Safety of Radiation Therapy for Treatment of Malignancy in Patients with Inflammatory Bowel Disease

PURPOSE/OBJECTIVE(S)

Inflammatory bowel disease (IBD) has been considered a relative contraindication to radiation therapy (RT) due to the potential greater risk of RT-induced toxicities, however, there is limited toxicity data using modern RT techniques. This study aims to assess toxicity outcomes in patients with IBD treated with abdominal or pelvic RT.

MATERIALS/METHODS

After institutional review board approval, patients with IBD who received RT to the abdomen or pelvis were filtered from an institutional research repository and their electronic medical records were reviewed. Acute toxicity was defined as that occurring within 3 months of RT. Toxicities were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. Univariable Cox proportional hazards regression was used to assess rates of grade ≥2 toxicity-free survival.

RESULTS

We identified 62 patients with median age of 69 years (interquartile range [IQR] 62-77) who received RT from 2006-2022. Median follow up was 15 months (IQR 4-33). Most patients were male (42; 68%) and had a diagnosis of ulcerative colitis (44; 71%). The most common primary malignancy was colorectal/anal (26; 42%). Intensity-modulated RT (IMRT) was most frequently used (38; 61%) followed by 3-dimensional conformal RT (3D-CRT) (12; 19%) and stereotactic body RT (SBRT)/brachytherapy (12; 19%). For IMRT/3D-CRT, median dose delivered was 50 Gy (IQR 49-59) in 25 fractions (IQR 25-30), and median maximum dose (Dmax) to bowel was 48 Gy (IQR 43-52); whereas for SBRT/brachytherapy, the median dose was 32 Gy (IQR 27-40) in 3 fractions (IQR 2-5) and median bowel Dmax was 32 Gy (IQR 20-37). The median biologically effective dose delivered with an assumed alpha/beta ratio of 10 (BED10) across all RT modalities was 63 Gy (IQR 60-72). After initiation of RT, 31 patients (50%) and 14 patients (23%) experienced grade ≥2 acute and late toxicity, respectively. Thirteen patients (21%) and 7 patients (11%) experienced grade 3 acute and late toxicity, respectively. No patients experienced grade >3 toxicity. Acute toxicity resulted in interruption to RT for 5 patients (8%), 2 of which did not resume RT. Four patients (6%) required adjustment to chemotherapy or IBD medication dosage as a result of their acute toxicity. Median time from RT start to acute toxicity onset was 41 days (IQR 32-46), whereas median time to onset of late toxicity was 9 months (IQR 5-15). The most common acute and late toxicities were diarrhea (21; 34%) and bowel obstruction/perforation/fistula (4; 6%), respectively. Rates of grade ≥2 toxicity-free survival overtime were not significantly associated with IBD status (active vs quiescent), delivered BED10, or bowel Dmax BED3.

CONCLUSION

In patients with IBD treated with abdominal or pelvic RT for malignancy, RT was feasible with acceptable rates of toxicity and active versus quiescent IBD status did not impact toxicity outcomes. Future research is needed to elucidate specific dose constraints when treating patients with IBD.

Impact of Employment and Insurance Status on Hope Among Patients Treated within Radiation Oncology

PURPOSE/OBJECTIVE(S)

Hope is important in serious illnesses including cancer, as it has been linked to patient well-being and quality of life. We assessed hope among patients seen in radiation oncology and aimed to determine associated socioeconomic and disease factors. We hypothesized that patients who may have less resources to cope with their illness would have lower hope scores.

MATERIALS/METHODS

The Adult Dispositional Hope Scale (AHS) is a questionnaire that aims to measures an individual's determination to accomplish goals and planning strategies to accomplish goals. We prospectively collected AHS survey scores from patients with benign or malignant disease seen in 2 radiation oncology clinics at our institution from 10/2022 to 1/2023. The AHS survey contains 12 items to measure hope through two qualities: agency (goal-directed energy) and pathways (plan to meet goals). Each item is answered using an 8-point scale. There are 4 items each for the Agency and Pathway subscales with 4 filler items for total scores ranging from 8 to 64, with higher scores reflecting higher agency and pathways thinking. Kruskal-Wallis H test and Kendall's Tau Rank Correlation were used to determine differences between categorical and continuous variables on AHS scores, respectively.

RESULTS

We included 228 patients with a median age of 62 years (range 16.9-92.6). Half were male (51%), 56% were white, and 77% had malignant disease. The primary disease subsite was CNS, GI and other in 76 (34%), 70 (31%), and 81 (36%) patients, respectively. Of patients with known occupation and insurance information, 32 (14%), 67 (29%), and 49 (22%) were not employed, employed, and retired, respectively, and 115 (50%), 85 (37%), and 20 (9%) had private insurance, Medicare, and Medical, respectively. Median agency, pathway, and total hope scores were 27 (interquartile range [IQR] 24-29), 28 (IQR 24-30), and 55 (IQR 48-58), respectively. Higher total hope scores were associated with being employed (p = 0.02), having private insurance (p<0.02), and higher ECOG scores (p<0.01). After excluding those who are not employed because they are retired (n = 99), lack of employment was significantly associated with hope (p<0.01). Characteristics such as race/ethnicity, gender, marital status, pain, symptoms from disease, malignant or benign disease, stage of disease, and treatment modalities were not associated with AHS scores.

CONCLUSION

In our study, patients with non-private insurance and being currently unemployed had lower AHS scores. The lower hope scores suggest that these patients may have fewer resources to cope with their treatments and diagnoses and may benefit from further inquiry about the need to mitigate cancer-related financial burden to improve hope levels. Further studies are needed to evaluate whether financial toxicity, which has been shown to negatively impact patient outcomes, is correlated to coping and hope.

