The verification of wildland-urban interface fire evacuation models

This paper introduces a protocol for the verification of multi-physics wildfire evacuation models, including a set of tests used to ensure that the conceptual modelling representation of each modelling layer is accurately implemented, as well as the interactions between different modelling layers and sub-models (wildfire spread, pedestrian movement, traffic evacuation, and trigger buffers). This work presents a total of 24 verification tests, including (1) 4 tests related to pedestrians, (2) 15 tests for traffic evacuation, (3) 5 tests concerning the interaction between different modelling layers, along with 5 tests for wildfire spread and trigger buffers. The evacuation tests are organized in accordance with different core components related to evacuation modelling, namely Population, Pre-evacuation, Movement, Route/destination selection, Flow constraints, Events, Wildfire spread and Trigger buffers. A reporting template has also been developed to facilitate the application of the verification testing protocol. An example application of the testing protocol has been performed using an open wildfire evacuation modelling platform called WUI-NITY and its associated trigger buffer model k-PERIL. The verification testing protocol is deemed to improve the credibility of wildfire evacuation model results and stimulate future modelling efforts in this domain.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11069-023-05913-2.

Roxborough Park Community Wildfire Evacuation Drill: Data Collection and Model Benchmarking

Wildfires are increasing in scale, frequency and longevity, and are affecting new locations as environmental conditions change. This paper presents a dataset collected during a community evacuation drill performed in Roxborough Park, Colorado (USA) in 2019. This is a wildland-urban interface community including approximately 900 homes. Data concerning several aspects of community response were collected through observations and surveys: initial population location, pre-evacuation times, route use, and arrival times at the evacuation assembly point. Data were used as inputs to benchmark two evacuation models that adopt different modelling approaches. The WUI-NITY platform and the Evacuation Management System model were applied across a range of scenarios where assumptions regarding pre-evacuation delays and the routes used were varied according to original data collection methods (and interpretation of the data generated). Results are mostly driven by the assumptions adopted for pre-evacuation time inputs. This is expected in communities with a low number of vehicles present on the road and relatively limited traffic congestion. The analysis enabled the sensitivity of the modelling approaches to different datasets to be explored, given the different modelling approaches adopted. The performance of the models were sensitive to the data employed (derived from either observations or self-reporting) and the evacuation phases addressed in them. This indicates the importance of monitoring the impact of including data in a model rather than simply on the data itself, as data affects models in different ways given the modelling methods employed. The dataset is released in open access and is deemed to be useful for future wildfire evacuation modelling calibration and validation efforts.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10694-023-01371-1.

The Egress Enabler: Development and psychometric evaluation of an instrument to measure egressibility

BACKGROUND

Egressibility has been defined as a person-environment fit issue and describes accessibility to means of evacuation. Although egressibility concerns everyone, it has become a useful concept particularly in relation to safety and accessibility for people with functional limitations, commonly highlighted as a vulnerable group in egress scenarios. Egressibility is an important safety factor, but there has been limited efforts trying to quantify it.

OBJECTIVE

The aim has been to develop an instrument to measure egressibility in public buildings, as well as conducting initial psychometric testing of the instrument.

METHODS

The Egress Enabler is based on the previously developed Housing Enabler instrument. The Egress Enabler was developed in several steps by an interdisciplinary team, incorporating an expert panel and a case study.

RESULTS

Evaluation of content validity was in line with previous similar efforts, inter-rater reliability was considered "good" to "excellent" by means of intraclass correlation, and qualitative assessment of construct validity showed theoretically sound results.

CONCLUSIONS

It is suggested that an instrument like the Egress Enabler is needed for a systematic evaluation of egressibility during design. construction or operation. This is needed for ensuring equal access to egress for people with functional limitations.

A scoping review of public building accessibility

BACKGROUND

The built environment needs to be designed so that all people can participate in the activities they want and need to do. Yet, accessibility is difficult to put into practice, and accessibility issues tend to be overlooked in the building and planning processes.

OBJECTIVES

The aim of this scoping review was to summarize the research front in the area of accessibility to public buildings. Specific aims were to identify knowledge gaps, to identify access activities in relation to environmental features and to link to predominant activities in terms of the International Classification of Functioning, Disability and Health (ICF).

METHODS

A literature search was performed in PubMed, PsycINFO, Inspec, Embase and Cochrane databases. Articles in English based on original empirical studies investigating accessibility of public buildings for adults aged ≥18 years with functional limitations were considered.

RESULTS

Of the 40 articles included, ten involved study participants, while 30 only examined buildings using instruments to assess accessibility. In addition, the psychometric properties were only tested for a few of them. All articles concerned mobility and several visual limitations, while few addressed cognitive or hearing limitations. Ten main access activities were identified, from using parking/drop-off area to exiting building.

CONCLUSIONS

By using the ICF and theoretically relating the accessibility problems to activities, the results revealed that there are large knowledge gaps about accessibility to public buildings for older people and people with functional limitations and that there is a need for more methodological considerations in this area of research.

