Status of Napoleon wrasse in Laamu Atoll, Maldives, after three decades of protection

The Napoleon or humphead wrasse Cheilinus undulatus is a large, globally threatened coral reef fish. In recognition of suspected declines and considering its ecotourism importance, the Maldives was the first country to ban its export in 1995. The present study, a quarter-century after the ban, documents the species around Laamu Atoll, southern Maldives, using dive guides and researchers to conduct surveys during commercial dive tourism trips. Data were collected on abundance, body size, and potential spawning sites in 4 habitat types: channels (reef passes to open ocean), inner reefs (reef slopes inside the atoll), outer reefs (reef slopes outside the atoll), and faros (isolated submerged reefs inside the atoll). Abundance was recorded in number of fish per hectare, and fish length was classified as <100 cm, ≥100 cm, or unknown size. Possible spawning aggregation sites were identified based on multiple occasions of temporarily increased fish density associated with large male presence. Mean densities ranged from 6.02 fish ha-1 in channels, 2.65 and 2.29 fish ha-1 in outer and inner reefs, respectively, and 0.73 fish ha-1 in faros. These densities are consistent with those found in unexploited areas in similar habitats elsewhere and indicate successful protection of the species on Laamu Atoll. The data highlight the significance of reef channel habitat for this species as important megafauna and the need for management to conserve both species and channel habitats. The value of non-specialist observers for conducting labour-intensive surveys on large, wide-ranging species is demonstrated.

Clinical efficacy of a novel radiofrequency toothbrush for tooth stain reduction and tooth whitening: A randomized controlled trial

BACKGROUND

The authors aimed to evaluate the effect of a novel radiofrequency (RF) toothbrush on tooth stains and shades compared with a sonic vibrating toothbrush (CVS Health SmileSonic Pro Advanced Clean Sonic Toothbrush, Ranir) that earned the American Dental Association Seal of Acceptance.

METHODS

The authors conducted a single-blind prospective study over 6 weeks. Participants were randomized to 1 of 2 study groups to receive either an RF toothbrush (ToothWave, Home Skinovations [test]) or a sonic vibrating toothbrush (SmileSonic powered toothbrush, Ranir [control]) and performed twice-daily toothbrushing with fluoridated toothpaste (Crest Cavity Protection, Procter & Gamble) for 6 weeks. Tooth stains and shades were assessed using the Lobene Stain Index and VITA Bleachedguide 3D-MASTER shade guide (VITA North America) at baseline and after 4 and 6 weeks of toothbrushing. In addition, the VITA Easyshade Advance 4.0 spectrophotometer (VITA North America) was used for shade evaluation. Safety was evaluated by means of oral soft-tissue examinations at each visit. Percentage reduction from baseline was compared between the groups. Statistical analyses were conducted using Mann-Whitney nonparametric model.

RESULTS

Eighty-six participants (43 in each group) completed the study with fully evaluable data. At baseline, the groups did not differ significantly in mean measurement scores. Percentage reductions of the measured scores were significantly greater (more extrinsic stain removal and whitening) in the test group than in the control group (P < .001). Both toothbrushes were well-tolerated, and no device-related adverse events were reported during the study.

CONCLUSIONS

The RF toothbrush produced substantial benefits in the reduction of tooth stains and whitening of tooth shade compared with a powered toothbrush (CVS Health SmileSonic Pro Advanced Clean Sonic Toothbrush, Ranir) that earned the American Dental Association Seal of Acceptance.

PRACTICAL IMPLICATIONS

The novel RF toothbrush is a safe and effective tool for stain removal and tooth whitening and can serve as an alternative to other whitening agents. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT03885609.

Anti-caries evaluation of a nano-hydroxyapatite dental lotion for use after toothbrushing: An in situ study

OBJECTIVES

The aim of this randomized, double-blind, two-arm crossover in situ study was to investigate whether nano-hydroxyapatite (nanoHAP) dental lotion (Apagard Deep Care) applied immediately after tooth-brushing with nanoHAP toothpaste (Apagard M-plus) enhances the remineralization promotion and the demineralization inhibition efficacies of nanoHAP toothpastes.