The Strong Black Woman versus Mental Health Utilization: A Qualitative Study

Recent investigations have elucidated the influence of the strong Black woman (SBW) ideal on the mental health and treatment-seeking behaviors of Black women in the United States. However, factors related to how the SBW ideal affects Black women's positive and negative attitudes toward seeking professional psychological help have yet to be identified. The current study fills this void in the literature through a qualitative examination of how the SBW ideal affects Black women's mental health utilization. Analyses were based on 62 participants, including college students and community members, ranging in age from 18 to 72 years. The present study advances the idea that endorsement of the SBW ideal affects Black women's mental utilization. These results offer evidence and clarification of the impact of the SBW ideal on Black women's mental health and identity-specific points of intervention for mental health practitioners conducting therapeutic work with Black women. Authors provide practice recommendations for practitioners and suggestions for future research.

Self-Esteem, Problem Solving, and Family Coping Responses: Determinants and Consequences for Black Women

Stress is a significant contributor to disease and often worsens pre-existing conditions. Little research to date has focused on stress and coping in black families, particularly black women. The present study examined how self-esteem affects family coping and problem solving among mothers and daughters (N = 119). Results indicate that black mothers had significantly higher amounts of self-esteem than did daughters, potentially signifying that many issues that reduce self-esteem have been resolved for mothers, whereas daughters might still be dealing with issues that lower their self-esteem. Black mothers scored significantly lower than their daughters on perception of ability to solve problems, suggesting that black daughters might still be facing issues that they are actively using problem-solving skills to address. A significant difference between mothers and daughters on the amount of stress they experienced further supports the intergenerational nature of stress, problem solving, and lower self-esteem in the sample of daughters. The results suggest that black women with spouses or domestic partners are better able to adapt to stress than those who are not in partnerships or married. This study provides a more in-depth understanding of intergenerational family processes related to stress and coping among black women.

No Longer Invisible: Understanding the Psychosocial Impact of Skin Color Stratification in the Lives of African American Women

This article examines how skin color stratification, termed "colorism," affects the psychological well-being of African American women. Previous research has shown that the experience of colorism is pervasive within the black community and that black women have been culturally or personally affected by intraracial discrimination. This article describes a qualitative study that used focus groups to investigate the experiences of black women that were categorized according to their self-ascribed skin tone group. The findings indicated that women of different hues have distinctive experiences based on their skin tone, and that these experiences influence how they felt about themselves and interact with others. The article concludes with a discussion of practice, research, and policy implications.

Diversification and the evolution of dispersal ability in the tribe Brassiceae (Brassicaceae)

BACKGROUND AND AIMS

Dispersal and establishment ability can influence evolutionary processes such as geographic isolation, adaptive divergence and extinction probability. Through these population-level dynamics, dispersal ability may also influence macro-evolutionary processes such as species distributions and diversification. This study examined patterns of evolution of dispersal-related fruit traits, and how the evolution of these traits is correlated with shifts in geographic range size, habitat and diversification rates in the tribe Brassiceae (Brassicaceae).

METHODS

The phylogenetic analysis included 72 taxa sampled from across the Brassiceae and included both nuclear and chloroplast markers. Dispersal-related fruit characters were scored and climate information for each taxon was retrieved from a database. Correlations between fruit traits, seed characters, habitat, range and climate were determined, together with trait-dependent diversification rates.

KEY RESULTS

It was found that the evolution of traits associated with limited dispersal evolved only in association with compensatory traits that increase dispersal ability. The evolution of increased dispersal ability occurred in multiple ways through the correlated evolution of different combinations of fruit traits. The evolution of traits that increase dispersal ability was in turn associated with larger seed size, increased geographic range size and higher diversification rates.

CONCLUSIONS

This study provides evidence that the evolution of increased dispersal ability and larger seed size, which may increase establishment ability, can also influence macro-evolutionary processes, possibly by increasing the propensity for long-distance dispersal. In particular, it may increase speciation and consequent diversification rates by increasing the likelihood of geographic and thereby reproductive isolation.

Black women talk about workplace stress and how they cope

Black women face the same struggles as White women; however, they have to face issues of diversity on top of inequality. The purpose of this study was to explore work-related stressors that affect the lives of Black women and how they cope with them. Using an exploratory design with grounded-theory methods, five basic themes emerged that identify when racism and sexism are experienced as stressors for African American women in the workplace. The themes are: (1) being hired or promoted in the workplace, (2) defending one’s race and lack of mentorship, (3) shifting or code switching to overcome barriers to employment, (4) coping with racism and discrimination, and (5) being isolated and/or excluded. The results from this study indicate African American women use emotion- and problem-focused coping responses to manage stress (e.g., racism and sexism) in the workplace. The article concludes with a discussion of practice implications of these findings.

Integrating diversity into graduate social work education: a 30-year retrospective view by MSW-level African American social workers

The study surveyed a national sample of 100 African American master of social work graduates to retroactively assess perceived diversity content in Human Behavior courses before and after the Council on Social Work Education (CSWE) established accreditation standards on diversity. Seventy-one percent of the respondents were females, the mean age was 45.8 years, and their graduation years ranged from 1958 to 2002. Most graduated from northeastern schools (34%), followed by midwestern (28%), southeastern (22%), northwestern (11%), and southwestern (5%) schools. Investigators used the Preparation for Graduate Education Social Work Education Scale and the Human Behavior Survey Addendum (alpha = .97). There were no statistically significant differences on diversity content scores for participants enrolled before and after CSWE diversity standards were established, but graduates of historically Black colleges gave higher diversity content scores in every area. Study includes discussion and implications for Afrocentric theory and the need to prepare practitioners for future social work careers in multicultural communities.

Conditioned responses in courtship behavior of normal and mutant Drosophila

Male courtship behaviour in Drosophila melanogaster is modified by prior sexual experience. Whereas naive males nearly always court virgin females persistently, males previously paired with unreceptive fertilized females subsequently court virgin females in an abbreviated manner, if at all. The probability of diminished male courtship is directly related to the duration of the prior "conditioning" period with a fertilized female. Naive males court fertilized females less vigorously than they court virgins; this depression of male behavior occurs even if the male is blind or if the fertilized female cannot actively reject his courtship. These results suggest that fertilized females are a source of both courtship-provoking and courtship-inhibiting olfactory cues and that the central association of these cues in males is sufficient to bring about the retention of modified courtship behavior. Mutant "amnesiac" males, selected as memory-deficient in a learning test unrelated to courtship [Quinn, W. G., Sziber, P. P. & Booker, R. (1979) Nature (London) 277, 212-214], are trainable by exposure to fertilized females, but the experience-dependent behavior-diminished courtship performance-wanes abnormally rapidly-i.e., less than 1 hour, compared to 2-3 hr for wild-type flies.

