Optimizing the Nutrition Support Care Model: Analysis of Survey Data

BACKGROUND

Malnutrition is under-recognized and under-diagnosed, despite high prevalence rates and associated poor clinical outcomes. The involvement of clinical nutrition experts, especially physicians, in the care of high-risk patients with malnutrition remains low, despite evidence demonstrating lower complication rates with nutrition support team (NST) management. To facilitate solutions, a survey was designed to elucidate the nature of NSTs and physician involvement and identify needs for novel nutrition support care models.

METHODS

This survey assessed demographics of NSTs, factors contributing to the success of NSTs, elements of nutrition education, and other barriers to professional growth.

RESULTS

Of 255 respondents, 235 complete surveys were analyzed. The geographic distribution of respondents correlated with population concentrations of the United States (r = 90.8%, p-value <0.0001). Most responding physicians (80.7%) reported being a member of NSTs, compared with 56.5% of dietitians. Of those not practicing in NSTs (N = 81, 34.4%), 12.3% reported an NST was previously present at their institution but had been disbanded. Regarding NSTs, financial concerns were common (48.9%), followed by leadership (30.6%), and healthcare professional (HCP) interest (23.4%). A majority (73.6%) of all respondents wanted additional training in nutrition, but reported insufficient protected time, ability to travel, or support from administrators or other HCPs.

CONCLUSION

Core actions resulting from this survey focused on formalizing physician roles, increasing inter-disciplinary nutrition support expertise, utilizing cost-effective screening for malnutrition, and implementing intervention protocols. Additional actions included increasing funding for clinical practice, education, and research, all within an expanded portfolio of pragmatic nutrition support care models.

CLINICAL RELEVANCY STATEMENT

Physician engagement in nutrition support continues to remain low despite the increasing prevalence of malnutrition. This problem, and the working solution, is in the context of decreased engagement of other healthcare professionals in nutrition support, as well as declining Nutrition Support Team utilization. To address these issues, the ASPEN Physician Engagement Committee (PEC) conducted a survey of healthcare professionals (HCPs) involved in nutrition support. Key findings include: (1) lack of financial support and physician champions with financial knowledge; (2) inadequate valuation of physicians and other nutrition support HCPs and NSTs, and their impact on clinical outcomes; and (3) significant barriers to primary and supplementary training for physicians in nutrition. Accordingly, the PEC recommends: (1) development of cost-effective screening and intervention for malnutrition; (2) expansion of nutrition support care models appropriately scaled to the available resources and expertise; and (3) development of a knowledge translation platform to foster transmission of novel breakthroughs while addressing research, knowledge, and practice gaps. This article is protected by copyright. All rights reserved.

The first juvenile dromaeosaurid (Dinosauria: Theropoda) from Arctic Alaska

Compared to the osteological record of herbivorous dinosaurs from the Late Cretaceous Prince Creek Formation of northern Alaska, there are relatively fewer remains of theropods. The theropod record from this unit is mostly comprised of isolated teeth, and the only non-dental remains known can be attributed to the troodontid cf. Troodon and the tyrannosaurid Nanuqsaurus. Thus far, the presence of members of Dromaeosauridae has been limited to isolated teeth. Here we describe a symphyseal portion of a small dentary with two ziphodont teeth. Based on tooth shape, denticle morphology, and the position of the Meckelian groove, we attribute this partial dentary to a saurornitholestine dromaeosaurid. The fibrous bone surface, small size, and higher number of mesial denticles compared to distal ones point to a juvenile growth stage for this individual. Multivariate comparison of theropod teeth morphospace by means of principal component analysis reveals an overlap between this dentary and Saurornitholestinae dromaeosaurid morphospace, a result supported by phylogenetic analyses. This is the first confirmed non-dental fossil specimen from a member of Dromaeosauridae in the Arctic, expanding on the role of Beringia as a dispersal route for this clade between Asia and North America. Furthermore, the juvenile nature of this individual adds to a growing body of data that suggests Cretaceous Arctic dinosaurs of Alaska did not undergo long-distance migration, but rather they were year-round residents of these paleopolar latitudes.