METHODS

64 sound enamel blocks and 64 blocks bearing artificially-produced initial caries were produced from human permanent molar teeth. During each treatment period, lasting 14 days per arm, two blocks, one sound and one lesion-bearing, were exposed to either 5% nanoHAP-containing or placebo dental lotion after tooth-brushing with 5% nanoHAP toothpaste, via an intra-oral appliance worn by 30 adults in each of the study groups. Baseline and post-test mineral loss were quantified using transverse microradiography (TMR). One-sided t-test of one group mean was used for intragroup comparison, while two-sided t-test of two independent means was used to compare the two dental lotions.

RESULTS

Pairwise comparison (baseline vs. post-test) indicated significant (p<.001) remineralization by nanoHAP toothpaste in both groups. However, when compared against each other, there was a significantly (p<.001) greater percentage of remineralization with nanoHAP lotion [58.4(±1.8)%] than with placebo lotion [37.7(±2.2)%]. TMR examination showed absolute demineralization inhibition in sound enamel blocks exposed to either lotions.

CONCLUSIONS

Toothpaste containing 5% nanoHAP effectively remineralized initial caries and inhibited demineralization of healthy enamel; however, the application of a dental lotion containing 5% nanoHAP after brushing resulted in superior remineralization compared to a placebo lotion.

CLINICAL SIGNIFICANCE

Dental lotion containing 5% nanohydroxyapatite used immediately after toothbrushing with 5% nanohydroxyapatite toothpaste can serve as an adjunct to enhance the clinical benefits of the toothpaste.

1121 Single Use Nasal Endoscopes – A Review of The Cost and Organisational Implications Based on Department Size

Aim

Single use nasal endoscopes have become increasingly popular since the COVID-19 pandemic. By avoiding the risk of cross contamination and reducing exposure by eliminating the need for re-processing, the disposable scopes have clear safety benefits. Despite ENT UK guidelines recommending that disposable nasal endoscopes be available in every department for use in emergencies, they have often been considered prohibitively expensive. The aim of this study was to analyse the costs associated with traditional nasal endoscopes and compare them to the single use scopes.

Method

A micro costing exercise was undertaken in three ENT departments: 2 university hospitals, and 1 district general hospital. The outcomes were compared and discussed with relation to the logistics of the departments, as well as organizational considerations.

Results

Cost per procedure varied according to the reprocessing methods used in the different departments. The cost of the disposable nasal endoscopes appears high, however there are many hidden costs associated with the traditional scopes, which can be difficult to quantify accurately.

Conclusions

Although disposable endoscopes appear costly, reprocessing and frequent repairs required for re-usable scopes account for the comparable cost per procedure. The high risk of COVID-19 transmission from examining the upper aerodigestive tract means that the safety benefits bear more weight in the current climate. However, concerns regarding environmental impact, image quality and storage of examinations also need to be considered.

The Potential of Hydroxyapatite Toothpaste to Prevent Root Caries: A pH-Cycling Study

PURPOSE

The effectiveness of a hydroxyapatite (HAP) toothpaste and a fluoride toothpaste in preventing root tissue demineralization (root caries) was compared using an established pH-cycling caries model.

MATERIALS AND METHODS

Sixty dentin blocks were produced from the root tissue of extracted human teeth and were assigned to 3 test groups (n=20/group): 10% hydroxyapatite toothpaste (HAP), 1450 ppm fluoride toothpaste (fluoride), and artificial saliva (artsaliva). Early root caries lesions were developed in each sample by 7-day demineralization using a pH-cycling caries model. The daily cyclic treatment regimen consists of two 2-minute toothpaste-slurry treatment periods, one 6-hour acid challenge using acidified gel (pH 4.5), and then storage in remineralizing solution (artsaliva) for the rest of the time. Demineralization was assessed as the amount of mineral loss (∆z) using transverse microradiography (TMR). Pairwise comparisons (between treatments) were performed using analysis of variance (ANOVA), and then Tukey's HSD for multiple comparisons. All p-values are considered significant if p<0.05.