Assessment of exposure to secondhand smoke at outdoor bars and family restaurants in Athens, Georgia, using salivary cotinine

Exposure to secondhand smoke (SHS) in outdoor settings is a growing public health concern due to recent indoor smoking bans. The objective of this study was to measure salivary cotinine, a metabolite of nicotine, in subjects aged 21-30 exposed to SHS outside bars and restaurants in Athens, Georgia. Nonsmokers participated during 6-hr periods in outdoor standing or seating areas of bars and restaurants where indoor smoking was banned, as well as a control outdoor location with no smokers over six weekends during the summer and early fall of 2007. Pre- and post-exposure saliva samples (N = 25 person-days at the bar site, N = 28 person-days at the restaurant site, and N = 11 person-days at the control) were collected and analyzed for cotinine. The mean change in the response, (ln(post) - ln(pre)) salivary cotinine levels, was significantly impacted by the type of site (bar, restaurant, control) (F = 5.09; d.f. = 2, 6.7; p = 0.0455). The median percent increase in salivary cotinine from pre-test to post-test was estimated to be 162%, 102%, and 16% at the bar, restaurant, and control sites, respectively, values that were significant increases at bars (t = 4.63; d.f. = 9.24; p = 0.0011) and restaurants (t = 4.33; d.f. = 4.47; p = 0.0097) but not at the control sites. On average, these pre-test to post-test increases in salivary cotinine were significantly higher at bar sites than control sites (t = 3.05; d.f. = 9.85; p = 0.0176) and at restaurant sites compared with control sites (t = 2.35; d.f. = 5.09; p = 0.0461). Nonsmokers outside restaurants and bars in Athens, Georgia, have significantly elevated salivary cotinine levels indicative of secondhand smoke exposure.

The impact of kin and fictive kin relationships on the mental health of black adult children of alcoholics

The purpose of this qualitative study was to examine how kin and fictive kinship relationships help to ameliorate or buffer responses to parental alcoholism and the breakdown in parenting. This qualitative study investigated coping responses developed by college students, who self-identified as adult children of alcoholics (ACOAs) who lived with an alcoholic parent or caregiver. In-depth interviews and follow-up participant checks were used. A descriptive model was developed describing conditions that affected the development of positive self-esteem, the phenomena that arose from those conditions, the context that influenced strategy development, the intervening conditions that influenced strategy development, and the consequences of those strategies. Subcategories of each component of the descriptive model are identified and illustrated by narrative data in relation to the ACOAs' psychological well-being. Implications for research, policy, and practice are discussed.

An exploratory study of differences in self-esteem, kinship social support, and coping responses among African American ACOAs and Non-ACOAs

The author sought to identify differences in kinship social support, self-esteem, and coping responses between African American college students who identify themselves as adult children of alcoholics (ACOAs) and adult children of nonalcoholics (non-ACOAs) at 2 separate universities. The results indicate that there were no differences in levels of self-esteem, kinship social support, and coping responses among ACOAs and non-ACOAs. The author addresses implications for practice, policy, and research.

Principles and problems revolving around rhythm-related genetic variants

Much of what is known about the regulation of circadian rhythms has stemmed from the induction, recognition, or manufacture of genetic variants. Such investigations have been especially salient in chronobiological analyses of Drosophila. Many starting points for elucidation of rhythmic processes operating in this insect entailed the isolation of mutants or the design of engineered gene modifications. Various features of the principles and practices associated with the genetic approach toward understanding clock functions, and chronobiologically related ones, are discussed from perspectives that are largely genetic as such, although intertwined with certain neurogenetic and molecular-genetic concerns when appropriate. Key themes in this treatment connect with the power and problems associated with multiply mutant forms of rhythm-related genes, with the opportunistic or problematical aspects of multigenic variants that are in play (sometimes surprisingly), and with a question as to how forceful chronogenetic inferences have been in terms of elucidating the mechanisms of circadian pacemaking.

Randomized clinical trial of single-dose antibiotic prophylaxis for non-reconstructive breast surgery

Background

The aim of this randomized clinical trial was to determine whether a single intravenous dose of 2 g flucloxacillin could prevent wound infection after primary non-reconstructive breast surgery.

Methods

The study included 618 patients undergoing local excision (n = 490), mastectomy (n = 107) or microdochectomy (n = 21). Patients were randomized to receive either a single dose of flucloxacillin immediately after the induction of anaesthesia or no intervention. Wound morbidity was monitored by an independent research nurse for 42 days after surgery.

Results

The incidence of wound infection was similar in the two groups: 10 of 311 (3·2 per cent) in the flucloxacillin group and 14 of 307 (4·6 per cent) in the control group (χ2 = 0·75, P = 0·387; relative risk 0·71, 95 per cent confidence interval 0·32 to 1·53). The groups also had similar wound scores and rates of moderate or severe cellulitis. Wound infection presented a median of 16 days after surgery.

Conclusion

The administration of a single dose of flucloxacillin failed to reduce the rate of wound infection after non-reconstructive breast surgery.

Measurement of the total active 8B solar neutrino flux at the Sudbury Neutrino Observatory with enhanced neutral current sensitivity

The Sudbury Neutrino Observatory has precisely determined the total active (nu(x)) 8B solar neutrino flux without assumptions about the energy dependence of the nu(e) survival probability. The measurements were made with dissolved NaCl in heavy water to enhance the sensitivity and signature for neutral-current interactions. The flux is found to be 5.21 +/- 0.27(stat)+/-0.38(syst) x 10(6) cm(-2) s(-1), in agreement with previous measurements and standard solar models. A global analysis of these and other solar and reactor neutrino results yields Deltam(2)=7.1(+1.2)(-0.6) x 10(-5) eV(2) and theta=32.5(+2.4)(-2.3) degrees. Maximal mixing is rejected at the equivalent of 5.4 standard deviations.