Data supporting Maastrichtian paleoclimate variables applying a multi proxy approach to a paleosol profile, Arctic Alaska

We provide the dataset of climate variables related to the research article “Paleoclimate reconstruction of the Prince Creek Formation, Arctic Alaska, during Maastrichtian global warming” [1]. The dataset includes mean annual precipitation (MAP) values determined using two independent proxies, estimates of the oxygen isotope composition of meteoric water (δ¹⁸O_w) obtained from smectites and a comparison with previously published siderite data. We also provide the data used to calculate the total flux of CO₂ required for the weathering of silicates. This dataset is an example of a multi proxy approach that could add further insight for researchers in the selection of suitable proxies for paleoclimatic interpretations.

The First Definite Lambeosaurine Bone From the Liscomb Bonebed of the Upper Cretaceous Prince Creek Formation, Alaska, United States

The Prince Creek Formation of Alaska, a rock unit that represents lower coastal plain and delta deposits, is one of the most important formations in the world for understanding vertebrate ecology in the Arctic during the Cretaceous. Here we report on an isolated cranial material, supraoccipital, of a lambeosaurine hadrosaurid from the Liscomb Bonebed of the Prince Creek Formation. The lambeosaurine supraoccipital has well-developed squamosal bosses and a short sutural surface with the exoccipital-opisthotic complex, and is similar to lambeosaurine supraoccipitals from the Dinosaur Park Formation in having anteriorly positioned squamosal bosses. Affinities with Canadian lambeosaurines elucidate more extensive faunal exchange between the Arctic and lower paleolatitudes which was previously suggested by the presence of Edmontosaurus, Pachyrhinosaurus, tyrannosaurids, and troodontids in both regions. The presence of one lambeosaurine and nine hadrosaurine supraoccipitals in the Liscomb Bonebed suggests hadrosaurine dominated faunal structure as in the Careless Creek Quarry of the USA that was also deposited under a near-shore environment. It differs from the lambeosaurine dominant structures of localities in Russia and China interpreted as inland environments. This may suggest that lambeosaurines had less preference for near-shore environments than hadrosaurines in both Arctic and lower paleolatitudes.

Note: Internal diamagnetic flux measurements on ASDEX Upgrade

Internal diamagnetic flux measurements, with measurement loops and compensation magnetic probes inside the vacuum vessel, are now available on the ASDEX Upgrade tokamak. The measured diamagnetic flux is compared to that predicted by simulations and calculated from equilibrium reconstruction. The diamagnetic flux measured at 2 positions separated toroidally by 180° in the vacuum vessel is compared.

Lacosamide Pharmacokinetics in a Critically Ill Patient Receiving Continuous Venovenous Hemofiltration

Lacosamide is a new-generation antiepileptic drug (AED) that is eliminated by both hepatic and renal mechanisms. Lacosamide elimination by continuous renal replacement therapy (CRRT) has never been studied. The objective of this case report was to describe lacosamide pharmacokinetics in the setting of CRRT. We describe a single patient admitted to the study center with status epilepticus and multiorgan failure. The patient required both continuous venovenous hemofiltration (CVVH) and several AEDs. He was receiving intravenous lacosamide 200 mg twice/day at steady state prior to sampling. Plasma lacosamide concentrations were derived using a validated high-performance liquid chromatography method. Parameters were calculated using Phoenix WinNonlin 7.1 software. The peak concentration at steady state was 7.7 mg/L, the trough concentration was 5.9 mg/L (goal 5-12 mg/L). The volume of distribution was 0.7 L/kg, the elimination half-life was 21 hours, and the sieving coefficient was 0.8 (± 0.06). Lacosamide was cleared by CVVH as demonstrated by the sieving coefficient, but plasma concentrations remained within goal range throughout the dosing interval. These results may suggest that lacosamide 200 mg twice/day is a useful dosing strategy for critically ill patients who require CVVH.