RESULTS

Both ANOVA and Tukey's HSD indicated no significant (ANOVA; n=20) difference in mean ∆z among the groups, with least ∆z (±Sd) in the HAP (1117±366) compared to fluoride (1392±334) and artsaliva (1406±223). Relative to control, HAP and fluoride inhibited root demineralization by 21% and 6%, respectively.

CONCLUSION

Within the limit of the present study, the tested toothpaste containing 10% HAP is an effective root caries control toothpaste. Toothpaste containing 10% HAP was slightly more effective in preventing tooth demineralization than 1450 ppm fluoride provided as sodium fluoride. Thus, this study shows that HAP toothpastes can serve as an effective alternative to fluoride toothpastes for root caries management.

Comparative efficacy of a hydroxyapatite and a fluoride toothpaste for prevention and remineralization of dental caries in children

Objective

This in situ study compared the effectiveness of two toothpastes containing hydroxyapatite or 500 ppm fluoride in promoting remineralization and inhibiting caries development.

Materials and methods

Two enamel blocks (human primary teeth), one sound and one with artificially-produced caries lesion, were exposed to toothpaste containing either 10% hydroxyapatite or 500 ppm F⁻ (amine fluoride) via intra-oral appliance worn by 30 adults in two-arm double blind randomized crossover study lasting 14 days per arm (ClinicalTrials.gov: NCT03681340). Baseline and post-test mineral loss and lesion depth (LD) were quantified using microradiography. One-sided t-test of one group mean was used for intragroup comparison (baseline vs. post-test), while two-sided t-test of two independent means was used to compare the two toothpaste groups.

Results

Pairwise comparison (baseline vs. test) indicated significant (p < 0.0001) remineralization and LD reduction by either toothpaste; however, when compared against each other, there was no statistically significant difference in remineralization or LD reduction between the two toothpastes. No demineralization could be observed in sound enamel blocks exposed to either toothpaste. While F⁻ induced lesion surface lamination, HAP produced a more homogenous lesion remineralization.

Conclusions

10% hydroxyapatite achieved comparable efficacy with 500 ppm F⁻ in remineralizing initial caries and preventing demineralization. Thus the HAP toothpaste is confirmed to be equal to the fluoride toothpaste in this study.

Female gender and diabetes mellitus increase the risk of recurrence after laparoscopic incisional hernia repair

BACKGROUND

Laparoscopic hernia repair is used widely for the repair of incisional hernias. Few case studies have focussed on purely 'incisional' hernias. This multicentre series represents a collaborative effort and employed statistical analyses to provide insight into the factors predisposing to recurrence of incisional hernia after laparoscopic repair. A specific hypothesis (ie, laterality of hernias as well as proximity to the xyphoid process and pubic symphysis predisposes to recurrence) was also tested.

METHODS

This was a retrospective study of all laparoscopic incisional hernias undertaken in six centres from 1 January 2004 to 31 December 2010. It comprised a comprehensive review of case notes and a follow-up using a structured telephone questionnaire. Patient demographics, previous medical/surgical history, surgical procedure, postoperative recovery, and perceived effect on quality of life were recorded. Repairs undertaken for primary ventral hernias were excluded. A logistic regression analysis was then fitted with recurrence as the primary outcome.

RESULTS

A total of 186 cases (91 females) were identified. Median follow-up was 42 months. Telephone interviews were answered by 115/186 (62%) of subjects. Logistic regression analyses suggested that only female sex (odds ratio (OR) 3.53; 95% confidence interval (CI) 1.39-8.97) and diabetes mellitus (3.54; 1-12.56) significantly increased the risk of recurrence. Position of the defect had no statistical effect.