EXPOSED: An occupant exposure model for confined spaces to retrofit crowd models during a pandemic

Crowd models can be used for the simulation of people movement in the built environment. Crowd model outputs have been used for evaluating safety and comfort of pedestrians, inform crowd management and perform forensic investigations. Microscopic crowd models allow the representation of each person and the obtainment of information concerning their location over time and interactions with the physical space/other people. Pandemics such as COVID-19 have posed several questions on safe building usage, given the risk of disease transmission among building occupants. Here we show how crowd modelling can be used to assess occupant exposure in confined spaces. The policies adopted concerning building usage and social distancing during a pandemic can vary greatly, and they are mostly based on the macroscopic analysis of the spread of disease rather than a safety assessment performed at a building level. The proposed model allows the investigation of occupant exposure in buildings based on the analysis of microscopic people movement. Risk assessment is performed by retrofitting crowd models with a universal model for exposure assessment which can account for different types of disease transmissions. This work allows policy makers to perform informed decisions concerning building usage during a pandemic.

New "Smart" Systems for Atmospheric Aerosol and Reactive Gas Sampling in Ambient Air

Nowadays a recognized need for accurate observations of atmospheric aerosols (AEs) and reactive gases (RGs) exists in the framework of regional, national and global near-surface networks based on permanent or mobile measurement stations. In this context, a paramount and not-trivial issue is related to the correct execution of continuous sampling of ambient air and its subsequent distribution to measurement analyzers hosted inside the stations. Sampling artifacts must be minimized for obtaining reliable pictures of ambient air composition. To respond to this need, a suite of novel “smart” and relatively low-cost systems for the continuous sampling of ambient air was developed in the framework of the 2012–2015 I-AMICA Project. These systems were designed to execute AE and RG measurements according with WMO/GAW and ACTRIS recommendations and standard operation procedures. A particular attention was dedicated to the stabilization and control of the sampling flow rates and temperatures. The analysis of one full year of operations at the WMO/GAW regional station of Capo Granitola (GAW ID: CGR, Italy), allowed to conclude that these systems are effective in meeting the technical requirements for correct execution of AE and RG measurements.

A Double-Labeling Assay for Simultaneous Estimation and Characterization of Estrogen and Progesterone Receptors using Radioiodinated Estradiol and Tritiated Org 2058

Estrogen (ER) and progesterone receptors (PgR) appear to be a prerequisite to elicit a biologic response by a hormone-target organ. Current methodologies for analysis of these proteins (e.g., dextran-coated charcoal, DCC) in single-label assay (SLA) require relatively large amounts of tissue material, time and laboriousness. Therefore, we have developed for breast cancer tissue an improved dual-label assay (DLA) for simultaneous titration (by DCC) and/or characterization (by sedimentation properties) of ER and PgR on the same sample, using 125I-E2 and 3H-Org 2058 as tracers. The interaction of 125I-E2 with ER and plasma proteins in comparison to 3H-E2 was studied in terms of specificity, time course, affinity binding and sedimentation pattern. 125I-E2 bound the same molecular forms displayed by 3H-E2 (9 and 3S) but with lower titers (about 1.3-fold), irrespective of the technique used, and did not bind to sex hormone-binding globulin. Simultaneous detection of 125I and 3H was achieved by use of a gamma counter plus a beta counter sequentially. ER and PgR titrations with DCC in DLA were in good agreement with those obtained with SLA, in terms of titers and Ka values. An analogous result was obtained with sucrose density gradient (SDG) analysis. Both the DLA methods were highly reproducible (CV < 8.0 %). Between the rotors available for SDG, the vertical one was preferable because of the larger number of samples processed and of less purturbation of sedimenting receptor molecules. Furthermore, a biochemical application of the method is described. In conclusion, the DLA procedure, by simplifying ER and PgR estimation, makes it possible to study, even on small tumor biopsies, the molecular properties of these proteins in relation to the clinical response of the disease.

Detection of the 170 kDa P-Glycoprotein in Neoplastic and Normal Tissues

A membrane purification procedure and an immunoblotting assay have been designed to allow screening of human solid tumors for overexpression of the GP170 glycoprotein without employing a disaggregation method to obtain cell suspensions. The electrophoresed membrane proteins were probed, after Western Blotting, with the C219 monoclonal antibody and iodinated Protein A. The labeling intensity of the bands on the autoradioimmunoblots were quantified by densitometry. To test for the presence of GP170, we used membranes from the UV 2237 fibrosarcoma line and its adriamycin-resistant variant ADMR, grown in vitro or as solid tumor in mice. Membranes of human normal and tumor tissues obtained from previously untreated patients were also tested. An immunoreaction was observed in the adriamycin-resistant UV 2237 lines grown in vitro or in vivo. Quantitatively, the binding of the resistant cell line grown in vitro was higher than that observed in cells grown in mice. Bands in the GP 170 region were observed in 4/7 normal and in 7/7 tumor colon tissues and in the normal medulla from 2 patients with cancer of the renal cortex. No reaction could be found in samples from normal tissue, primary tumor or nodal metastasis from 7 patients with breast cancer.