Real-time diamagnetic flux measurements on ASDEX Upgrade

Real-time diamagnetic flux measurements are now available on ASDEX Upgrade. In contrast to the majority of diamagnetic flux measurements on other tokamaks, no analog summation of signals is necessary for measuring the change in toroidal flux or for removing contributions arising from unwanted coupling to the plasma and poloidal field coil currents. To achieve the highest possible sensitivity, the diamagnetic measurement and compensation coil integrators are triggered shortly before plasma initiation when the toroidal field coil current is close to its maximum. In this way, the integration time can be chosen to measure only the small changes in flux due to the presence of plasma. Two identical plasma discharges with positive and negative magnetic field have shown that the alignment error with respect to the plasma current is negligible. The measured diamagnetic flux is compared to that predicted by TRANSP simulations. The poloidal beta inferred from the diamagnetic flux measurement is compared to the values calculated from magnetic equilibrium reconstruction codes. The diamagnetic flux measurement and TRANSP simulation can be used together to estimate the coupled power in discharges with dominant ion cyclotron resonance heating.

Emotions correlate with perceived mental effort and concentration disruption in adult sport performers

Two studies explored the relationship between emotions, perceived mental effort and concentration disruption in adult sport performers. In Study 1, semi-professional association football players completed questionnaire measures before and after a competitive match. In Study 2, student athletes completed questionnaire measures for two performance scenarios: one in which they were performing above their normal level and one in which they were performing below their normal level. Findings demonstrated that cognitive trait anxiety was associated with greater disruptions in concentration but was unrelated to mental effort. For state measures, athletes reported greater levels of concentration disruption when experiencing high levels of anxiety or high levels of happiness, and fewer disruptions in concentration when experiencing high levels of excitement. Findings also showed that excitement was associated with low levels of mental effort during good performances and high levels of mental effort during poor performances; anxiety and happiness were associated with high levels of mental effort during good performances and low levels of mental effort during poor performances. Taken together, these studies point towards potential benefits accompanying high levels of excitement and potential disadvantages accompanying high levels of anxiety and happiness.

Cognitive and affective components of challenge and threat states

We explored the cognitive and affective components of the Theory of Challenge and Threat States in Athletes (TCTSA) using a cross-sectional design. One hundred and seventy-seven collegiate athletes indicated how they typically approached an important competition on measures of self-efficacy, perceived control, achievement goals, emotional states and interpretation of emotional states. Participants also indicated to what extent they typically perceived the important competition as a challenge and/or a threat. The results suggest that a perception of challenge was not predicted by any of the cognitive components. A perception of threat was positively predicted by avoidance goals and negatively predicted by self-efficacy and approach goals. Both challenge and threat had a positive relationship with anxiety. Practical implications of this study are that an avoidance orientation appeared to be related to potentially negative constructs such as anxiety, threat and dejection. The findings may suggest that practitioners and researchers should focus on reducing an avoidance orientation, however the results should be treated with caution in applied settings, as this study did not examine how the combination of constructs exactly influences sport performance. The results provided partial support for the TCTSA with stronger support for proposed relationships with threat rather than challenge states.

May 2001: 32 year old female with dural mass encircling cervical spinal cord

The May COM. A 32-year-old woman with a history of previous mastoid surgery presented with bilateral extremity weakness and ambulatory instability. MRI revealed a dural-based mass completely encircling the upper cervical spinal cord. Workup was significant for an abnormally elevated c-ANCA, positive at a dilution of 1:128. A portion of the lesion was removed by a posterior surgical approach to decompress the cervical cord. Histologic examination of the dura showed a dense granulomatous infiltrate with vasculitis and giant cells; coupled with the positive c-ANCA, the process was felt to be most consistent with Wegener's granulomatosis. Wegener's granulomatosis infrequently involves the dura or meninges and has not previously been reported to affect dura of the cervical cord. Symptomatic improvement followed surgical decompression and high-dose corticosteroid therapy, with resultant resolution of an elevated c-ANCA titer.

