W.3 min(-1) in the other. The cardiorespiratory responses at VT and peak exercise were similar between protocols. At 50 W and 80 W the cardiorespiratory responses were generally lower (P < 0.05) in the 10W trial. However, RPE was 11.5 +/- 2.9 and 12.1 +/- 3.2 at 50 W and 15.1 +/- 2.7 and 15.3 +/- 2.8 at 80 W in the 10-W and 30-W trials, respectively (P > 0.05). The RPE at VT was 13.9 +/- 2.4 in the 10-W trial and 12.4 +/- 2.4 in the 30-W trial (P < 0.05). In that variations in submaximal RPE did not coincide with variations in central mediators of exertion, locals cues of exertion may have provided the dominate sensory signal.

Attainment of maximal exercise criteria in boys and men

BACKGROUND

This study tested the hypothesis that the occurrence of a VO(2) plateau at maximal exercise would be greater in men versus boys. Secondary indicators of maximal effort also were examined.

METHODS

Sixteen boys (10.7+/-0.6 yrs) and 21 men (22.5+/-2.0 yrs) performed a graded exercise test on a treadmill at a constant speed of 8.04 km x hr(-1) with 2.5% increments in elevation. The men also performed a second test at 11.26 km x hr(-1) with similar increases in slope.

RESULTS

At 8.04 km x hr(-1) , VO(2) max was 52.3+/-6.0 and 52.5+/-5.1 ml x kg(-1) x min(-1) in boys and men, respectively (p>0.05). In the men, VO(2) max (53.3+/-5.4 ml x kg(-1) x min(-1) ) was higher (p<0.05) in the faster protocol. The percentage of men achieving the criterion was nearly double the percentage of boys (23.8 vs 12.5%), although the difference was not significant. Age-specific criteria heart rate (HR) and respiratory exchange ratio (RER) were achieved in a similar manner; however, more men (100%) than boys (86.7%) achieved an age-specific blood lactate (BLa) criterion (p<0.05). Plateau achievement increased to 33.0% in the 11.26 km x hr(-1) protocol, but was not significantly different from 8.04 km x hr(-1). HR, RER and BLa criteria achievement were comparable.

CONCLUSIONS

Maturation may influence the achievement of a plateau and BLa criteria, but not age-specific criteria for RER or HR.

The research nurse role in a clinic-based oncology research setting

Public demand and government support for evaluating new cancer drugs and methods in a more timely manner have significantly affected clinical research programs. To meet these demands, it is critical to have research personnel with an appropriate skill mix to ensure that clinical trials are conducted safely and effectively, while scientific integrity is maintained. This article describes the development and integration of the research nurse role within an oncology research program in a large outpatient oncology clinic. Methods for evaluating the research nurse role included literature review, analysis of job descriptions, and dialogue with research staff, oncology staff, and a clinical nurse specialist. A Review of the Nurse Practice Act of Wisconsin and the Oncology Nursing Society standards provided license and practice standards. Similarities and differences between the roles of the research nurse and the chemotherapy nurse are analyzed. Complementary roles and functions are identified, and areas of role overlap are defined. This report expands the limited current literature regarding this subject. The findings provide the reader with a framework for evaluating the roles of registered nurse personnel in a clinical setting. Although each institution has unique characteristics or research needs, the method used to address the reported program is transferable.

Framing treatment options: a method to enhance informed consent

Advanced practice nurses are challenged with counseling and providing information to clients about treatment options during the informed consent process. In the clinical area of oncology, clients are faced with choosing treatment options that are undesirable or affect quality and quantity of life directly. Framing as a nursing intervention to assist advanced practice nurses during the informed consent process is explored in this article. Framing provides a method to present information from different vantage points and perspectives with a focus on the client's values and perceptions of quality of life. Parse's man-living-health theory is used to guide nursing practice. Quality of life is addressed with an assessment tool by Ferrans. The use of framing to present treatment options from the client's perspective of health and quality of life, as well as from the biomedical and nursing perspectives, can result in a consent that is truly informed.

Evaluation of speech following prosthetic obturation of surgically acquired maxillary defects

The speech intelligibility of patients who have undergone partial surgical resection of the maxilla was investigated. The intelligibility characteristics of connected discourse in each patient were compared under three experimental conditions: presurgical, postsurgical with immediate prosthetic obturation, and postsurgical with definitive prosthetic obturation. The ability of untrained listeners to differentiate between presurgical speech and postsurgical speech following definitive prosthetic treatment was also studied. Each subject recorded a standard passage of connected discourse, the Rainbow Passage, under the three conditions stated above. Each of the 24 recordings was then segmented into 23 phrases and presented over earphones to listeners. A group of 10 listeners evaluated each recording, or a total of 240 listeners was used. The recordings were graded by the number of words correctly written. Analysis of variance showed no significant loss in intelligibility across the three conditions. A group of 50 listeners than evaluated sentence pairs containing samples of presurgical speech and speech produced following surgery and definitive prosthetic obturation. Their task was to judge whether there was a difference between the two speech samples. This was done in a classroom over loudspeakers. Sign-test procedures revealed that listeners could differentiate presurgical speech samples from postsurgical speech with definitive prosthetic obturation in four of the eight patients studied.