Variations in Estrogen and Progesterone Receptor Content in Premenopausal Breast Cancer Patients Throughout the Menstrual Cycle

Estrogen (ER) and progesterone (PgR) receptor content was assayed in 290 premenopausal women with primary breast cancer, in order to investigate the influence of endogenous hormones on cytoplasmic receptor concentrations throughout the menstrual cycle, subdivided into four phases of ovarian function (early and late follicular phase, early and late luteal phase). Of the total population, 231 (79.7 %) patients were ER positive and 59 (20.3 %) were ER negative; 220 (75.9 %) were PgR positive and 70 (24.1 %) were PgR negative. The percentages of positive cases were almost constant in each phase. No significant difference in mean values of ER concentration was noted throughout the cycle. Instead, the PgR concentration significantly increased from the first to the third phase (P = 0.02) and decreased from the third to the fourth phase (P = 0.01). Our results suggest that ER- and PgR- cases are homogeneously distributed and not influenced by the phase of the cycle. Moreover, they suggest that PgR measurement in the luteal phase, rather than in other phases, prevents the occurrence of false low PgR levels and, at the same time, improves its prognostic significance and response rate to endocrine therapy.

Distribution of Estrogen and Progesterone Receptors in Primary Tumor and Lymph Nodes in Individual Patients with Breast Cancer

Primary breast cancer tissue and lymph nodes were obtained from 48 patients. Estrogen receptors (ER) and progesterone receptors (PgR) were determined by a dextran-coated charcoal assay. ER were present in 72.9 % of the primary tumors and in 62.4 % of the malignant lymph nodes, whereas PgR were present in 73.0 % and 50.0 % of the cases, respectively. The primary tumor and the corresponding malignant lymph nodes showed an identical ER and PgR status, i.e., both tumor sites were receptor positive or both receptor negative in 89.6 % and 77.1 %, respectively. However, 10.4 % of the patients had ER-positive tumors but ER-negative lymph nodes and 22.9 % had PgR-positive primaries with PgR-negative lymph nodes. No receptor-positive lymph nodes showed a combination with receptor-negative primary tumor. This preliminary data shows that receptor-positive malignant lymph nodes mostly display the same receptor status as the corresponding primary tumor, whereas receptor-negative lymph nodes may have a receptor-positive primary tumor.

Prognostic Significance of Progesterone Receptors Alone or in Association with Estrogen Receptors in Human Breast Cancer

Estrogen (ER) and progesterone (PgR) receptors were measured simultaneously in 1144 consecutive breast cancer patients to determine the distribution of patients according to receptor and menopausal status when receptor occurrence rates were considered. The prognostic signicance of PgR, either alone or in association with ER, was studied on 187 consecutive breast cancer patients treated only by radical mastectomy. All the cases, as regards axillary node status, were pathologically assessed as node negative. These patients did not receive any adjuvant treatment after mastectomy. At 36 months after mastectomy, the follow-up indicated that PgR- patients have a worse prognosis than PgR+ ones. This is evident when PgR alone is considered as a prognostic factor as well as when it is used to identify, within ER+ cases, those with a higher probability of relapse. In conclusion, it can be stated that although PgR status is an independent prognostic factor, it is useful to evaluate ER and PgR simultaneously for better patient management.

An Improved Criterion for the Evaluation of Estrogen Receptor Binding Data in Human Breast Cancer

The evaluation of the data is an important step in performing the estrogen receptor test. For this reason an effort has been made to derive a more reliable threshold criteria. Among the parameters considered, Xo, Ka, and BI %, only the former 2 appear to be suitable to allow a proper evaluation of the results. From the analysis of different types of carcinomatous or normal breast specimens, limit values of these parameters have been recovered for positivity and negativity of the estrogen receptor test. We found all the samples showing Ka < 1.5 × 109 M 1 or Xo < 5 fmol/mg proteins to be negative, those characterized by low values of both the parameters were borderline, and all the remaining ones were positive.

Hormonal and Receptor Status in Postmenopausal Women with Endometrial Carcinoma before and after Treatment with Tamoxifen

Twenty-four patients with endometrial carcinoma received tamoxifen (Nolvadex) for 7 days. Before and after administration, circulating hormones (estradiol, testosterone, progesterone, gonadotropins FSH and LH) were evaluated. Estrogen (ER) and progesterone receptors (PgR) in neoplastic tissue were also assayed. Our results show a net increase in PgR content and a signicant decrease in gonadotropin levels after the treatment. The authors suggest that clinical trials be conducted using tamoxifen and progestins for adjuvant therapy after surgery of endometrial carcinoma and for the therapeutic approach of advanced carcinoma.