Agitation and/or aggression after traumatic brain injury in the pediatric population treated with ziprasidone. Clinical article

OBJECT

Agitation and aggression are common after traumatic brain injury (TBI) and can hamper recovery and rehabilitative efforts. To date, there is no consensus on pharmaceutical intervention for these conditions after TBI. Ziprasidone has been reported efficacious in this population but the evidence is limited. The authors report their experience of using ziprasidone to treat posttraumatic brain injury agitation in 20 consecutive pediatric patients. A secondary objective of this case series was to attempt to establish an age-specific dosage and identify possible side effects of this medication.

METHODS

This case series study was performed at a university hospital and pediatric trauma center. Over an 18-month period, all patients who presented to the pediatric intensive care unit with TBI and later developed agitation and/or aggression were treated with ziprasidone as the sole intervention. Pre- and posttreatment scores on the Riker Sedation-Agitation Scale (SAS) were recorded along with demographic data.

RESULTS

Twenty children received ziprasidone for agitation and/or aggression during the immediate recovery period from TBI. The median patient age was 8 years (range 9 months-17 years). Children were stratified into 4 age groups: <2 years old (Group 1), 2-6 years old (Group 2), 7-12 years old (Group 3), and >or=13 years old (Group 4). The SAS score, before and 24 hours after the initiation of ziprasidone, demonstrated a significant reduction after initiation of the medication (p<0.001). The initial dose for Groups 1-4 was 1.7, 0.9, 0.7, and 0.6 mg/kg, respectively, with final doses of 1.8, 1.5, 1.7, and 0.07 mg/kg, respectively. The duration of therapy for Groups 1-4 was 5, 8, 6, and 3 days, respectively. All patients received continuous cardiac and blood-pressure monitoring. No adverse events were reported in any of the age groups.

CONCLUSIONS

Based on this limited patient series, ziprasidone appears to be safe and effective in pediatric patients with closed head injuries who develop agitation and/or aggression in the immediate postinjury period. Ziprasidone consistently lowered SAS scores and did so in all age groups. There were minimal dose adjustments and the duration of therapy was relatively brief. No adverse events were reported. A prospective trial of ziprasidone in this population appears warranted.

Use of real-time qPCR to quantify members of the unculturable heterotrophic bacterial community in a deep sea marine sponge, Vetulina sp

In this report, real-time quantitative PCR (TaqMan qPCR) of the small subunit (SSU) 16S-like rRNA molecule, a universal phylogenetic marker, was used to quantify the relative abundance of individual bacterial members of a diverse, yet mostly unculturable, microbial community from a marine sponge. Molecular phylogenetic analyses of bacterial communities derived from Caribbean Lithistid sponges have shown a wide diversity of microbes that included at least six major subdivisions; however, very little overlap was observed between the culturable and unculturable microbial communities. Based on sequence data of three culture-independent Lithistid-derived representative bacteria, we designed probe/primer sets for TaqMan qPCR to quantitatively characterize selected microbial residents in a Lithistid sponge, Vetulina, metagenome. TaqMan assays included specificity testing, DNA limit of detection analysis, and quantification of specific microbial rRNA sequences such as Nitrospira-like microbes and Actinobacteria up to 172 million copies per microgram per Lithistid sponge metagenome. By contrast, qPCR amplification with probes designed for common previously cultured sponge-associated bacteria in the genera Rheinheimera and Marinomonas and a representative of the CFB group resulted in only minimal detection of the Rheiheimera in total DNA extracted from the sponge. These data verify that a large portion of the microbial community within Lithistid sponges may consist of currently unculturable microorganisms.