CONCLUSIONS

These data suggest an increased risk of recurrence after laparoscopic incisional hernia repair in females and subjects with diabetes mellitus. These data will help inform surgeons and patients when considering laparoscopic management of incisional hernias. We recommend a centrally hosted, prospectively maintained national/international database to carry out additional research.

Abstract S4-07: Effects of bisphosphonate treatment on recurrence and cause-specific mortality in women with early breast cancer: A meta-analysis of individual patient data from randomised trials

Background: Disseminated tumour cells can remain dormant in the bone marrow for years prior to subsequent activation and the development of overt metastases. Bisphosphonates (BP) have profound effects on bone physiology and could potentially modify the metastatic disease process. Variable outcomes in terms of disease recurrence have been reported, with efficacy apparently influenced by menopausal status.

Methods: We sought individual patient data for meta-analysis from 41 randomised trials that compared BP to no BP (placebo or open control). Primary outcomes were time to recurrence, time to first distant recurrence and breast cancer mortality. Predefined subgroup comparisons were of type of BP (amino-/non-amino), duration and schedule of BP treatment, menopausal status, age, ER status, concomitant chemotherapy and site of distant recurrence (bone/other).

Results: Data on 17,751 women (75% of 23,573 randomised in relevant trials) have so far been received, with around 3,300 breast cancer recurrences and 2,500 deaths. Effects on breast cancer mortality, recurrence and bone metastases for 17,016 women in the locked database and for 10,540 who were postmenopausal are shown below.

No. eventsRate Ratio (SE)10 year gain2p valueAll women (n = 17,016)Breast cancer mortality2,0490.91 (0.04)1.7%0.04Breast cancer recurrence3,2840.94 (0.04)1.0%0.13Distant recurrence2,7510.92 (0.04)1.3%0.05Bone recurrence8250.79 (0.07)1.4%0.002Other distant recurrence1,9260.99 (0.05)0.1%0.8Postmenopausal women (n = 10,540)Breast cancer mortality1,1070.83 (0.06)3.1%0.004Breast cancer recurrence1,8090.86 (0.05)3.0%0.002Distant recurrence1,5030.83 (0.05)3.3%0.0007Bone recurrence4450.65 (0.08)2.9%0.00001Other distant recurrence1,0580.93 (0.06)0.7%0.26

Reductions in bone recurrence for postmenopausal women were similar irrespective of bisphosphonate type, treatment schedule, ER status, nodal involvement or use of concomitant chemotherapy. There were no improvements in bone (RR = 1.00, 2p = 0.97) or other recurrence for premenopausal women. Adjuvant bisphosphonates also reduced bone fractures (RR = 0.83, 2p = 0.009).

Conclusion: Adjuvant bisphosphonates reduce bone recurrences and improve breast cancer survival in postmenopausal but not premenopausal women.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr S4-07.

The nuclear experience of CPEB: implications for RNA processing and translational control

CPEB is a sequence-specific RNA binding protein that promotes polyadenylation-induced translation in early development, during cell cycle progression and cellular senescence, and following neuronal synapse stimulation. It controls polyadenylation and translation through other interacting molecules, most notably the poly(A) polymerase Gld2, the deadenylating enzyme PARN, and the eIF4E-binding protein Maskin. Here, we report that CPEB shuttles between the nucleus and cytoplasm and that its export occurs via the CRM1-dependent pathway. In the nucleus of Xenopus oocytes, CPEB associates with lampbrush chromosomes and several proteins involved in nuclear RNA processing. CPEB also interacts with Maskin in the nucleus as well as with CPE-containing mRNAs. Although the CPE does not regulate mRNA export, it influences the degree to which mRNAs are translationally repressed in the cytoplasm. Moreover, CPEB directly or indirectly mediates the alternative splicing of at least one pre-mRNA in mouse embryo fibroblasts as well as certain mouse tissues. We propose that CPEB, together with Maskin, binds mRNA in the nucleus to ensure tight translational repression upon export to the cytoplasm. In addition, we propose that nuclear CPEB regulates specific pre-mRNA alternative splicing.

Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials

BACKGROUND

In early breast cancer, variations in local treatment that substantially affect the risk of locoregional recurrence could also affect long-term breast cancer mortality. To examine this relationship, collaborative meta-analyses were undertaken, based on individual patient data, of the relevant randomised trials that began by 1995.

METHODS

Information was available on 42,000 women in 78 randomised treatment comparisons (radiotherapy vs no radiotherapy, 23,500; more vs less surgery, 9300; more surgery vs radiotherapy, 9300). 24 types of local treatment comparison were identified. To help relate the effect on local (ie, locoregional) recurrence to that on breast cancer mortality, these were grouped according to whether or not the 5-year local recurrence risk exceeded 10% (<10%, 17,000 women; >10%, 25,000 women).

FINDINGS

About three-quarters of the eventual local recurrence risk occurred during the first 5 years. In the comparisons that involved little (<10%) difference in 5-year local recurrence risk there was little difference in 15-year breast cancer mortality. Among the 25,000 women in the comparisons that involved substantial (>10%) differences, however, 5-year local recurrence risks were 7% active versus 26% control (absolute reduction 19%), and 15-year breast cancer mortality risks were 44.6% versus 49.5% (absolute reduction 5.0%, SE 0.8, 2p<0.00001). These 25,000 women included 7300 with breast-conserving surgery (BCS) in trials of radiotherapy (generally just to the conserved breast), with 5-year local recurrence risks (mainly in the conserved breast, as most had axillary clearance and node-negative disease) 7% versus 26% (reduction 19%), and 15-year breast cancer mortality risks 30.5% versus 35.9% (reduction 5.4%, SE 1.7, 2p=0.0002; overall mortality reduction 5.3%, SE 1.8, 2p=0.005). They also included 8500 with mastectomy, axillary clearance, and node-positive disease in trials of radiotherapy (generally to the chest wall and regional lymph nodes), with similar absolute gains from radiotherapy; 5-year local recurrence risks (mainly at these sites) 6% versus 23% (reduction 17%), and 15-year breast cancer mortality risks 54.7% versus 60.1% (reduction 5.4%, SE 1.3, 2p=0.0002; overall mortality reduction 4.4%, SE 1.2, 2p=0.0009). Radiotherapy produced similar proportional reductions in local recurrence in all women (irrespective of age or tumour characteristics) and in all major trials of radiotherapy versus not (recent or older; with or without systemic therapy), so large absolute reductions in local recurrence were seen only if the control risk was large. To help assess the life-threatening side-effects of radiotherapy, the trials of radiotherapy versus not were combined with those of radiotherapy versus more surgery. There was, at least with some of the older radiotherapy regimens, a significant excess incidence of contralateral breast cancer (rate ratio 1.18, SE 0.06, 2p=0.002) and a significant excess of non-breast-cancer mortality in irradiated women (rate ratio 1.12, SE 0.04, 2p=0.001). Both were slight during the first 5 years, but continued after year 15. The excess mortality was mainly from heart disease (rate ratio 1.27, SE 0.07, 2p=0.0001) and lung cancer (rate ratio 1.78, SE 0.22, 2p=0.0004).

INTERPRETATION

In these trials, avoidance of a local recurrence in the conserved breast after BCS and avoidance of a local recurrence elsewhere (eg, the chest wall or regional nodes) after mastectomy were of comparable relevance to 15-year breast cancer mortality. Differences in local treatment that substantially affect local recurrence rates would, in the hypothetical absence of any other causes of death, avoid about one breast cancer death over the next 15 years for every four local recurrences avoided, and should reduce 15-year overall mortality.