Hormone Treatment and Sex Steroid Receptors in Metastatic Renal Cell Carcinoma: Report of a Multicentric Prospective Study

Twenty-eight patients with metastatic renal cell carcinoma entered a multicentric prospective study to evaluate the response to high-dose medroxyprogesterone acetate (MPA) and testosterone in MPA failures in relation to sex steroid receptors. No objective remission was seen in the 24 evaluable patients, and only disease stabilizations of short duration were achieved in one-third of treated patients. Stabilizations achieved with second line testosterone were all seen in patients unresponsive to MPA. Receptor studies demonstrated that estrogen, progesterone, or androgen receptors were found in low concentrations and in only 6 of 23 tumors (26%) and 13 normal tissue samples (56%). Surprisingly, no disease stabilization was achieved in patients positive for receptors. It can be concluded that the occasional objective responses to hormone therapy reported in the literature may have been due to some cytotoxic effect of hormone therapy rather than to a true hormonal mechanism.

Results of the Italian Interlaboratory Quality Control Program for Estradiol Receptor Assay

This article presents results of the first Italian quality control program for determining the estradiol receptor on lypophilized guinea pig and calf uteri. Despite considerable variability in quantitative terms, the results concur in ability to define samples as positive or negative for receptor content. One of the parameters that most strongly influences accuracy of determination of receptor concentration is protein assay. The evaluation of several lyophilized preparations at scalar concentrations permitted identification, by linear regression, for each laboratory of the systematic and non-systematic variables. More comparable results will be forthcoming when a standardized methodology program has been fully adopted.

Dissuasive exit signage for building fire evacuation

This work presents the result of a questionnaire study which investigates the design of dissuasive emergency signage, i.e. signage conveying a message of not utilizing a specific exit door. The work analyses and tests a set of key features of dissuasive emergency signage using the Theory of Affordances. The variables having the largest impact on observer preference, interpretation and noticeability of the signage have been identified. Results show that features which clearly negate the exit-message of the original positive exit signage are most effective, for instance a red X-marking placed across the entirety of the exit signage conveys a clear dissuasive message. Other features of note are red flashing lights and alternation of colour. The sense of urgency conveyed by the sign is largely affected by sensory inputs such as red flashing lights or other features which cause the signs to break the tendencies of normalcy.

A dynamic approach for the impact of a toxic gas dispersion hazard considering human behaviour and dispersion modelling

The release of toxic gases due to natural/industrial accidents or terrorist attacks in populated areas can have tragic consequences. To prevent and evaluate the effects of these disasters different approaches and modelling tools have been introduced in the literature. These instruments are valuable tools for risk managers doing risk assessment of threatened areas. Despite the significant improvements in hazard assessment in case of toxic gas dispersion, these analyses do not generally include the impact of human behaviour and people movement during emergencies. This work aims at providing an approach which considers both modelling of gas dispersion and evacuation movement in order to improve the accuracy of risk assessment for disasters involving toxic gases. The approach is applied to a hypothetical scenario including a ship releasing Nitrogen dioxide (NO2) on a crowd attending a music festival. The difference between the results obtained with existing static methods (people do not move) and a dynamic approach (people move away from the danger) which considers people movement with different degrees of sophistication (either a simple linear path or more complex behavioural modelling) is discussed.

Variable Message Signs for road tunnel emergency evacuations

This paper investigates the design of Variable Message Signs (VMS) as a way-finding aid for road tunnel emergency evacuations. The use of the Theory of Affordances is suggested to provide recommendations on the design of VMS. A preliminary evaluation of 11 selected VMS systems was performed and 6 of them were further evaluated using an affordance-based within subject stated-preference questionnaire administered to a sample of 62 participants. Results are used to provide recommendations on the characteristics of the VMS systems, such as (1) size of the sign (large or small); (2) use of flashing lights; (3) colour scheme; (4) message coding (i.e., text, pictograms or a combination of them). The best performing VMS features for road tunnel emergency evacuation included the use of larger signs, flashing lights, the combination of emergency exit pictorial symbol in green in one panel and text in amber in the other panel.

A neutron camera system for MAST

A prototype neutron camera has been developed and installed at MAST as part of a feasibility study for a multichord neutron camera system with the aim to measure the spatial and time resolved 2.45 MeV neutron emissivity profile. Liquid scintillators coupled to a fast digitizer are used for neutron/gamma ray digital pulse shape discrimination. The preliminary results obtained clearly show the capability of this diagnostic to measure neutron emissivity profiles with sufficient time resolution to study the effect of fast ion loss and redistribution due to magnetohydrodynamic activity. A minimum time resolution of 2 ms has been achieved with a modest 1.5 MW of neutral beam injection heating with a measured neutron count rate of a few 100 kHz.

Gain stabilization control system of the upgraded magnetic proton recoil neutron spectrometer at JET

Burning plasma experiments such as ITER and DEMO require diagnostics capable of withstanding the harsh environment generated by the intense neutron flux and to maintain stable operating conditions for times longer than present day systems. For these reasons, advanced control and monitoring (CM) systems will be necessary for the reliable operation of diagnostics. This paper describes the CM system of the upgraded magnetic proton recoil neutron spectrometer installed at the Joint European Torus focusing in particular on a technique for the stabilization of the gain of the photomultipliers coupled to the neutron detectors. The results presented here show that this technique provides good results over long time scales. The technique is of general interest for all diagnostics that employ scintillators coupled to photomultiplier tubes.

