Postvaccination Symptoms After a Fourth Dose of mRNA SARS-CoV-2 Vaccination in Patients With Inflammatory Bowel Disease

Overall, 1933 participants with IBD completed at least 1 questionnaire regarding postvaccination symptoms after administration of each of the 4 mRNA SARS-CoV-2 vaccine doses. Symptoms after a fourth mRNA vaccine are less frequent and generally milder than after previous doses.

Effects of a recovery swim on subsequent running performance

The effects of a swimming-based recovery session implemented 10 h post high intensity interval running on subsequent run performance the next day was investigated. Nine well trained triathletes performed two high intensity interval running sessions (HIIS) (8x3 min at 85-90% VO(2peak) velocity), followed 10 h later by either a swim recovery session (SRS) (20x100 m at 90% of 1 km time trial speed), or a passive recovery session (PRS). Subsequently, a time to fatigue run (TTF) was completed 24 h post-HIIS. Venous blood samples were taken pre-HIIS and pre-TTF to determine the levels of circulating C-Reactive Protein (CRP). Subjects were also asked to rate their perceived recovery prior to commencing the TTF run. The SRS resulted in a significantly longer (830+/-198 s) TTF as compared to PRS (728+/-183 s) ( P=0.005). There was also a significant percentage change from baseline in the CRP levels 24 h post-HIIS (SRS=-23%, PRS=+/-5%, P=0.007). There were no significant differences in perceived recovery between two conditions ( P=0.40) . The findings of the present study showed that a swimming-based recovery session enhanced following day exercise performance, possibly due to the hydrostatic properties of water and its associated influence on inflammation.

Physiologic and anatomic assessment of a canine carotid artery stenosis model utilizing phase contrast with vastly undersampled isotropic projection imaging

BACKGROUND AND PURPOSE

Noninvasive assessment of the hemodynamic significance of carotid stenosis is often performed with MR angiography and supplemented with carotid Doppler sonography. Phase contrast with vastly undersampled isotropic projection reconstruction (PC-VIPR), a novel MR imaging technique, accelerates phase-contrast MR flow imaging and provides both images of the vessels and measurements of blood-flow velocities. For this study, we determined the accuracy of PC-VIPR blood-flow velocity measurements to determine pressure gradients across an experimental carotid stenosis.

MATERIALS AND METHODS

A focal stenosis was surgically created in each common carotid artery of 6 canines. Digital subtraction angiography (DSA) was performed, and the degree of stenosis was determined using the North American Symptomatic Carotid Endarterectomy Trial methodology. A microcatheter was positioned in the carotid artery proximal and distal to the stenosis, and pressures were measured in the vessel through the catheter. PC-VIPR was then performed on a 1.5T MR imaging scanner with parameters producing 0.8-mm isotropic voxel resolution. From the velocity measurements, pressure gradients were calculated from the Navier-Stokes relationship to compare with the pressures measured by a catheter.

RESULTS

Carotid stenoses in the 50%-85% range were produced in the 12 arteries. Pressure gradients across the stenoses ranged from 6 to 26 mm Hg. The pressure gradient calculated from the PC-VIPR data correlated (r = 0.91, P < .0001) with the actual pressure measurements.

CONCLUSION

With PC-VIPR, a novel MR imaging technique, the hemodynamic effect of a stenosis on flow and pressure can be evaluated.

Extended flexible sigmoidoscopy performed by colonoscopists for colorectal cancer screening: a pilot study

BACKGROUND

Caecal intubation can be achieved by extended flexible sigmoidoscopy in 32% of patients.

AIM

To assess the feasibility of extended flexible sigmoidoscopy performed by colonoscopists for colorectal cancer screening.

METHODS

We enrolled 41 patients referred for screening flexible sigmoidoscopy. After purging, examination was performed with a colonoscope. All patients completed sigmoidoscopy (success in meeting referral goal); 93% and 71% had examination to the transverse or ascending colon, and caecum, respectively. Overall yield and right-sided polyps was 56% and 27%, respectively. Caecal intubation and complete examination with polypectomy took 6.0 +/- 2.5 and 18.3 +/- 5.1 min, respectively; with no complications. Twelve patients requested colonoscope withdrawal because of discomfort. Although 46% reported moderate to severe discomfort, 39% and 36%, respectively, were definitely or probably willing to repeat flexible sigmoidoscopy.