Lacryglobin in human tears, a potential marker for cancer

Lacrygobin has been identified in human tears. This protein has high sequence homology to the mammaglobins, proteins upregulated in breast cancer and in breast cancer metastasis. In order to investigate the utility of tear screening for cancer tear samples were collected from patients with different types of cancer and compared to controls. Tear samples were taken from five controls and eight breast, six lung, five colon, one prostate and three ovary cancer patients. Tears were analysed using 2-D gel electrophoresis (n = 25) and 1-D electrophoresis (n = 3). Lacryglobin was present in the following percentage of patients: breast cancer (88%), lung (83%), colon (100%), ovary (33%), prostate (100%) and controls (60%). Two control patients with lacryglobin had a family history of breast and prostate cancer. Lacryglobin was detected in some but not all tear samples and further studies are warranted to investigate its potential as a marker for cancer.

Lack of cross-species transmission of porcine endogenous retrovirus infection to nonhuman primate recipients of porcine cells, tissues, or organs

BACKGROUND

Nonhuman primates (NHPs) have been widely used in different porcine xenograft procedures inevitably resulting in exposure to porcine endogenous retrovirus (PERV). Surveillance for PERV infection in these NHPs may provide information on the risks of cross-species transmission of PERV, particularly for recipients of vascularized organ xenografts for whom data from human clinical trials is unavailable.

METHODS

We tested 21 Old World and 2 New World primates exposed to a variety of porcine xenografts for evidence of PERV infection. These NHPs included six baboon recipients of pig hearts, six bonnet macaque recipients of transgenic pig skin grafts, and nine rhesus macaque and two capuchin recipients of encapsulated pig islet cells. Serologic screening for PERV antibody was done by a validated Western blot assay, and molecular detection of PERV sequences in peripheral blood mononuclear cells (PBMCs) and plasma was performed using sensitive polymerase chain reaction and reverse transcriptase-polymerase chain reaction assays, respectively. Spleen and lymph node tissues available from six bonnet macaques and three rhesus macaques were also tested for PERV sequences.

RESULTS

All plasma samples were negative for PERV RNA suggesting the absence of viremia in these xenografted animals. Similarly, PERV sequences were not detectable in any PBMC and tissue samples, arguing for the lack of latent infection of these compartments. In addition, all plasma samples were negative for PERV antibodies.

CONCLUSION

These data suggest the absence of PERV infection in all 23 NHPs despite exposure to vascularized porcine organs or tissue xenografts and the use of immunosuppressive therapies in some animals. These findings suggest that PERV is not easily transmitted to these NHP species through these types of xenografts.

Herbs and the brain: friend or foe? The effects of ginkgo and garlic on warfarin use

In the quest for longevity and as an alternative to Western medicine, there has been a resurgence in traditional remedies. However, several concerns have been raised about the increased use of herbal remedies, including potential interactions with "Western" medicines, the lack of quality control, the assessment of herbal clinical trials, and the adulteration of herbal remedies by traditional prescribers. Taking an herbal history is not usually a part of medical/nursing practice, and patients usually do not readily volunteer such information. In the cerebrovascular and cardiac settings, it is particularly important to gain such a history and to educate patients and family members about the potential interactions of herbal remedies with anticoagulants. Two herbal supplements in particular, ginkgo biloba and garlic, have demonstrated effects on warfarin.

Modulation of tear film protein secretion with phosphodiesterase inhibitors

A double-blind randomized clinical study was conducted to determine whether nicardipine hydrochloride was a useful treatment for dry eye.We examined its effect on the tear film, ocular surface and ocular comfort. Nicardipine hydrochloride, 3-isobutyl-1-methylxanthine and pilocarpine hydrochloride were dissolved in an artificial tear vehicle and applied topically to one eye of 12 subjects on separate days. Ocular physiology, ocular comfort and tear volume were assessed. The trial was repeated with nicardipine in an aqueous gel vehicle. Tears were collected and assessed for protein concentration and protein profile, using electrophoresis and mass spectrometry. Nicardipine induced conjunctival redness and symptoms of dryness and irritation. There was no change in total tear protein concentration or volume. An increase in a 68 kDa protein was observed, this was probably due to conjunctival vessel dilation and leakage of albumin. The adverse symptomatology and increased conjunctival redness experienced with nicardipine make it an undesirable treatment for dry eye.