Validating TRANSP simulations using neutron emission spectroscopy with dual sight lines

A method to generate modeled neutron spectra from bulk and fast ion distributions simulated by TRANSP has been developed. In this paper, modeled data generated from fuel ion distributions modeled with TRANSP is compared to measured data from two neutron spectrometers with different lines of sight; TOFOR with a radial one and the MPRu with a tangential one. The information obtained from the analysis of the measured neutron spectra such as the relative intensity of the emission from different ion populations places additional constraints on the simulation and can be used to adjust the parameters of the simulation.

A neural networks framework for real-time unfolding of neutron spectroscopic data at JET

A determination of fast ion population parameters such as intensity and kinetic temperature is important for fusion reactors. This becomes more challenging with finer time resolution of the measurements, since the limited data in each time slice cause increasing statistical variations in the data. This paper describes a framework using Bayesian-regularized neural networks (NNs) designed for such a task. The method is applied to the TOFOR 2.5 MeV fusion neutron spectrometer at JET. NN training data are generated by random sampling of variables in neutron spectroscopy models. Ranges and probability distributions of the parameters are chosen to match the experimental data. Results have shown good performance both on synthetic and experimental data. The latter was assessed by statistical considerations and by examining the robustness and time consistency of the results. The regularization of the training algorithm allowed for higher time resolutions than simple forward methods. The fast execution time makes this approach suitable for real-time analysis with a time resolution limit in the microsecond time scale.

Genetic testing: policy issues for the new millennium

The purpose of this article is to provide a brief overview of the policy considerations underlying the Organization for Economic Cooperation and Development (OECD) workshop, "Genetic Testing: Policy Issues for the New Millennium," which was organised and hosted by the governments of the United Kingdom (UK) and Austria in Vienna, 23-25 February 2000, with the support of the European Commission (EC). It reviews the various topics presented at the meeting and offers a brief summary of its main conclusions.

[Education of the hypertensive patient: are educational booklets useful?]

A good level of knowledge about hypertension can improve patients' compliance to treatment so achieve better therapeutic results. The aim of our study was to evaluate the degree of knowledge about their disease in hypertensives followed in a hospital out-patient unit; and whether an informative booklet could increase this awareness. The patients were presented a questionnaire on the following items: 1. their interest in health news as presented by the mass-media and their judgement on physicians' willingness to provide information about hypertension; 2. the health hazards of being hypertensive; 3. the importance of a family history of hypertension; 4. life style and blood pressure; 5. the reasons for treating hypertension and the length of treatment. Upon completion of the questionnaire, the patients were handed out a booklet in which these same topics were analyzed. At the next follow-up visit, they were invited to answer a set of questions quite similar to the first ones, but presented in a different verbal form. 200 patients completed the first questionnaire; 159, both of them. Basically, they show a high degree of correct knowledge about their disease, giving between 77% and 94% of correct answers to the different questions. After the booklet, for most of the questions the percentage of correct answers remains the same; when it does change, this is usually for the worse. Simply handing out a booklet doesn't help patients to better understand their disease. On the contrary it may have an opposite effect, inducing some degree of confusion.

Effects of low-dose aspirin on clinic and ambulatory blood pressure in treated hypertensive patients. Collaborative Group of the Primary Prevention Project (PPP)--Hypertension study

Nonsteroidal antiinflammatory drugs may affect blood pressure (BP) control in hypertensive patients receiving drug treatment, but data on the effects of low-dose aspirin are scanty. This study assessed the effects of chronic treatment with low doses of aspirin (100 mg/day) on clinic and ambulatory systolic (SBP) and diastolic (DBP) BP in hypertensives on chronic, stable antihypertensive therapy. The study was conducted in the framework of the Primary Prevention Project (PPP), a randomized, controlled factorial trial on the preventive effect of aspirin or vitamin E in people with one or more cardiovascular risk factors. Fifteen Italian hypertension units studied 142 hypertensive patients (76 men, 66 women; mean age 59 +/- 5.9 years) treated with different antihypertensive drugs: 71 patients were randomized to aspirin and 71 served as controls. All patients underwent a clinic BP evaluation with an automatic sphygmomanometer and a 24-h ambulatory BP monitoring, at baseline and after 3 months of aspirin treatment. At the end of the study the changes in clinic SBP and DBP were not statistically different in treated and untreated subjects. Ambulatory SBP and DBP after 3 months of aspirin treatment were similar to baseline: deltaSBP -0.5 mmHg (95% confidence intervals [CI] from -1.9 to +2.9 mm Hg) and deltaDBP -1.1 mm Hg (95% CI from -2.5 to +0.3 mm Hg). The pattern was similar in the control group. No interaction was found between aspirin and the most used antihypertensive drug classes (angiotensin converting enzyme inhibitors and calcium antagonists). Despite the relatively small sample size our results seem to exclude any significant influence of low-dose aspirin on BP control in hypertensives under treatment.