RESULTS

Unsedated colonoscopy introduced as extended flexible sigmoidoscopy emphasizes the benefits of added yield rather than the negative image of withholding of discomfort relief. The patient can choose to accept the equivalent of an unsedated colonoscopy or reject the option based on perceived discomfort during extended flexible sigmoidoscopy performed by the colonoscopist.

CONCLUSION

Extended flexible sigmoidoscopy is a feasible option in carefully selected patients, fully prepared and by an experienced colonoscopist.

1. Positron Emission Tomography of Thoracic Malignancies. Reduction of Myocardial Fluorodeoxyglucose Uptake Artifacts With a Carbohydrate Restricted Diet

Purpose: To reduce the artifact caused by cardiac uptake of F-18 fluorodeoxyglucose (FDG); we investigated the change in myocardial FDG uptake after placing a group of patients on a carbohydrate-restricted diet.Methods: Case control study involving 130 whole body FDG PET scans. 73 scans were of patients on carbohydrate-restriction; the remaining 57 were without dietary restrictions. Dietary intake for the last meal prior to scanning was recorded for both groups. Coronal and axial images were assessed and scored based on myocardial FDG uptake the presence of associated image artifacts.Results: Of the 73 patients on the diet, 50 did not consume carbohydrates, while of the 57 patients without dietary restriction, 13 did not consume carbohydrates. Of the 67 patients from both groups who consumed carbohydrates prior to their PET scan, 17 (25.4%) had a clinically significant image artifact versus only 6 (9.5%) of the 63 patients who did not consume carbohydrates (P = 0.018) in their meals prior to scanning. The odds ratio was calculated to be 3.23 (confidence interval 1.09-10.00), indicating that the risk a clinically significant image artifact will occur is 3.23 times higher for patients who consume carbohydrates in their last meal prior to scanning.Conclusion: A substantial reduction in the prevalence of myocardial FDG uptake image artifacts among patients who did not consume carbohydrates was observed. A carbohydrate dietary restriction prior to scanning may play a significant role in increasing lesion detectability and in preventing false negative scans when imaging for thoracic neoplasm.

Murine CD1d-restricted T cell recognition of cellular lipids

NKT cells are associated with immunological control of autoimmune disease and cancer and can recognize cell surface mCD1d without addition of exogenous antigens. Cellular antigens presented by mCD1d have not been identified, although NKT cells can recognize a synthetic glycolipid, alpha-GalCer. Here we show that after addition of a lipid extract from a tumor cell line, plate-bound mCD1d molecules stimulated an NKT cell hybridoma. This hybridoma also responded strongly to three purified phospholipids, but failed to recognize alpha-GalCer. Seven of sixteen other mCD1d restricted hybridomas also showed a response to certain purified phospholipids. These findings suggest NKT cells can recognize cellular antigens distinct from alpha-GalCer and identify phospholipids as potential self-antigens presented by mCD1d.

Razor blade surgery: use of the Castroviejo blade breaker and holder

BACKGROUND

To remove skin lesions, many dermatologists use the razor blade which may be manipulated with or without the aid of an instrument. However, the techniques previously described employ the use of an entire razor blade.

OBJECTIVE

To outline a technique that is easily performed with better control of the blade and with more precise cutting than by holding the blade by hand. This report reviews the merits of razor blade use in cutaneous surgery as well as the advantages of using the Castroviejo razor blade breaker.

METHODS

The method for cutting double-edged razor blades and holding the sections with a Castroviejo blade breaker is described as well as a basic guide for selecting blade size for performing shave biopsies and shave excisions.

CONCLUSIONS

Using the Castroviejo razor blade breaker and holder with cut razor blades is safe and allows better control and more precise cutting than using a complete double-edged blade alone.