Targeting the Hprt locus in mice reveals differential regulation of Tie2 gene expression in the endothelium

To study the in vivo expression of the murine Tie2 gene, we have targeted the hypoxanthine phosphoribosyltransferase (Hprt) gene locus to generate two single-copy transgenic mice: T1, containing the 2,100-bp Tie2 promoter upstream from the beta-galactosidase (LacZ) gene, and T5, which also included an enhancing element originating from the first intron of the Tie2 gene. Comparing T1 and T5 embryos at day E10.5 revealed differential endothelial cell-specific expression of LacZ, whereas colocalization analyses showed that the expression was confined to endothelial cells. Moderate reporter gene activity was observed in the brain and kidney of T1 adults, whereas extensive LacZ gene expression was seen in the vasculature of most organs of the T5 adults. This study demonstrates the feasibility of targeting the Hprt locus with endothelial cell-specific sequences to analyze the spatial-temporal expression of transgenes. Of particular importance is the observation that the analysis of a single transgene copy in a defined locus allows for an accurate and rapid comparison of transcriptional activity among regulatory DNA sequences.

A patient preference study comparing raltitrexed ('Tomudex') and bolus or infusional 5-fluorouracil regimens in advanced colorectal cancer: influence of side-effects and administration attributes

Current chemotherapy regimens used in advanced colorectal cancer (ACRC) are similar in terms of efficacy, but differ importantly in terms of side-effects and administration profiles. These differences may impact significantly on patients' lives. We have evaluated patient preferences between raltitrexed ('Tomudex') and 5-fluorouracil-based chemotherapy regimens, with regard to side-effect attributes (raltitrexed and Mayo regimens) and administration attributes (raltitrexed, Mayo, De Gramont and Lokich regimens) in a study based on 82 patients with ACRC. Patients completed a series of rating tasks on how 'upsetting' these attributes were to them using a visual analogue scale (VAS) in a structured interview conducted by a research nurse. Mucositis and asthenia were the most and least upsetting side-effects, respectively. The side-effect profile of raltitrexed was clearly preferred by 78% of patients versus 14% for Mayo (P < 0.001). When side-effects and administration attributes were combined into an overall profile, 91% of patients selected raltitrexed as their clearly preferred regimen, versus 6% for Mayo (P < 0.001). The administration regimen of raltitrexed was ranked most acceptable (mean rank score 1.5 compared with Mayo 2.6, De Gramont 2.7, and Lokich 3.3). Given similar palliative effects, patients with ACRC exhibit preferences for raltitrexed over other regimens, based on administration and/or side-effect attributes. Such preferences should constitute an important part of decisions relating to the choice of chemotherapy regimen in ACRC.

Case study: nursing care of the patient with vertebral artery aneurysm treated by endovascular stenting and coil implantation

As we move towards the 21st Century, it is evident that healthcare is significantly altered by advancements in technology. The following case study describes the first reported procedure in a human, in which a vertebral artery stent was inserted to act as a "bridge" for coil placement in the treatment of a wide-necked vertebral artery aneurysm. Due to the size, shape and calcification of the aneurysm, conventional neurosurgery and/or endovascular coiling were considered inappropriate obliterative mechanisms. Instead, a new therapy that combined surgical and endovascular techniques was successfully initiated. Therapies such as the stent procedure have only been successful in canine studies. Aneurysms unsuitable for conventional therapy, including clipping or endovascular techniques, were once thought untreatable. Stenting now provides the surgeon and patient with another therapeutic modality to better manage difficult wide-necked aneurysms.