A novel explosive process is required for the γ-ray burst GRB 060614

Over the past decade, our physical understanding of gamma-ray bursts (GRBs) has progressed rapidly, thanks to the discovery and observation of their long-lived afterglow emission. Long-duration (> 2 s) GRBs are associated with the explosive deaths of massive stars ('collapsars', ref. 1), which produce accompanying supernovae; the short-duration (< or = 2 s) GRBs have a different origin, which has been argued to be the merger of two compact objects. Here we report optical observations of GRB 060614 (duration approximately 100 s, ref. 10) that rule out the presence of an associated supernova. This would seem to require a new explosive process: either a massive collapsar that powers a GRB without any associated supernova, or a new type of 'engine', as long-lived as the collapsar but without a massive star. We also show that the properties of the host galaxy (redshift z = 0.125) distinguish it from other long-duration GRB hosts and suggest that an entirely new type of GRB progenitor may be required.

Relativistic ejecta from X-ray flash XRF 060218 and the rate of cosmic explosions

Over the past decade, long-duration gamma-ray bursts (GRBs)--including the subclass of X-ray flashes (XRFs)--have been revealed to be a rare variety of type Ibc supernova. Although all these events result from the death of massive stars, the electromagnetic luminosities of GRBs and XRFs exceed those of ordinary type Ibc supernovae by many orders of magnitude. The essential physical process that causes a dying star to produce a GRB or XRF, and not just a supernova, is still unknown. Here we report radio and X-ray observations of XRF 060218 (associated with supernova SN 2006aj), the second-nearest GRB identified until now. We show that this event is a hundred times less energetic but ten times more common than cosmological GRBs. Moreover, it is distinguished from ordinary type Ibc supernovae by the presence of 10(48) erg coupled to mildly relativistic ejecta, along with a central engine (an accretion-fed, rapidly rotating compact source) that produces X-rays for weeks after the explosion. This suggests that the production of relativistic ejecta is the key physical distinction between GRBs or XRFs and ordinary supernovae, while the nature of the central engine (black hole or magnetar) may distinguish typical bursts from low-luminosity, spherical events like XRF 060218.

The afterglow of GRB 050709 and the nature of the short-hard gamma-ray bursts

The final chapter in the long-standing mystery of the gamma-ray bursts (GRBs) centres on the origin of the short-hard class of bursts, which are suspected on theoretical grounds to result from the coalescence of neutron-star or black-hole binary systems. Numerous searches for the afterglows of short-hard bursts have been made, galvanized by the revolution in our understanding of long-duration GRBs that followed the discovery in 1997 of their broadband (X-ray, optical and radio) afterglow emission. Here we present the discovery of the X-ray afterglow of a short-hard burst, GRB 050709, whose accurate position allows us to associate it unambiguously with a star-forming galaxy at redshift z = 0.160, and whose optical lightcurve definitively excludes a supernova association. Together with results from three other recent short-hard bursts, this suggests that short-hard bursts release much less energy than the long-duration GRBs. Models requiring young stellar populations, such as magnetars and collapsars, are ruled out, while coalescing degenerate binaries remain the most promising progenitor candidates.

An asymptotic-giant-branch star in the progenitor system of a type Ia supernova

Stars that explode as supernovae come in two main classes. A type Ia supernova is recognized by the absence of hydrogen and the presence of elements such as silicon and sulphur in its spectrum; this class of supernova is thought to produce the majority of iron-peak elements in the Universe. They are also used as precise 'standard candles' to measure the distances to galaxies. While there is general agreement that a type Ia supernova is produced by an exploding white dwarf star, no progenitor system has ever been directly observed. Significant effort has gone into searching for circumstellar material to help discriminate between the possible kinds of progenitor systems, but no such material has hitherto been found associated with a type Ia supernova. Here we report the presence of strong hydrogen emission associated with the type Ia supernova SN2002ic, indicating the presence of large amounts of circumstellar material. We infer from this that the progenitor system contained a massive asymptotic-giant-branch star that lost several solar masses of hydrogen-rich gas before the supernova explosion.