Effects of vitamin E on clinic and ambulatory blood pressure in treated hypertensive patients. Collaborative Group of the Primary Prevention Project (PPP)--Hypertension study

A randomized controlled open trial studied the effect of vitamin E supplementation (300 mg/day) on clinic and 24-h ambulatory blood pressure (BP) in 142 treated hypertensive patients. After 12 weeks, clinic BP decreased whether or not patients were randomized to vitamin E. Ambulatory BP showed no change in systolic BP and a small decrease in diastolic BP (-1.6 mm Hg, 95% confidence intervals from -2.8 to -0.4 mm Hg), approaching statistical significance in comparison to the control group (P = .06). Vitamin E supplementation thus seems to have no clinically relevant effect on BP in hypertensive patients already under controlled treatment.

[Rhabdomyolysis caused by improper intraoperative positioning. Clinical and medico-legal aspects]

The etiology, diagnosis, pathology and treatment of rhabdomyolysis due to intraoperative malpositioning and the medico-legal implications of physicians involved in the surgical treatment and anesthesia of the patient are described. According to the Italian law, the anesthesiologist is the only physician of the surgery-anesthesia team responsible for the patient's positioning. The anesthesiologist must assume primary responsibility for protecting the patient from iatrogenic injuries due to improper positioning, and/or inadequate preventive measures.

[Anesthesiologic incidents from esophageal intubation. Presentation of three cases and medico-legal evaluation]

Undiagnosed esophageal intubation is still prominently in anesthesia-related morbidity and mortality. Three cases of undiagnosed esophageal intubation taken into consideration for possible anesthesiologic malpractice are presented. A review of the international anesthetic-related morbidity and mortality statistics indicates that this misadventure remains a problem even among anesthesia personnel, a medical population specifically trained in such a procedure. It is not only the frequency of this misadventure but the potential catastrophic consequences for the patient that underline the importance of being able to recognise and correct an esophageal intubation. The reliability of commonly prescribed methods of assessing tracheal tube position is reviewed and the conclusion is drawn that continuous end-tidal carbon dioxide measurement during anesthesia is perhaps the most reliable means under all circumstances for determining proper tube position and should be employed routinely whenever possible.

Genistein in the control of breast cancer cell growth: insights into the mechanism of action in vitro

Genistein significantly inhibited cell growth (IC50 around 10 microM) of MCF-7, MDAMB-231 and HBL-100 cell lines, but not of skin-derived fibroblasts and counteracted the growth-stimulatory effects exerted by estradiol and growth factors. It abolished the paracrine stimulation observed in MCF-7 cells in co-culture with MDAMB-231 or fibroblasts. Genistein-treated cells accumulated in the S and G2/M phases of the cell cycle and underwent apoptosis. Genistein decreased tyrosine phosphorylation induced upon treatment with transforming growth factor-alpha. Finally, genistein bound the estrogen receptor (ER) (relative affinity constant Kd = 4 nM), induced pS2 and cathepsin-D transcription and increased nuclear ER levels.

Effects of photoperiod on brain corticosteroid receptors and the stress response in the golden hamster (Mesocricetus auratus)

Following exposure to short daylengths, in golden hamsters, changes in basal adrenal glucocorticoid secretion are associated with a significant increase in Type I receptor binding, and are preceded by alterations in the stress-induced release of glucocorticoids, which is one of the major modes of operation of the hypothalamo-pituitary-adrenocortical axis (HPA). These results lend support to the hypothesis that corticosteroid receptors, and in particular the Type I receptor subtype, play a central role in the regulation of circadian and circannual rhythms of the HPA.

Oral doxophylline in patients with chronic obstructive pulmonary disease

Doxophylline, or 2-(7'-theophyllinemethyl)1,3-dioxolane, is a theophylline derivative which has shown interesting bronchodilating activity, and it appears to determine few adverse effects. The aim of the present investigation was to evaluate clinical therapeutic effects of the drug in the treatment of 2 groups of patients suffering from moderate to severe chronic obstructive pulmonary disease differing in acute response to the inhaled beta 2-agonist salbutamol and to compare changes of lung function tests to serum concentration of doxophylline. We studied 67 patients with chronic obstructive pulmonary disease (median age 63 years, 9 females and 58 males) who were all clinically stable at the time of the study. Patients were separated into 2 groups on the basis of their reaction to inhalation of 200 micrograms of salbutamol: those with an increased FEV1 of more than 20% from baseline value (group 1), and those with no increase (group 2). Doxophylline was administered orally at the dose of 400 mg 3 times daily. Serum levels of doxophylline were determined by high-pressure liquid chromatography. Spirometry and blood gas analysis were performed before and 10 days after treatment. Four patients stopped drug assumption because of side effects (3 for dyspepsia and 1 for anxiety). In group 1 (34 patients), a significant increase in SVC, FVC, FEV1, FEF 25-75% and PEFR was observed. In group 1 (29 patients), only PEFR significantly increased. No modifications in blood gas analysis were observed. The mean serum level of doxophylline was 14 micrograms/ml in group 1 and 9 micrograms/ml in group 2: the difference was statistically significant. The relation between serum levels of doxophylline and FVC showed an increase in the parameter up to the concentration of 12-13 micrograms/ml, after which a plateau phase was observed. On the basis of our data, doxophylline appears to have an interesting bronchodilating effect in patients responsive to the inhaled beta 2-agonist salbutamol. The lower limit of the therapeutic range seems to be 12-13 micrograms/ml. The upper limit of the therapeutic range was not determined because it was not possible to obtain serum samples when side effects occurred.

