Radionuclides in Peconic River fish, mussels, and sediments

For regulatory oversight and quality control of Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) actions, fish, mussels, and sediments were analyzed from the Peconic River system on Long Island, NY, downstream of the Brookhaven National Laboratory, as well as from control locations. The analyses were for photon-emitting radionuclides (notably 60Co and 137Cs), uranium, plutonium, and americium. Sediments were cored in 4 sections to 0.37 m depth, whole fish were analyzed, and mussels were separated into flesh and shells. Radioisotopes of the cited elements were detected in sediment, some of the fish contained 137Cs, 241Am, and uranium, and mussel flesh contained 137Cs and uranium. All of the 60Co, 233U, and enriched uranium, and some of the 137Cs and 241Am, can most likely be attributed to Brookhaven National Laboratory. The other radionuclides (and some of the 137Cs and 241Am) are believed to have either fallout or nature as their origin. The New York State Department of Health (NYSDOH) evaluated the radiological data in terms of adverse health implications due to consumption of fish with the levels of reported radioactivity. The NYSDOH determined that the added radiation doses likely to result from eating this fish are a small fraction of the radiation dose that normally results from radionuclides present in the body from natural sources.

Characteristics and natural history of transient postoperative pseudosubluxation after total hip arthroplasty

A series of 13 total hip arthroplasties (THAs) in which immediate postoperative radiographs revealed axial subluxation were reviewed, and the timing, incidence, and subsequent natural history of this phenomenon were determined. Each patient had received perioperative epidural anesthesia and was placed in an abduction splint before transfer to the postoperative care unit. All initial radiographs were taken while the patient was still under the effect of the epidural anesthetic agent (average, 54 minutes; range, 37-80 minutes) postoperatively. In each case, radiographs taken after anesthetic recovery and without limb manipulation revealed reduced components. The balance of the postoperative care and rehabilitation was uncomplicated; patients were followed at least 36 months postoperatively, and in only 1 patient did a subsequent hip dislocation occur. Over a 6-month period, the postoperative films of all THAs were studied, and postoperative subluxation was identified in about 3% of the cases. Postoperative subluxation is likely to be noted when the radiograph is obtained within 1 hour of transfer to the postoperative care unit. It does not appear to have a dramatic effect on the rate of postoperative dislocation, however. This radiographic finding probably is due to the continued effects of regional anesthesia, and reduction occurs as muscle tone returns. If transient subluxation is identified, no change in postoperative care is necessary.

Managing menopausal symptoms in breast cancer survivors: results of a randomized controlled trial

BACKGROUND

Menopausal symptoms (e.g., hot flashes, vaginal dryness, and stress urinary incontinence) are very common in breast cancer survivors and cannot be managed with standard estrogen replacement therapy (ERT) in these patients. The purpose of this study was to test the efficacy of a comprehensive menopausal assessment (CMA) intervention program in achieving relief of symptoms, the improvement in quality of life (QOL), and sexual functioning in breast cancer survivors.

METHODS

Using a two-group, randomized controlled design, we assigned 76 postmenopausal breast cancer survivors with at least one severe target symptom either to the intervention group or to a usual-care group. Seventy-two women were evaluable at the end of the study period. The CMA intervention, delivered by a nurse practitioner, focused on symptom assessment, education, counseling and, as appropriate, specific pharmacologic and behavioral interventions for each of the three target symptoms. Psychosocial symptoms were assessed with the use of a self-report screening instrument, and distressed women were referred for counseling if needed. The intervention took place over a 4-month period. Outcomes measured were scores on a composite menopausal symptom scale, the RAND Short Form Health Survey Vitality Scale, and the Cancer Rehabilitation Evaluation System (CARES) Sexual Functioning Scale at baseline and at 4-month follow-up. All statistical tests were two-sided and were performed at the alpha =. 05 significance level.