Constraints on nucleon decay via invisible modes from the Sudbury Neutrino Observatory

Data from the Sudbury Neutrino Observatory have been used to constrain the lifetime for nucleon decay to "invisible" modes, such as n-->3nu. The analysis was based on a search for gamma rays from the deexcitation of the residual nucleus that would result from the disappearance of either a proton or neutron from 16O. A limit of tau(inv)>2 x 10(29) yr is obtained at 90% confidence for either neutron- or proton-decay modes. This is about an order of magnitude more stringent than previous constraints on invisible proton-decay modes and 400 times more stringent than similar neutron modes.

Role of peritoneal mesothelial cells in peritonitis

Background

Peritoneal mesothelial cells have a remarkable capacity to respond to peritoneal insults. They generate an intense biological response and play an important role in the formation of adhesions. This review describes these activities and comments on their relationship to surgical drainage, peritoneal lavage and laparostomy in the management of patients with peritonitis.

Methods and results

Material was identified from previous review articles, references cited in original papers and a Medline search of the literature. The peritoneal mesothelium adapts to peritonitis by facilitating the clearance of contaminated fluid from the peritoneal cavity and inducing the formation of fibrinous adhesions that support the localization of contaminants. In addition, the fluid within the peritoneal cavity is a battleground in which effector mechanisms generated with the involvement of peritoneal mesothelial cells meet the contaminants. The result is a complex mix of cascading processes that have evolved to protect life in the absence of surgery.

Conclusion

Future advances in the management of patients with severe peritonitis may depend upon molecular strategies that modify the activity of peritoneal mesothelial cells.

Surgeons and cognitive processes

BACKGROUND

The surgical mind is geared to make important decisions and perform highly skilled tasks. The aim of this review is to explore the cognitive processes that link these actions.

METHODS

The core of this review is derived from a literature search of a computer database (Medline).

RESULTS AND CONCLUSION

The surgical image is one of action. However, the effective performance of surgery requires more than mere manual dexterity and it is evident that competent surgeons exhibit the cognitive traits that are held by all experts. The changes that are occurring in surgery indicate a need to place greater emphasis on the cognitive processes that underpin the practice of surgery. It is important that surgeons do not become victims of their own cult image.

Thidiazuron induces shoot organogenesis at low concentrations and somatic embryogenesis at high concentrations on leaf and petiole explants of African violet (Saintpaulia ionantha Wendl)

Regeneration via shoot organogenesis and somatic embryogenesis was observed from thidiazuron (TDZ)-treated leaf and petiole explants of greenhouse- and in vitro-grown African violet plants. The response of cultures to other growth regulators over a range of 0.5 microM to 10 microM was 50% less than that observed with TDZ. A comparative study among several cultivars of African violet indicated that "Benjamin" and "William" had the highest regeneration potential. In "Benjamin", higher frequencies of shoot organogenesis (twofold) and somatic embryogenesis (a 50% increase) were observed from in vitro- and greenhouse-grown plants, respectively. At concentrations lower than 2.5 microM, TDZ induced shoot organogenesis, whereas at higher doses (5-10 microM) somatic embryos were formed. These findings provide the first report of simultaneous shoot organogenesis and somatic embryogenesis of African violet explants in response to TDZ.

The prevention of wound infection in patients undergoing colorectal surgery

Colorectal operations are, at best, clean-contaminated procedures, and at times there is gross contamination of both the peritoneal cavity and the surfaces of the surgical wound. In addition, the diseases of the large bowel that require surgery tend to afflict elderly patients. Collectively, the combination of an unclean environment, major surgery and debilitated patients creates a situation that is associated with a very high incidence of wound infection. This review documents the considerable support from clinical trials and meta-analyses that exists for the prophylactic use of a single dose of a suitable parenteral antimicrobial agent. In addition, although the evidence is less clear cut, it does not appear that the use of mechanical bowel preparations reduces the incidence of wound infections after colorectal surgery.

Synthesis of ligand-specific phage-display ScFv against the herbicide picloram by direct cloning from hyperimmunized mouse

Immunoglobulin genes were directly isolated from the splenocytes of a BALB/C mouse hyperimmunized with the auxinic herbicide picloram conjugated to bovine serum albumin. Variable light and heavy domain DNA were joined to produce single-chain Fv (scFv) DNA, which was cloned into phage vector fd-tet-GIIID to display multiple copies of scFv on the filamentous phage minor coat protein gIIIp. The phage-display scFv library (10(4) clones) was selected against picloram conjugated to ovalbumin. After five rounds of panning, individual clones were analyzed. ScFv with different affinities to picloram (IC(50) values ranging from 20 ppb to 10 ppm) were detected in the final enriched pool. The increased avidity of the phage vector enhanced the selection (i.e., panning) of multiple picloram-specific recombinant antibodies. Stringent selection was required to isolate the clones with the highest affinity. Nucleotide sequence analysis of six isolated clones revealed that all of the V(L) belonged to the V kappa 9A family joined to J kappa 2 segments. All of the V(H) belonged to the V(H)()7183 family and joined to two different J segments (i.e., J(H)()2 or J(H)()4). Different from the immune response to large molecular weight molecules (MW > 10,000 Da), which requires both VDJ segment rearrangement and somatic hypermutations, production of high-affinity antibodies to picloram, a small ligand having a formula weight of 241.5 Da, predominantly requires somatic hypermutations.