Survivin in glioblastomas. Protein and messenger RNA expression and comparison with telomerase levels

CONTEXT

Survivin is a novel inhibitor of apoptosis that acts via a pathway independent of bcl-2. Little is known about its distribution in brain tumors or how it correlates with other biomarkers of malignancy, such as telomerase, an enzyme that plays a critical role in cellular immortalization and cancer biology.

OBJECTIVES

To assess survivin protein expression in gliomas and to compare expression with that of telomerase.

DESIGN

Immunohistochemical staining for survivin protein expression was performed using an antibody developed in our laboratory. Quantitative survivin messenger RNA (mRNA) levels were assessed by reverse transcriptase-polymerase chain reaction. In selected cases, survivin results were compared with quantitative telomerase values analyzed by polymerase chain reaction-based telomerase repeat amplification protocol (TRAP) assay. Twenty-five tumor tissue samples from 16 cases of glioblastoma multiforme (GBM; including multiple tissue samples in 6 patients), 2 grade II gliomas, 4 grade III gliomas, and 3 control temporal lobectomy specimens were studied.

RESULTS

Nuclear immunoreactivity for survivin protein and survivin mRNA were detectable in most glioma samples, regardless of grade. Glioblastoma multiforme demonstrated moderate protein expression and survivin mRNA levels compared to epithelial malignancies previously tested in our laboratory. Although the association of survivin mRNA with the levels of telomerase within the GBM cases did not reach statistical significance, most GBMs also expressed survivin. The quantitative score for survivin mRNA was higher in GBMs than in grade II and III gliomas (P =.02), after accounting for multiple specimens per patient.

CONCLUSIONS

Quantitative survivin mRNA analysis, but not immunohistochemistry, distinguished GBMs from lower grade gliomas. Mechanisms that promote both cell proliferation (telomerase expression) and cell survival (survivin expression) are often activated in GBMs.

Reaching high poloidal beta at Greenwald density with internal transport barrier close to full noninductive current drive

In the ASDEX Upgrade tokamak, high poloidal beta up to beta(pol) = 3 at the Greenwald density with H-mode confinement has been reached. Because of the high beta, the plasma current is driven almost fully noninductively, consisting of 51% bootstrap and 43% neutral beam driven current. To reach these conditions the discharge is operated at low plasma current ( I(P) = 400 kA) and high neutral beam heating power ( P(NBI) = 10 MW). The discharge combines an edge (H mode) and internal transport barrier at high densities without confinement-limiting MHD activities. The extrapolation to higher plasma currents may offer a promising way for an advanced scenario based fusion reactor.

Three new peroxides from the sponge Plakinastrella species

Two new five-membered-ring peroxide acids, plakinic acid F (3) and epiplakinic acid F (4), and a new peroxide-lactone, plakortolide F (5), were isolated from a sponge of the genus Plakinastrella collected from Felicite Island, Seychelles. The structures were elucidated through spectral analysis. The free acids 3 and 4 exhibit moderate antifungal activity against Candida albicans with minimum inhibitory concentrations of 25 micrograms/mL (SDB) and 3.1 micrograms/mL (RPMI) for 3, and 25 micrograms/mL (SDB) and 6.25 micrograms/mL (RPMI) for 4, respectively. Both also showed moderate in vitro inhibition of Aspergillus fumigatus with IC90's of 25 micrograms/mL.

The role of small intestinal bacterial overgrowth, intestinal permeability, endotoxaemia, and tumour necrosis factor alpha in the pathogenesis of non-alcoholic steatohepatitis

BACKGROUND

Small intestinal bacterial overgrowth may contribute to the development of non-alcoholic steatohepatitis, perhaps by increasing intestinal permeability and promoting the absorption of endotoxin or other enteric bacterial products.

AIMS

To investigate the prevalence of small intestinal bacterial overgrowth, increased intestinal permeability, elevated endotoxin, and tumour necrosis factor alpha (TNF-alpha) levels in patients with non-alcoholic steatohepatitis and in control subjects.