RESULTS

Patients receiving the intervention demonstrated statistically significant improvement (P =.0004) in menopausal symptoms but no significant change in vitality (P =.77). Sexual functioning was statistically significantly improved (P =.04) in the treatment group compared with the usual-care group.

CONCLUSIONS

A clinical assessment and intervention program for menopausal symptom management in breast cancer survivors is feasible and acceptable to patients, leading to reduction in symptoms and improvement in sexual functioning. Measurable improvement in a general QOL measure was not demonstrated.

Foodstuff survey around a major nuclear facility with test of satellite images application

A foodstuff survey was performed around the Savannah River Site, Aiken, South Carolina. It included a census of buildings and fields within 5 km of the boundary and determination of the locations and amounts of crops grown within 80 km of the Savannah River Site center. Recent information for this region was collected on the amounts of meat, poultry, milk, and eggs produced, of deer hunted, and of sports fish caught. The locations and areas devoted to growing each crop were determined by the usual process of applying county agricultural statistics reported by state agencies. This process was compared to crop analysis of two LANDSAT Thematic Mapper images. For use with environmental radionuclide transfer and radiation dose calculation codes, locations within 80 km were defined for 64 sections by 16 sectors centered on the Site and by 16-km distance intervals from 16 km to 80 km. The median areas per section devoted to each of four food crops based on county agricultural statistics were about two-thirds of those based on satellite image analysis. Most locally-raised foodstuff was distributed regionally and not retained locally for consumption.

Correcting tritium concentrations in water vapor monitored with silica gel

A correction is needed to calculate the activity concentration of airborne tritium oxide when dried silica gel is used as the collector. A tracer study using tritiated water with silica gel showed that the concentration of tritium in desorbed water is lower than that in adsorbed water by a fraction that increases with the amount of adsorbed water. The hypothesis was tested that adsorbed tritiated water is diluted by isotopic exchange with both non-tritiated water and hydroxyl groups within the silica gel matrix. The extent of dilution was measured from 4% to 14% adsorbed water, which is typical of moisture on field collectors for monitoring airborne tritium oxide. For this range of percent adsorbed water, the inferred percent exchangeable water in the silica gel under study was 6.3 +/- 0.1%. This value compares to the silica gel weight loss of 5.3% after heating to 1,050 degrees C. An explanation of the difference between 6.3% and 5.3% is proposed. The contribution of the HTO/H2O vapor pressure isotope effect was considered in calculating isotopic exchange. A curve is presented for correcting the measured tritium concentration in the distillate from the silica gel as a function of the amount of adsorbed water. The tritium tracer procedure is recommended for determining the percent exchangeable water in other silica gels to correct tritium measurements of water vapor collected by them.

Are older breast carcinoma survivors willing to take hormone replacement therapy?

BACKGROUND

Breast carcinoma survivors are the largest segment of the expanding cancer survivor community. As a result, there has been increasing discussion of the safety and efficacy of hormone replacement therapy for women with a past history of breast carcinoma. Little is known about the willingness of older breast carcinoma survivors to accept hormone replacement therapy for the alleviation of menopausal symptoms (such as hot flashes, vaginal dryness, and urinary incontinence) or for reduction in the risk of serious heart disease or osteoporotic hip fracture.

METHODS

A structured decision analysis interview was conducted, in which visual aids were used to describe therapy and hypothetical risks of breast carcinoma recurrence. Subjects were presented with a series of scenarios in which a hypothetical woman might be experiencing one of several menopausal symptoms or might have a reduction in the risk of serious heart disease or osteoporotic hip fracture.