The nonA gene in Drosophila conveys species-specific behavioral characteristics

The molecular basis of species-specific differences in courtship behavior, a critical factor in preserving species boundaries, is poorly understood. Genetic analysis of all but the most closely related species is usually impossible, given the inviability of hybrids. We have therefore applied interspecific transformation of a single candidate behavioral locus, no-on-transient A (nonA), between Drosophila virilis and D. melanogaster, to investigate whether nonA, like the period gene, might encode species-specific behavioral information. Mutations in nonA can disrupt both visual behavior and the courtship song in D. melanogaster. The lovesong of nonA(diss) mutant males superficially resembles that of D. virilis, a species that diverged from D. melanogaster 40-60 mya. Transformation of the cloned D. virilis nonA gene into D. melanogaster hosts carrying a synthetic deletion of the nonA locus restored normal visual function (the phenotype most sensitive to nonA mutation). However, the courtship song of transformant males showed several features characteristic of the corresponding D. virilis signal, indicating that nonA can act as a reservoir for species-specific information. This candidate gene approach, together with interspecific transformation, can therefore provide a direct avenue to explore potential speciation genes in genetically and molecularly tractable organisms such as Drosophila.

Molecular genetic dissection of the sex-specific and vital functions of the Drosophila melanogaster sex determination gene fruitless

A multibranched hierarchy of regulatory genes controls all aspects of somatic sexual development in Drosophila melanogaster. One branch of this hierarchy is headed by the fruitless (fru) gene and functions in the central nervous system, where it is necessary for male courtship behavior as well as the differentiation of a male-specific abdominal structure, the muscle of Lawrence (MOL). A preliminary investigation of several of the mutations described here showed that the fru gene also has a sex-nonspecific vital function. The fru gene produces a complex set of transcripts through the use of four promoters and alternative splicing. Only the primary transcripts produced from the most distal (P1) promoter are sex-specifically spliced under direction of the sex-determination hierarchy. We have analyzed eight new fru mutations, created by X-ray mutagenesis and P-element excision, to try to gain insight into the relationship of specific transcript classes to specific fru functions. Males that lack the P1-derived fru transcripts show a complete absence of sexual behavior, but no other defects besides the loss of the MOL. Both males and females that have reduced levels of transcripts from the P3 promoter develop into adults but frequently die after failing to eclose. Analysis of the morphology and behavior of adult escapers showed that P3-encoded functions are required for the proper differentiation and eversion of imaginal discs. Furthermore, the reduction in the size of the neuromuscular junctions on abdominal muscles in these animals suggests that one of fru's sex-nonspecific functions involves general aspects of neuronal differentiation. In mutants that lack all fru transcripts as well as a small number of adjacent genes, animals die at an early pupal stage, indicating that fru's function is required only during late development. Thus, fru functions both in the sex-determination regulatory hierarchy to control male sexual behavior through sex-specific transcripts and sex-nonspecifically to control the development of imaginal discs and motorneuronal synapses during adult development through sex-nonspecific transcript classes.

The effects of competition and competitiveness on cardiovascular activity

Cardiovascular activity was measured at resting baseline and in response to a car racing game, undertaken in competition or in cooperation with an experimenter, or individually. Competitiveness and win and goal orientations were assessed by questionnaire. Competition provoked increases in blood pressure and heart rate, and a significant shortening of the preejection period, an index of enhanced beta-adrenergic influences on the heart. The cooperation task was largely without effect, and although the solo task affected cardiovascular activity, it did so to a lesser extent and much less consistently than did the competition task. The three task conditions, then, were largely distinguishable by their capacity to activate beta-adrenergic processes. Participants high in competitiveness and desire to win showed higher blood pressure reactions and greater shortening of the preejection period to competition than those low in these characteristics.

Seasonal leaching and biodegradation of dicamba in turfgrass

The leaching of surface-applied herbicides, such as dicamba (2methoxy-3,6-dichlorobenzoic acid), to ground water is an environmental concern. Seasonal changes in soil temperature and water content, affecting infiltration and biodegradation, may control leaching. The objectives of this study were to (i) investigate the leaching of dicamba applied to turfgrass, (ii) measure the degradation rate of dicamba in soil and thatch in the laboratory under simulated field conditions, and (iii) test the ability of the model EXPRES (containing LEACHM) to simulate the field transport and degradation processes. Four field lysimeters, packed with sandy loam soil and topped with Kentucky bluegrass (Poa pratensis L.) sod, were monitored after receiving three applications (May, September, November) of dicamba. Concentrations of dicamba greater than 1 mg L(-1) were detected in soil water. Although drying of the soil during the summer prevented deep transport, greater leaching occurred in late autumn due to increased infiltration. From the batch experiment, the degradation rate for dicamba in thatch was 5.9 to 8.4 times greater than for soil, with a calculated half-life as low as 5.5 d. Computer modeling indicated that the soil and climatic conditions would influence the effectiveness of greater degradation in thatch for reducing dicamba leaching. In general, EXPRES predictions were similar to observed concentration profiles, though peak dicamba concentrations at the 10-cm depth tended to be higher than predicted in May and November. Differences between predictions and observations are probably a result of minor inaccuracies in the water-flow simulation and the model's inability to modify degradation rates with changing climatic conditions.

A new role for cryptochrome in a Drosophila circadian oscillator

Cryptochromes are flavin/pterin-containing proteins that are involved in circadian clock function in Drosophila and mice. In mice, the cryptochromes Cry1 and Cry2 are integral components of the circadian oscillator within the brain and contribute to circadian photoreception in the retina. In Drosophila, cryptochrome (CRY) acts as a photoreceptor that mediates light input to circadian oscillators in both brain and peripheral tissue. A Drosophila cry mutant, cryb, leaves circadian oscillator function intact in central circadian pacemaker neurons but renders peripheral circadian oscillators largely arrhythmic. Although this arrhythmicity could be caused by a loss of light entrainment, it is also consistent with a role for CRY in the oscillator. A peripheral oscillator drives circadian olfactory responses in Drosophila antennae. Here we show that CRY contributes to oscillator function and physiological output rhythms in the antenna during and after entrainment to light-dark cycles and after photic input is eliminated by entraining flies to temperature cycles. These results demonstrate a photoreceptor-independent role for CRY in the periphery and imply fundamental differences between central and peripheral oscillator mechanisms in Drosophila.