Adverse events in the treatment of hypertensive patients

We evaluated frequency and type of adverse events (AE) and measures adopted in outpatients attending a hospital hypertension unit in a two-part study: (1) a retrospective review of the charts of the 412 patients seen in 1991 with at least one follow-up visit and (2) a prospective study of the 491 patients seen in 1993 with at least one follow-up visit for whom physicians were asked to fill out an AE form. In 1991 18.6% of patients spontaneously reported an AE; those with an AE were older (p<0.001) than those without and included a greater proportion of females (p<0.002). This retrospective analysis of AE is reproducible as demonstrated by a blind review of 30 randomly selected charts undertaken by two independent observers (McNemar's test:p=ns). In 1993 AE were reported by 24.4% of patients who had more follow-up visits (p<0.001) and included a higher proportion of females (p=0.016) than the subgroup without AE. AE were different in the two studies (p<0.001), more specific and drug-related in 1993. AE were usually considered as mild or moderate (87.4%), the drugs most often involved were calcium antagonists and ACE-inhibitors and the measure adopted was switching to another substance (44%). The frequency of AE reporting varied widely between different physicians.

Expression of exogenous genes transferred into the avian limb in ovo

We report on a simple method of direct gene transfer which allows the ectopic expression of proteins and the study of mesoderm-specific genes in the chick embryo. We microinjected into the avian embryonic limb several plasmids containing reporter genes under the control of various promoter sequences, including a minimal chicken muscle acetylcholine receptor alpha-subunit promoter [Klarsfeld, A., Daubas, A., Bourachot, B. and Changeux, J.P., Mol. Cell. Biol., 7 (1987) 951-955]. Gene expression is detectable for 3 days, is reproducible, is restricted to the site of injection, and correlates with the amount of DNA injected. Our observations indicate that it is possible to transfer and express genes in ectodermal and mesodermal cells of the chick limb by direct DNA injection and that the method can be used to analyze promoter sequences in vivo during specific windows of development.

Promoter-specific regulation of gene expression by an exogenously added homedomain that promotes neurite growth

pAntp, a 60 amino acid long peptide corresponding to the homeodomain of the Drosophila Antennapedia protein, translocates through neuronal membranes when added exogenously to neurons in culture, where it accumulates in the nucleus and promotes neurite outgrowth. We proposed that the peptide, once internalized, may compete for homeoprotein DNA binding sites. To investigate this point, we have produced a permanent fibroblast cell line which carries a luciferase reporter gene under the control of a 93 bp genomic region of the HOXD9 promoter with binding sites for homeoproteins. Externally added pAntp specifically down-regulates the expression of the reporter gene, suggesting that the neurotrophic effects observed previously are mediated by direct binding of pAntp to homeoprotein target sites.

Down-regulation of the Drosophila morphogen bicoid by the torso receptor-mediated signal transduction cascade

Anterior body pattern in Drosophila is specified by the graded distribution of the bicoid protein (bcd), which activates subordinate genes in distinct anterior domains. Subsequently, transcription of these target genes is repressed at the anterior pole owing to the activity of the receptor tyrosine kinase torso (tor). We show that both activation by bcd and repression by tor can be reproduced by a minimal promoter containing only bcd-binding sites upstream of a naive transcriptional start site. Repression requires the D-raf kinase and is associated with phosphorylation of bcd protein. Repression does not require either tailless or huckebein, which were previously thought to constitute the sole zygotic output of the tor signaling system. Finally, addition of a heterologous transcriptional activation domain to bcd renders the protein insensitive to tor-mediated repression. We propose that phosphorylation resulting from the activity of the tor signal transduction cascade down-regulates transcriptional activation by the bcd morphogen.

Steady state analysis of hypothalamic GnRH mRNA levels in male Syrian hamsters: influences of photoperiod and androgen

An in situ hybridization assay, utilizing a free floating technique was used to estimate the steady state levels of hypothalamic luteinizing hormone-releasing hormone (GnRH) mRNA levels in the brains of male golden hamsters maintained in different photoperiods. In situ histochemistry was performed using a 32P-labelled 66-nucleotide long oligomer complementary to the sequence of the human GnRH mRNA coding region. The oligonucleotide hybridized specifically to mRNA encoding the GnRH precursor as suggested by the distribution of labelled neurons and as shown by an RNAse protection assay on septal and preoptic-hypothalamic mRNA from gonadally regressed hamsters. To test the hypothesis that short-day photoperiods reduce GnRH synthesis, intact male hamsters or castrated males bearing subcutaneously inserted testosterone implants were exposed to long-day (14 h light:10 h dark) or short-day (10 h light 14 h dark) photoperiods for 4 weeks. Exposure to short day lengths never caused a decrease in GnRH expressing neurons and actually was associated with an increase in the number of radiolabelled cells specifically in the diagonal band of Broca/medial septum in the gonadally intact group. The mean number of grains per labelled cell for the short day animals similarly was not reduced from that seen in long day animals. The results are consistent with previous studies on photoperiod and GnRH content in the same brain regions and support the notion that the suppression of the synthesis of GnRH does not accompany the low levels of LH secretion observed during the early stages of reproductive quiescence in this species.