PATIENTS AND METHODS

Twenty two patients with non-alcoholic steatohepatitis and 23 control subjects were studied. Small intestinal bacterial overgrowth was assessed by a combined (14)C-D-xylose and lactulose breath test. Intestinal permeability was assessed by a dual lactulose-rhamnose sugar test. Serum endotoxin levels were determined using the limulus amoebocyte lysate assay and TNF-alpha levels using an ELISA.

RESULTS

Small intestinal bacterial overgrowth was present in 50% of patients with non-alcoholic steatosis and 22% of control subjects (p=0.048). Mean TNF-alpha levels in non-alcoholic steatohepatitis patients and control subjects were 14.2 and 7.5 pg/ml, respectively (p=0.001). Intestinal permeability and serum endotoxin levels were similar in the two groups.

CONCLUSIONS

Patients with non-alcoholic steatohepatitis have a higher prevalence of small intestinal bacterial overgrowth, as assessed by the (14)C-D-xylose-lactulose breath test, and higher TNF-alpha levels in comparison with control subjects. This is not accompanied by increased intestinal permeability or elevated endotoxin levels.

Improved Recoverability of Microbial Colonies from Marine Sponge Samples

The growth of microorganisms from marine sponge samples was studied on various low to high nutrient solid media using media supplements. The supplements utilized were catalase, sodium pyruvate, and a combination of the two. Medium composition was found to influence the growth response on the supplemented media. Microorganisms on low nutrient media responded more favorably to the media additions than on high nutrient media. Thirty-five percent of the supplemented media demonstrated colony forming unit (CFU) recoveries that were 50% or greater than those of the unamended control plates. Twenty-one percent showed recoveries of more than 100% of the control values, with sodium pyruvate additions providing for the greatest overall increase in recovery, whether alone or in conjunction with catalase. These findings suggest that addition of catalase or sodium pyruvate to solid growth and isolation media may improve recoverability of microorganisms from natural samples.

Frequency of lipid-lowering drug therapy after coronary and carotid operations for atherosclerosis

BACKGROUND

Coronary artery bypass grafting (CABG) and carotid endarterectomy (CE) are palliative operations for patients with severe atherosclerosis of the coronary or carotid arteries. Secondary preventive measures after these operations have received little attention.

METHODS

We conducted a retrospective observational study to determine the frequency of lipid-lowering drug therapy before and after CABG or CE done in 1997.

RESULTS

Of the 204 patients who had CABG, 56 (27%) were receiving lipid-lowering drug therapy before admission, and 71 (37%) of 192 were discharged receiving it. Of the 59 patients who had CE, only 12 (20%) were taking a lipid-lowering drug before admission, and 8 (14%) upon discharge. Of those 59 patients, 23 (39%) had coronary artery disease.

CONCLUSION

Secondary prevention after coronary or carotid operations for atherosclerosis has been underemphasized at our institution, prompting the establishment of a postoperative risk reduction program.

Secobatzellines A and B, two new enzyme inhibitors from a deep-water Caribbean sponge of the genus Batzella

Secobatzelline A (1), a new batzelline natural analogue, and secobatzelline B (2), a likely artifact formed during the isolation procedure, have been isolated from a deep-water marine sponge of the genus Batzella. Secobatzellines A and B inhibited the phosphatase activity of calcineurin, and secobatzelline A inhibited the peptidase activity of CPP32. Both compounds showed in vitro cytotoxicity against P-388 and A-549 cell lines. The isolation and structure elucidation of secobatzellines A (1) and B (2) are described.

Discorhabdin P, a new enzyme inhibitor from a deep-water Caribbean sponge of the genus Batzella

Discorhabdin P (1), a new discorhabdin analogue, has been isolated from a deep-water marine sponge of the genus Batzella. Discorhabdin P (1) inhibited the phosphatase activity of calcineurin and the peptidase activity of CPP32. It also showed in vitro cytotoxicity against P-388 and A-549 cell lines. The isolation and structure elucidation of discorhabdin P (1) are described.