Dominant enhancers of Egfr in Drosophila melanogaster: genetic links between the Notch and Egfr signaling pathways

The Drosophila epidermal growth factor receptor (EGFR) is a key component of a complex signaling pathway that participates in multiple developmental processes. We have performed an F1 screen for mutations that cause dominant enhancement of wing vein phenotypes associated with mutations in Egfr. With this screen, we have recovered mutations in Hairless (H), vein, groucho (gro), and three apparently novel loci. All of the E(Egfr)s we have identified show dominant interactions in transheterozygous combinations with each other and with alleles of N or Su(H), suggesting that they are involved in cross-talk between the N and EGFR signaling pathways. Further examination of the phenotypic interactions between Egfr, H, and gro revealed that reductions in Egfr activity enhanced both the bristle loss associated with H mutations, and the bristle hyperplasia and ocellar hypertrophy associated with gro mutations. Double mutant combinations of Egfr and gro hypomorphic alleles led to the formation of ectopic compound eyes in a dosage sensitive manner. Our findings suggest that these E(Egfr)s represent links between the Egfr and Notch signaling pathways, and that Egfr activity can either promote or suppress Notch signaling, depending on its developmental context.

Graphing health status can help pinpoint patient problems

Diagnosing the cause of a patient's complaints by reviewing physical symptoms alone may overlook indicators of psychological and emotional problems that need to be considered. A health status assessment (see "Health Status Assessment--A Vital Sign for Planning Patient Therapy," pages 2-9) using the Health Status Questionnaire enables a clinician to rapidly sort through the bases of presenting symptoms in physical and psychological terms. After a patient fills out the form, the data are input into a computer, which translates the results into a graph. The physician and patient then use the graph to review the results and develop a plan of therapy. The scenario below demonstrates use of the graph by Northfield, Minn., family practitioner Donald Lum, M.D., along with a standardized, scripted interpretation-and-questions process developed by Atlanta practitioner Dwana Bush, M.D., and Dr. Lum to plan patient therapy.

Needle stick injuries in country general practice

AIMS

The aims of this study were to determine the frequency of needle stick injury (NSI) in general practice, to determine what measures were being taken to protect against needle stick injury, and to gather other information regarding work practices, risk perception, and knowledge of transmission.

METHODS

A postal survey was undertaken of all general practitioners and one practice nurse per practice address in selected areas of New Zealand.

RESULTS

The response rate was 82%. An incidence rate of 22 needle stick injuries in 100 health care workers per 6 month period was found. For general practitioners alone the incidence rate was 25 in 100 per 6 month period and for practice nurses it was 17 in 100 per 6 month period. Recommended precautionary measures were not being followed by most individuals.

CONCLUSIONS

Needle stick injury is a substantial problem in general practice and exposes general practitioners and practice nurses to a serious risk of infection from bloodborne transmissible agents. All patients should be considered to pose a potentially high risk of infection and recommended precautionary measures should be followed at all times.

Completeness of hospital cancer case reporting from the SEER Program of the National Cancer Institute

BACKGROUND

To ascertain the quality of data entering a population-based reporting system, an essential requirement is to study levels of completeness of case-ascertainment and reporting. This study represents an effort to quantify completeness of case reporting in the SEER (Surveillance, Epidemiology, and End Results) Program of the National Cancer Institute.

METHODS

Hospitals in each of the participating SEER areas were stratified according to their annual hospital cancer caseload for the year 1987. Within each caseload stratum, a random sample of hospitals was selected for inclusion in this study. Files in the medical record, pathology, and radiation oncology departments in each hospital were reviewed for SEER reportable cases. These cases were then matched against SEER case listings to identify unreported cases.

RESULTS

The crude estimated completeness of reporting for 1987 in the six participating SEER areas was 97.7% and the registry-caseload standardized rate was 96.8%. Variation was noted by SEER registry, hospital cancer caseload, and casefinding source (hospital department). Three-quarters of unreported cases were of invasive disease and one-fourth were in situ, primarily of the cervix uteri.