A meta-analysis of peritoneal lavage for acute pancreatitis

BACKGROUND AND AIM

It has been postulated that continuous irrigation of the peritoneal cavity with crystalloid solutions in patients with acute pancreatitis can improve mortality and morbidity. The aim of the study is to perform a meta-analysis of available randomized prospective clinical trials, to evaluate whether lavage influences mortality and morbidity in patients with acute pancreatitis.

METHODS

We performed a computer search of Medline for all available literature on the use of lavage in patients with acute pancreatitis. A meta-analysis was conducted on eight randomized, prospective, clinical trials (a total of 333 patients) evaluating continuous peritoneal lavage in patients with acute pancreatitis. The end-points were mortality and morbidity (i.e. pancreatic necrosis, peripancreatic fluid collections, intra-abdominal abscess formation, septicemia, organ system failure).

RESULTS

Continuous lavage did not improve either mortality (weighted mean difference 1.6%, 95% CI -6.7% to 9.9%, not significant (n.s.)) or morbidity (weighted mean difference 6.2%, 95% CI -3.2% to 15.6%, n.s.) when compared with control patients.

CONCLUSIONS

The use of continuous peritoneal lavage in patients with acute pancreatitis has not been found to be associated with any significant improvement in mortality or morbidity.

Development of an enzyme-linked immunosorbent assay for the detection of dicamba

A competitive indirect enzyme-linked immunosorbent assay (CI-ELISA) was developed to quantitate the herbicide dicamba (3,6-dichloro-2-methoxybenzoic acid) in water. The CI-ELISA has a detection limit of 2.3 microg L(-1) and a linear working range of 10--10000 microg L(-1) with an IC(50) value of 195 microg L(-1). The dicamba polyclonal antisera did not cross-react with a number of other herbicides tested but did cross-react with a dicamba metabolite, 5-hydroxydicamba, and structurally related chlorobenzoic acids. The assay was used to estimate quantitatively dicamba concentrations in water samples. Water samples were analyzed directly, and no sample preparation was required. To improve detection limits, a C(18) (reversed phase) column concentration step was devised prior to analysis, and the detection limits were increased by at least by 10-fold. After the sample preconcentration, the detection limit, IC(50), and linear working range were 0.23, 19.5, and 5-200 microg L(-1), respectively. The CI-ELISA estimations in water correlated well with those from gas chromatography-mass spectrometry (GC-MS) analysis (r(2) = 0.9991). This assay contributes to reducing laboratory costs associated with the conventional GC-MS residue analysis techniques for the quantitation of dicamba in water.

New reproductive anomalies in fruitless-mutant Drosophila males: extreme lengthening of mating durations and infertility correlated with defective serotonergic innervation of reproductive organs

Several features of male reproductive behavior are under the neural control of fruitless (fru) in Drosophila melanogaster. This gene is known to influence courtship steps prior to mating, due to the absence of attempted copulation in the behavioral repertoire of most types of fru-mutant males. However, certain combinations of fru mutations allow for fertility. By analyzing such matings and their consequences, we uncovered two striking defects: mating times up to four times the normal average duration of copulation; and frequent infertility, regardless of the time of mating by a given transheterozygous fru-mutant male. The lengthened copulation times may be connected with fru-induced defects in the formation of a male-specific abdominal muscle. Production of sperm and certain seminal fluid proteins are normal in these fru mutants. However, analysis of postmating qualities of females that copulated with transheterozygous mutants strongly implied defects in the ability of these males to transfer sperm and seminal fluids. Such abnormalities may be associated with certain serotonergic neurons in the abdominal ganglion in which production of 5HT is regulated by fru. These cells send processes to contractile muscles of the male's internal sex organs; such projection patterns are aberrant in the semifertile fru mutants. Therefore, the reproductive functions regulated by fruitless are expanded in their scope, encompassing not only the earliest stages of courtship behavior along with almost all subsequent steps in the behavioral sequence, but also more than one component of the culminating events.

The circadian clock of fruit flies is blind after elimination of all known photoreceptors

Circadian rhythms are entrained by light to follow the daily solar cycle. We show that Drosophila uses at least three light input pathways for this entrainment: (1) cryptochrome, acting in the pacemaker cells themselves, (2) the compound eyes, and (3) extraocular photoreception, possibly involving an internal structure known as the Hofbauer-Buchner eyelet, which is located underneath the compound eye and projects to the pacemaker center in the brain. Although influencing the circadian system in different ways, each input pathway appears capable of entraining circadian rhythms at the molecular and behavioral level. This entrainment is completely abolished in glass(60j) cry(b) double mutants, which lack all known external and internal eye structures in addition to being devoid of cryptochrome.

Decompression, fusion, and instrumentation surgery for complex lumbar spinal stenosis

Between 1990 and 1993, 54 consecutive patients were treated with decompression, fusion and instrumentation surgery for complex lumbar spinal stenosis. The mean age of the patients was 60 years. The average followup was 39 months. Clinically, there was one deep wound infection, and three mechanical failures. There were two staged operations. There were three revision surgeries performed for mechanical reasons. Of the 47 patients who completed the questionnaire, 96% of patients were very satisfied or somewhat satisfied with the operation, 98% were satisfied with relief of pain, 94% were satisfied with their ability to walk, 89% were satisfied with their strength, and 94% were satisfied with balance. Survivorship analysis (failure endpoint was revision surgery) revealed that at the end of 4 years, the patient had a 92% chance of not undergoing revision surgery for any reason (mechanical and infectious), and a 94% chance of not undergoing revision surgery for mechanical reasons. Lumbar decompression, fusion, and instrumentation surgery seems to be efficacious in patients with complex lumbar spinal stenosis (associated previous lumbar spine operations with evidence of radiographic instability, radiographic evidence of junctional stenosis after surgery, radiographic evidence of instability, degenerative spondylolisthesis greater than Grade I with instability, if present, and degenerative scoliosis with a curve greater than 20 degrees).