Emerging applications of the single cell gel electrophoresis (Comet) assay. I. Management of invasive transitional cell human bladder carcinoma. II. Fluorescent in situ hybridization Comets for the identification of damaged and repaired DNA sequences in individual cells

ABSTRACT I: Management of invasive transitional cell human bladder carcinoma. The two main treatment options for invasive transitional cell bladder carcinoma are radiotherapy or primary cystectomy with urinary diversion or bladder substitution. Approximately 50% of patients fail to respond to radiotherapy and such patients so treated are disadvantaged by the absence of predictive information regarding their radiosensitivity, since the tumour gains additional time for metastatic spread before cystectomy is performed. The SF2 clonogenic assay, which measures the surviving fraction of tumour cells after 2 Gy X-ray irradiation, is regarded as a good measure of radiosensitivity. However, the assay is time consuming and provides results for only approximately 70% of human tumours. In this paper three bladder transitional cell carcinoma cell lines (HT1376, UMUC-3 and RT112) were exposed to X-irradiation (0-10 Gy). We have compared the responses obtained using a clonogenic assay and a more clinically feasible alkaline single cell gel electrophoresis (Comet) assay. A very good inverse correlation was obtained between cell survival (clonogenic assay) and mean tail moment (Comet assay) for the three cell lines, indicating that the Comet assay can be used to predict the radio-responsiveness of individual cell lines. The clinical usefulness of the assay for predicting response to radiotherapy in bladder cancer patients is currently being investigated. ABSTRACT II: Fluorescent in situ hybridization (FISH) Comets for the identification of damaged and repaired DNA sequences in individual cells. In mammalian cells the extent of DNA damage is partly and the rate of DNA repair very considerably dependent on DNA position and transcription. This has been established by biochemical techniques which are labour intensive and require large numbers of cells. The Comet assay for overall DNA damage and repair is relatively simple and allows individual cells to be examined. Here we present a protocol for combination of the Comet assay with fluorescent in situ hybridization (FISH) using a p53 gene probe which allows specific observation of p53 sequences within DNA comets. Chromosome-specific probes can also be used. Optimization of the FISH/Comet protocol to include automation of the analysis is currently underway to facilitate future application of the technique to study selective DNA damage and repair in defined sequences in single mammalian cells.

Near-infrared spectra of Ba(NO2)2•X2O (X = H,D) at 10 K. A local-mode approach

The fundamental and overtone vibrational spectra of Ba(NO2)2•X2O (X=H,D) have been interpreted using the local mode model. The calculated parameters are consistent with the structure, which has one strong hydrogen bond and one weak bifurcated hydrogen bond. Evidence for Fermi resonance between stretch and bend features having similar energies is discussed. Evidence for the breakdown of the simple Morse oscillator model, which was quite successful for [Formula: see text] hydrogen bonds, is also presented. Keywords: overtone, spectra, near-infrared, hydrates, local-mode model.

Evaluation of manual and image analysis quantification of DNA damage in the alkaline comet assay

The alkaline comet assay or single cell microgel electrophoresis assay is a sensitive method of detecting DNA strand breaks and alkali labile sites in individual cells. The results of this assay can be analysed by different methods. In this study we compared analyses of the same slides by a manual method and by image analysis, post-treatment of clone 707 Friend erythroleukaemia cells with H2O2. The parameters which were found to be particularly useful were comet area and comet length (measured manually) and percentage tail DNA, tail moment, tail length and tail length/head radius (L/H), measured using image analysis. The manual method for comet analysis presented in this paper would appear to provide good and reliable comet data. However, the image analysis comet system described offers an alternative analysis method which avoids the need for photomicrographs and tedious manual analysis. The image analysis parameters: % tail DNA, tail moment, tail length and L/H give good consistent results and for large-scale analysis it will, therefore, conceivably be the method of choice.