Immunocytochemical study of GnRH and GnRH-associated peptide in male Syrian hamsters as a function of photoperiod and gonadal alterations

Hypothalamic luteinizing-hormone-releasing hormone (GnRH) and gonadotropin-releasing-hormone-associated peptide (GAP) biosynthesis and storage were estimated by immunocytochemistry in male golden hamsters maintained in different photoperiods. Intact or castrated male hamsters with subcutaneously inserted testosterone implants were exposed to long-day (14:10) or short-day photoperiods (10:14) for 4-8 weeks. Exposure to short photoperiod for 4 weeks, an interval characterized by a suppression of gonadotropin secretion but not gonadal regression, was associated with an increase in the number of GnRH- and GAP-immunoreactive cells in the diagonal band of Broca/medial septum. Furthermore, morphometric analysis revealed that these animals displayed significantly more GnRH but not GAP immunoreactivity in the median eminence as opposed to hamsters exposed to long-day photoperiods. In additional studies, gonadally regressed hamsters exposed to short day lengths for 8 weeks had equal numbers of GnRH cells as did the long-day controls. These patterns suggest that reproductive quiescence in golden hamsters is not the result of depletions of neuronal GnRH stores available for secretion.

[Absorption of short-acting insulin mixed with different slow-release formulations]

Several authors point to a different action of soluble insulin when mixed with a lente formulation containing either protamine or zinc. We evaluated glucose and insulin profiles in 17 type I diabetics, every one of whom was given what was considered the optimal amount of insulin twenty minutes before a standard evening meal. The patients were studied on two occasions, one week apart. According to a randomized sequence, those who received first the protamine-soluble mixture, took the Zn-soluble combination after one week and vice-versa. At the same time, we determined anti-insulin antibodies in order to rule out any different immunological interference, in the two moments of the study. Our results confirm that protamine-insulin given together with regular shows a serum insulin peak which is earlier and higher than that obtained with the corresponding mixture of Zn-insulin and regular (ANOVA: F = 5, 96; p = 0.02); blood glucose levels were lower with the former regimen, even though the difference did not reach statistical significance. Our conclusion is that Zn-containing insulin partly inactivates regular insulin when administered in the same syringe, and this may have an impact on the long-term treatment of the diabetic patient.

Expression of P-glycoprotein in breast cancer tissue and in vitro resistance to doxorubicin and vincristine

Expression of P-glycoprotein was evaluated by C219 monoclonal antibody immunoblots in 34 previously untreated and 14 pretreated breast cancers and in benign breast lesions or histologically normal breast glands. P-glycoprotein was not detectable in the few cases of normal or benign tissue. P-glycoprotein was expressed in the 170 kD areas of 29% (10/34) of untreated and 64% (9/14) of previously treated tumours (P = 0.02). In treated tumours, high intensity expression was observed more frequently than in untreated breast cancer (40% vs. 9%). Moreover, there was a significant association between P-glycoprotein expression and in vitro resistance to doxorubicin and vincristine. Simultaneous resistance was observed in all of the P-glycoprotein positive and in only 56% of the P-glycoprotein negative tissues (P less than 0.01). Some aspects of the typical multidrug resistant phenotype, such as P-glycoprotein expression and simultaneous resistance to doxorubicin and vincristine, could be detected in small subsets of breast cancer patients. No relation between P-glycoprotein expression and the type of previous clinical treatment was observed.

Wernicke's lethal encephalopathy in voluntary, total, prolonged fasting

A lethal case of Wernicke's encephalopathy caused by prolonged fasting is reported; the liability of physicians is evaluated.

[The hypoglycemic reactions in diabetic patients in the emergency room. Which patients are going to be hospitalized?]

In one year, a retrospective study in a casualty department identified 67 hypoglycemic episodes occurring to adult diabetic patients: 40 insulin-treated, 20 oral antidiabetic-treated, 7 with unrecorded treatment. All the oral antidiabetic-treated patients were on glibenclamide and the mean dose was 6.5 mg/day: 35.7% of the patients admitted to the medical ward were discharged without antidiabetic drug prescription, suggesting that previous treatment had been unnecessary. Thirty one of the subjects had to be admitted to the medical ward: they were significantly older, mainly on oral antidiabetic treatment and their glucose blood levels were significantly lower than those of the patients treated in the casualty department and sent home. The subjects were admitted mainly because of associated disease, late complications of the diabetic status or home care shortage.