Complex chitinolytic system of Aspergillus fumigatus

Native polyacrylamide gels incorporating a glycol chitin substrate were used to detect several chitinolytic enzymes in the culture filtrate and cell surface, wall and mixed membrane fractions of Aspergillus fumigatus during the exponential phase of growth. Much of the cellular chitinase activity did not bind to concanavalin A (Con A) matrix and was heat-sensitive. In contrast, almost all chitinases secreted appeared to be heat-stable glycoproteins. The heavily glycosylated molecules, in a Con A-binding fraction, were the most immunologically-reactive components, as judged by their binding to anti-Aspergillus antibodies, present in the serum of patients with aspergillosis. Most of the cellular chitinases of A. fumigatus mycelium bound to an insoluble chitin matrix while most of the secreted chitinases did not bind to chitin.

The effect of an alphanumeric paging system on patient compliance with medicinal regimens

There are numerous actual and potential impediments to patient compliance with medicinal regimens. The implications of poor compliance include worsening disease states or symptoms, with resultant increased costs of care. Using a population of hospice patients at high risk for noncompliance, this study evaluated the use of an alphanumeric paging system as a memory prosthetic, finding that compliance rose from a mean of 56 percent to 96 percent when the system was used. We conclude that such a program is of use in this setting, and that these findings warrant study and suggest applications in other populations.

Patient education: bridging the gap between inpatient and ambulatory care

This article describes a model curriculum of perinatal education designed to bridge the gap between prenatal ambulatory care education and labor and delivery, postpartum and well child care in a high-risk population of inner city women. The curriculum, which consists of broad-based, maternal-child health information, was developed, implemented, and evaluated through an interdisciplinary approach. The initiative narrowed the preexisting gap between departments, increased clients' knowledge, and promoted positive changes in clients' behavior. The breadth of the curriculum content addresses the unquestionable need for perinatal education that will enhance compliance and empower clients toward health maintenance.

Sequelae of a 'magic mushroom banquet'

Magic mushroom festivals are becoming increasingly common especially in some areas of Wales where the mushroom can be found in profusion. The authors report on the sequelae of one such festival, and point out the dangers of which the participants generally are unaware.

Learning to take it easy

Stress can be deadly and more and more people are seeking outside help in dealing with it. Leicestershire AHA is taking positive steps; Vivienne Evans, senior health education officer, describes a scheme to teach people who feel under threat from stress to relax.

Studies On the Behaviour of Cyprinodent Fish I. the Agonistic and Sexual Behaviour of Aphyosemion Bivittatum (Lönnberg 1895)

Abstract

The agonistic and sexual behaviour of the Cyprinodont fish Aphyoseznion bivittatum is described. Both males and females develop colour patterns which are useful in identifying the motivational state of the fish and these are also described. Aggressive encounters between males are prolonged and highly ritualised. They result in dominant - subordinate relationships being set up and this is probably associated with a hierarchical structure of social organisation in the wild. The data was analysed to show differences in the sequences of aggressive behaviour of dominant and subordinate males. The possible adaptive values of the differences found are discussed. The sequence of courtship behaviour is relatively simple due to the limited behavioural repertoire of females.

Metabolism of 35S-labelled antithyroid drugs in man

Differences in the metabolic fate of antithyroid drugs influence the optimal frequency of administration and their therapeutic efficacy. (35)S propylthiouracil differed from the (35)S imidazoles (carbimazole and methimazole) in the more rapid absorption and excretion and the shorter biological half-life in the plasma of the former. Renal function may have a more important influence on the biological half-life of the drugs than thyroid status. Further work is required to determine the optimal frequency of administration for each compound.

Interrelationships of Erythrocyte Characters and Other Characters of British and Zebu Crossbred Beef Cattle

The following red cell characters were studied in a herd of 217 calves repre-senting Brahman cross, Africander cross, Grade Brahman, and British (Hereford X Shorthorn) breeding, and in their dams: packed cell volume, haemoglobin level, red cell count, fragility, potassium and sodium concentrations, catalase activity, and haemoglobin type. There were distinct breed differences. In some characters, e.g. packed cell volume and potassium concentration, Africander cross were inter-mediate between Brahman cross and British, whereas in others, e.g. fragility and catalase activity, they were indistinguishable from British. Within breeds, the characters showed highly repeatable differences between animals and high herita-bilities.