Pretreatment with glycine reduces the severity of warm intestinal ischemic-reperfusion injury in the rat

Free jejunal flaps may experience adverse effects immediately after revascularization because of ischemic-reperfusion injury. In this study the authors evaluated the ability of glycine to protect the small intestine against the effects of a warm ischemic-reperfusion injury. Male Wistar rats (N = 30) were randomized to either a baseline group (no intervention), a control group (local arterial infusion with normal saline), or a glycine group (local arterial infusion with 20% glycine). Pretreatment with 20% glycine increased significantly (p < 0.05) mucosal protein and deoxyribonucleic acid content, reduced intestinal myeloperoxidase activity, and maintained mucosal glutaminase activity. These results indicate that some of the indicators of ischemic-reperfusion injury are improved by pretreatment with a 20% glycine solution.

Immunoaffinity purification of chlorimuron-ethyl from soil extracts prior to quantitation by enzyme-linked immunosorbent assay

A competitive-indirect enzyme-linked immunosorbent assay (CI-ELISA) was developed to quantify chlorimuron-ethyl in soil. The linear working range of the assay was from 1 to 1000 ng mL(-)(1). The assay had an I(50) value of 54 ng mL(-)(1), with a limit of detection of 2 ng mL(-)(1) and a limit of quantification of 27 ng mL(-)(1). Three soils were extracted using a carbonate buffer (pH 9.0) and the extracts spiked with chlorimuron-ethyl. Because of the effects of coextractants (matrix effects) from soil on the accuracy and precision of the ELISA, immunoaffinity chromatography (IAC) was used to purify chlorimuron-ethyl from soil extracts prior to analysis. The immunoaffinity columns, which had a total binding capacity of 1350 ng of chlorimuron-ethyl mL(-)(1) of immunosorbent, were prepared by binding anti-chlorimuron-ethyl antibodies to protein G Sepharose 4B. Although the matrix effects were largely removed using the affinity column, they could be completely removed by first passing the extract through a column containing epoxy-coupled 1,6-diaminohexane (EAH) Sepharose 4B to remove organic acids prior to IAC. Assay sensitivity was increased 100-fold using IAC to purify and simultaneously concentrate chlorimuron-ethyl from soil extracts. The purification strategy (EAH followed by IAC chromatography) removed matrix effects from all three soils and allowed for the accurate quantitation of chlorimuron-ethyl in soil extracts.

The development of undergraduate curricula in surgery: III. Assessment

The present review is aimed at providing an overview of the assessment process. The mode of assessment has a powerful influence on the learning behaviour of students. It is therefore important to ensure that there is congruity between the objective, the task and the test. In other words: define it, teach it, examine it. It is difficult to evaluate many of the attributes that we desire in a doctor; and examples of this include empathy, ethical behaviour, problem-solving skills, ability to self-educate and teamwork. Nevertheless, it is generally agreed that it is better to measure uncertainly the significant than to measure reliably and validly the trivial. Furthermore different methods of assessment suit different educational objectives (fitness for purpose) and this supports the use of multiple assessment techniques.

The development of undergraduate curricula in surgery: II. Generic surgery

The present paper focuses upon the issues in curricular reform that have specific relevance for surgeons. A central theme is that, taking into account the dual diminution of general surgery and large central teaching hospitals, there is a need to have a clear vision of what should be included in surgical curricula and how we can adjust to new methods of teaching and learning.

Abnormalities of male-specific FRU protein and serotonin expression in the CNS of fruitless mutants in Drosophila

The fruitless gene in Drosophila produces male-specific protein (FRU(M)) involved in the control of courtship. FRU(M) spatial and temporal patterns were examined in fru mutants that exhibit aberrant male courtship. Chromosome breakpoints at the locus eliminated FRU(M). Homozygous viable mutants exhibited an intriguing array of defects. In fru(1) males, there were absences of FRU(M)-expressing neuronal clusters or stained cells within certain clusters, reductions of signal intensities in others, and ectopic FRU(M) expression in novel cells. fru(2) males exhibited an overall decrement of FRU(M) expression in all neurons normally expressing the gene. fru(4) and fru(sat) mutants only produced FRU(M) in small numbers of neurons at extremely low levels, and no FRU(M) signals were detected in fru(3) males. This array of abnormalities was inferred to correlate with the varying behavioral defects exhibited by these mutants. Such abnormalities include courtship among males, which has been hypothesized to involve anomalies of serotonin (5-HT) function in the brain. However, double-labeling uncovered no coexpression of FRU(M) and 5-HT in brain neurons. Yet, a newly identified set of sexually dimorphic FRU(M)/5-HT-positive neurons was identified in the abdominal ganglion of adult males. These sexually dimorphic neurons (s-Abg) project toward regions of the abdomen involved in male reproduction. The s-Abg neurons and the proximal extents of their axons were unstained or absent in wild-type females and exhibited subnormal or no 5-HT immunoreactivity in certain fru-mutant males, indicating that fruitless controls the formation of these cells or 5-HT production in them.

The development of undergraduate curricula in surgery: I. General issues

Undergraduate surgical education is evolving in line with societal changes, the growth of information technology, developments in educational processes, and shifts in the health-care industry. The underlying principles include the establishment of a strong linkage between the objectives and content of curricula, the identification of core knowledge and appropriate attitudes, achieving competence in basic skills, the creation of greater integration, and the promotion of study in depth. The aim of the present paper was to provide surgeons with an overview of these developments.

Polyclonal-based ELISA for the identification of cyclohexanedione analogs that inhibit maize acetyl coenzyme-A carboxylase

Cyclohexanedione herbicides inhibit monocotyledonous acetyl coenzyme-A carboxylase (ACCase; E.C. 6.4.1.2.), which catalyzes the first committed step in fatty acid biosynthesis. Although the target site has been identified, little is known about the mechanisms involved in herbicide binding. An immunological study was undertaken to create a model to better characterize the herbicide-enzyme interaction. Cyclohexanedione-specific antiserum was raised in New Zealand white rabbits by immunizing them with a cyclohexanedione analog-bovine serum albumin conjugate. Two indirect enzyme-linked immunosorbent assays (ELISA) were developed using 2 different cyclohexanedione analogs conjugated to ovalbumin as coating conjugates. Nineteen cyclohexanedione analogs, 13 active ACCase inhibitors, and 6 inactive analogs were tested for their ability to compete with both coating conjugates for antiserum binding. All active ACCase inhibitors were observed to compete with both coating conjugates, whereas all inactive analogs failed to compete with at least one coating conjugate. On the basis of these results, the immunological model could be used to distinguish all active ACCase inhibitors from inactive analogs using the 2 ELISAs sequentially.