CONCLUSIONS

There is variation in completeness of casefinding among SEER registries, hospital size, and hospital department source. Additional factors that appear to be related to case ascertainment are cancer site or type and who performs the casefinding function (hospital registry or central registry staff).

Can adolescent suicide attempters be distinguished from at-risk adolescents?

Psychiatric disorders, psychosocial dysfunction, family pathology, and environmental stressors are thought to be risk factors for adolescent suicide attempts. Variables from each of these categories were examined, by means of a structured interview and questionnaires, to determine whether a group of 21 adolescent suicide attempters could be differentiated from a group of 34 normal control subjects and a group of 15 at-risk adolescents (teenagers with known risk factors but without recent suicide attempt). The attempters differed significantly from control subjects on a large number of variables, particularly in the areas of substance abuse, depression, self-image, interpersonal relationships, communication patterns, family support, and problem behaviors. Only three items--the Beck Hopelessness Scale score, the SCL-90-R Positive Symptom Distress Index, and a history of suicidal ideation--differentiated the attempters from the at-risk adolescents. A discriminant analysis revealed that hopelessness and suicidal ideation were able to identify 93% of the suicide attempters.

The friends of the medical school

The Friends of the John A. Burns School of Medicine, as an organization, is an extension of a basic need. Mary Cutting has compiled a history of the organization in which she was an instrumental force. Some of the highlights are included below.

Cloning and sequencing of a gene encoding a glutamate and aspartate carrier of Escherichia coli K-12

A gene encoding a carrier protein for glutamate and aspartate was cloned into Escherichia coli K-12 strain BK9MDG by using the high-copy-number plasmid pBR322. The gene (designated gltP) is probably identical to a gene recently cloned from E. coli B (Y. Deguchi, I. Yamato, and Y. Anraku, J. Bacteriol. 171:1314-1319). A 1.6-kilobase DNA fragment containing gltP was subcloned into the expression plasmids pT7-5 and pT7-6, and its product was identified by a phage T7 RNA polymerase-T7 promoter coupled system (S. Tabor and C. C. Richardson, Proc. Natl. Acad. Sci. USA 82:1074-1078) as a polypeptide with an apparent mass of 38 kilodaltons. A portion of the gltP polypeptide was associated with the cytoplasmic membrane. The nucleotide sequence of the 1.6-kilobase fragment was determined. It contained an open reading frame capable of encoding a highly hydrophobic polypeptide of 395 amino acids, containing four possible transmembrane segments. Uptake of glutamate and aspartate was increased 5.5- and 4.5-fold, respectively, in strains containing gltP plasmids. Glutamate uptake was insensitive to the concentration of Na+ and was inhibited by L-cysteate and beta-hydroxyaspartate. These results suggest that gltP is a structural gene for a carrier protein of the Na(+)-independent, binding-protein-independent glutamate-aspartate transport system.

The psychosocial needs of the Chinese elderly

Changing Chinese family patterns caused by immigration have contributed to the breakdown of traditional community and familial control in Chinese-American families. As a result, the Chinese-American elderly are faced with unique psychosocial problems that workers must consider when providing services to this population.

Cutaneous mucinosis of infancy

Cutaneous mucinosis is a term that has been used to describe a group of diseases or conditions in which accumulation of mucin in the skin is a prominent feature. The cutaneous mucinoses includes myxedema (both diffuse and localized), lichen myxedematosus (papular mucinosis), lipoid proteinosis, follicular mucinosis, cutaneous focal mucinosis, cutaneous myxoid cyst, and others. All of these diseases share distinct histologic features. I examined a 16-month-old infant with a case of cutaneous mucinosis that had unique clinical and histologic features, unlike any of the known mucinoses.