Malnutrition: role of the TwoCal HN Med Pass program

Malnutrition is common in older adults and is associated with poor outcomes. The causes and outcomes of malnutrition are discussed, and the TwoCal HN Med Pass program, designed to overcome poor dietary intake, is described. Benefits of the program, role of the pharmacist, identification of candidates for the TwoCal HN Med Pass program, and health care team roles and responsibilities are reviewed.

Molecular and behavioral analysis of sex-linked courtship song variation in a natural population of Drosophila melanogaster

Genes controlling the "lovesong" in Drosophila are particularly interesting under a evolutionary point of view as they could be involved in the reproductive isolation between closely related species and, as a consequence, in the speciation process. We carried out a survey of sex-linked molecular and behavioral courtship song variation in 27 lines derived from a natural population of Drosophila melanogaster in Italy. We sequenced a 983 bp fragment of cacophony(cac), a calcium channel gene controlling aspects of the courtship song. The same region was also sequenced in a D. simulans strain. Only 5 non-coding sites were polymorphic among the D. melanogaster lines, and no amino acid substitutions were found between the two species. Statistical tests applied to the data did not reveal any significant deviations from a neutral model. Using the same lines we also carried out an analysis of three different song parameters which are known to be affected by the cac(S) song mutation: interpulse-interval (IPI), pulse amplitude (PA) and cycles per pulse (CPP). We found significant differences among the lines in IPI and PA, and for the latter a significant association with one of the polymorphic sites of cac.

Antibiotic prophylaxis for patients undergoing breast surgery

Some groups of patients undergoing clean surgery benefit from the provision of antibiotic prophylaxis against wound infection. Breast surgery may belong to this category because several substantial studies have reported that it is accompanied by an unacceptably high rate of wound infection. However, only two clinical trials have addressed this issue and both produced equivocal results. Resolution of this problem is important because, aside from the usual advantages obtained by preventing such complications, wound infection diminishes the proportion of patients with breast cancer who start adjuvant regimens within an optimum time after surgery.

Two novel doubletime mutants alter circadian properties and eliminate the delay between RNA and protein in Drosophila

Phosphorylation is an important feature of pacemaker organization in Drosophila. Genetic and biochemical evidence suggests involvement of the casein kinase I homolog doubletime (dbt) in the Drosophila circadian pacemaker. We have characterized two novel dbt mutants. Both cause a lengthening of behavioral period and profoundly alter period (per) and timeless (tim) transcript and protein profiles. The PER profile shows a major difference from the wild-type program only during the morning hours, consistent with a prominent role for DBT during the PER monomer degradation phase. The transcript profiles are delayed, but there is little effect on the protein accumulation profiles, resulting in the elimination of the characteristic lag between the mRNA and protein profiles. These results and others indicate that light and post-transcriptional regulation play major roles in defining the temporal properties of the protein curves and suggest that this lag is unnecessary for the feedback regulation of per and tim protein on per and tim transcription.

Cryptochromes: sensory reception, transduction, and clock functions subserving circadian systems

Cryptochromes (CRYs) are blue-light-absorbing proteins involved in a variety of biological phenomena. In animals, CRYs exhibit a certain versatility with regard to these organisms' circadian rhythms, as has been revealed by the effects of mutations and molecular manipulations. The rhythm system of Drosophila uses one gene's worth of CRY protein to transmit light into a circadian clock within the brain, which controls the fly's sleep-wake cycles. In fact, the relevant pacemaking neurons are themselves circadian photoreceptive structures. In peripheral tissues and others located posterior to the brain, Drosophila CRY may be a photoreceptive molecule and also part of the pacemaker mechanism. Mice have two CRY-encoding genes. They are expressed in many tissues, including the retina and a clock structure within the brain. In the former location, mouse CRY may play a circadian-photoreceptive role, along with that mediated by rhodopsins found elsewhere in the retina. In the latter tissue, the hypothalamic suprachiasmatic nucleus, mouse CRYs are closely connected to the multimolecule murine clock mechanism.

Starvation alters the activity and mRNA level of glutaminase and glutamine synthetase in the rat intestine

The metabolism of glutamine, the main respiratory fuel of enterocytes, is governed by the activity of glutaminase and glutamine synthetase. Because starvation induces intestinal atrophy, it might alter the rate of intestinal glutamine utilization. This study examined the effect of starvation on the activity, level of mRNA, and distribution of mRNA of glutaminase and glutamine synthetase in the rat intestine. Rats were randomized into groups and were either: (1) fed for 2 days with rat food ad libitum or (2) starved for 2 days. Standardized segments of jejunum and ileum were removed for the estimation of enzyme activity, level of mRNA, and in situ hybridization analysis. The jejunum of the fed rats had a greater activity of both enzymes per centimeter of intestine (P < 0.01), a greater glutaminase specific activity (1.97 +/- 0.45 vs. 1.09 +/- 0.34 micromol/hr/mg protein, P < 0.01), and a lower level of glutaminase and glutamine synthetase mRNA. The ileum of the fed rats had a greater activity of glutamine synthetase per centimeter of intestine (162.9 +/- 50.6 vs. 91.0 +/- 23.1 nmol/hr/cm bowel, P < 0.01), a lower level of glutaminase mRNA, and a greater level of glutamine synthetase mRNA. In situ hybridization analysis showed that starvation does not alter the distribution of glutaminase and glutamine synthetase mRNA in the intestinal mucosa. This study confirms that starvation decreases the total intestinal activity per centimeter of both glutaminase and glutamine synthetase. More importantly, the results indicate that the intestine adapts to starvation by accumulating glutaminase mRNA. This process prepares the intestine for a restoration of intake.