Staging of cancer of the colon and cancer of the rectum

A retrospective analysis of 1,826 cases (924 colon, 902 rectal) from ten institutions provided the basis of this study on the staging of cancer of the colon and rectum. The general rules of the American Joint Committee on the relationship between times and the staging of cancer have been followed. These represent modifications of the originally formulated TNM system of the Union Internationale Contre Le Cancer (UICC) which has been designed as a clinical-diagnostic classification, not applicable to cancer of inaccessible sites or structures requiring postsurgical treatment pathologic assessment of therapeutically removed specimens. Inadequacies of the clinical data requested for our study required adoption of the pTNM evaluation method of classification. Multiple regression analysis of the data demonstrated a relationship between survival and the following: depth of penetration (T), status of regional lymph nodes (N), and presence or absence of distant metastasis (M). This was similar for both sites. Basically, for the rectum it was in consonance with the original Dukes' classification (A, B, and C), and was remarkably applicable to the colon. The survival data for the two sites were so similar as to suggest the use of one set of pTNM categories not only for the postsurgical-treatment pathologic evaluation, but also for the stage grouping definitions. Strongly recommended for cancer of all sites is the development of General Oncology Data Forms to be included in the clinical charts and records of all patients with cancer.

Methylprednisolone sodium succinate treatment in global ischemia of the cat isolated heart

Effects of methylprednisolone were studied on isolated, blood-perfused cat hearts subjected to 1 hr of normothermic ischemic arrest. Untreated hearts sustained decreases in peak ventricular pressure pulse, dP/dt, and ventricular compliance. Ischemic hearts also became edematous, gained sodium, and lost potassium and creatine kinase enzyme activity. Steroid treatment did not significantly alter any of these ischemia-induced changes. Methylprednisolone treatment did increase resting coronary flow and also increased the hyperemic response after reperfusion. These results, in isolated hearts, provide no evidence that steroid treatment exerts a direct protective effect on the globally ischemic myocardium.

Effects of prior administration of Sn(II) complexes on in vivo distribution of 99mTc-pertechnetate

This report evaluates the effect of prior administration of several clinically used Sn(II)-containing agents on in vivo distribution of 99mTc. Abnormal binding of 99mTc to red blood cells can occur after administration of pertechnetate to patients who have previously received tin-containing agents. Increased blood levels of tin from other causes may have similar effects.

The health maintenance organization delivery system. A national study of attitudes of HMO project directors on HMO issues

A national survey of health maintenance organization project directors' attitudes on HMO delivery issues was conducted to gather data about HMO planning development and delivery areas. Questionnaire results revealed characteristics of the HMO project director, sponsoring institution, and developmental stage. Seven HMO issues (Prepayment Mechanism, Quality of Care, Degree of Federal Participation) Public and Private Funding, Physicians' Attitudes toward HMO, and Consumer Recruitment) were identified to measure the attitudes of directors. As a whole, responses were in the positive range. Scale 1 (Prepayment Mechanism) and Scale 2 (Quality of Care) received the lowest mean scores and were in the moderate agreement range. Scale 3 (Degree of Federal Regulation) and Scale 5 (Public and Private Funding) had the highest mean scores and fell between slight agreement and disagreement. Further research has been noted in various administrative features and issue areas of HMO. Most crucial is the outcome of HMO legislation which has a bearing on the policy and program of the HMO delivery system. On the basis of what appears to be a representative sample of directors of DHEW-funded HMO Planning and Development Projects, the study has assessed attitudes on important issues relevant to HMOs and determined areas of greatest agreement and disagreement.

Time trends in survival in acute lymphocytic leukemia

Comparison of patients under 20 years of age with acute lymphocytic leukemia diagnosed in 1955-64 with those whose disease was diagnosed in 1965-69 revealed a marked improvement in median survival time, from 9.5 to 16.8 months. This improvement occurred among patients with less favorable hematologic and symptomatic characteristics as well as among patients with more favorable ones. However, a shift in patient characteristics was consistent with the concept of diagnosis earlier in the natural history of the disease. In the more recent period, fewer patients were classified as severely disabled, and a somewhat higher proportion were in more favorable categories with respect to platelet count, percent of polymorphonuclear leukocytes, organomegaly, and bleeding or infection. Initial treatment was markedly different during the two time periods; this reflected a shift toward the use of combinations of chemotherapeutic agents and steroids.