RESULTS

Thirty-nine disease free breast carcinoma survivors who were age 60 years or older were recruited to participate in a study that included interview and physical examination. Subjects were age 68.3 years on average and had been diagnosed with breast carcinoma an average of 3.1 years previously. The majority had received hormone replacement therapy at some point in the past. They showed high levels of functioning as measured by the RAND Short Form Health Survey. Willingness to take estrogen was evident only when the increase in the risk of breast carcinoma recurrence was small and when severe symptoms of menopause were present. Under the hypothetical conditions of this interview, 56.4% of these 39 breast carcinoma survivors would be willing to take estrogen if they had all 3 menopausal symptoms and their risk of breast carcinoma recurrence increased from 25% to 32%. In contrast, for the osteoporosis and heart disease scenarios (in which women were as yet asymptomatic), only 17.9% were willing to take estrogen to reduce the risk of hip fracture by 50% and only 28.2% were willing to take estrogen to reduce the risk of heart attack by 50% under the same assumption of a 7% difference in the risk of recurrence (from 25% to 32%).

CONCLUSIONS

Overall, the study findings demonstrate the reluctance of these older breast carcinoma survivors to take estrogen after a breast carcinoma diagnosis. There was an increased willingness to consider therapy if multiple symptoms coexisted and the possible risk of recurrence was small (13% compared with 10%). There was also no significant correlation between current menopausal symptoms and the willingness to take estrogen in the hypothetical situations posed in the interview. These findings suggest an important feasibility problem that must be addressed before hormone replacement clinical trials involving breast carcinoma survivors are launched.

Development and validation of a physical examination scale to assess vaginal atrophy and inflammation

BACKGROUND

The assessment of vaginal atrophy is central to menopause-related research and clinical practice. However, methods of grading vaginal atrophy have not been subjected to reliability and validity assessments.

OBJECTIVE

To assess the validity and reproducibility of selected vaginal examination findings proposed to represent vaginal atrophy and inflammation.

DESIGN

Cross-sectional study.

PARTICIPANTS

A convenience sample of 40 postmenopausal volunteers with past history of breast cancer.

MEASUREMENTS

Participants completed questionnaires to assess vaginal symptoms. Pelvic examinations were carried out using specified criteria to assess the vaginal appearance. Vaginal cytological smears and pH measurements were performed using standardized techniques.

RESULTS

A four-item physical examination atrophy scale had an alpha reliability of 0.48 and was statistically significantly correlated with pH (r = 0.55) and parabasal cells (r = 0.50). A three-item physical examination inflammation scale had an alpha reliability of 0.45. It was not significantly associated with vaginal smear-measured inflammation. Masked inter-rater agreement for the examination was 90%. Self-reported symptoms of itching/irritation or dryness were poorly related to findings on physical examination.

CONCLUSIONS

These results offer objective validation that the physical characteristics proposed to represent atrophy are related to biomarkers of this condition. A relationship between examination characteristics believed to represent inflammation and inflammation biomarkers was not upheld.

Solubility of various forms of strontium titanate in lungs: in vitro and in vivo studies

At the In-Tank Precipitation Facility of the Savannah River Site, strontium and other radionuclides are removed from high-level radioactive waste and sent to the Defense Waste Processing Facility. Strontium removal is accomplished by adsorption using a slurry that includes monosodium titanate, which forms strontium titanate with unknown lung solubility characteristics. The purpose of this study was to determine the solubility of strontium titanate in the form created at the In-Tank Precipitation facility. An in vitro dissolution study was done with a slurry simulant and with several types of strontium titanate, and the results were compared. An in vivo study was also performed with high-fired SrTiO3 in rats. Strontium and titanium were measured by inductively-coupled plasma/atomic emission spectrometry. The data from both studies were used independently to assign the compounds to an absorption type based on criteria specified in ICRP 71. Results of the in vitro studies showed that the Defense Waste Processing Facility simulant should be assigned to Type M and the strontium titanate should be assigned to Type S. Results of the in vivo study verified that SrTiO3 should be assigned to Type S. Lung clearance data of SrTiO3 from rats showed that 85% cleared within the first 24 h and the remaining 15% cleared with a half-time of 130 d. The initial rapid clearance is attributed to deposition in airways as compared to the alveolar region.

Transfusion-free surgery is a treatment plan for all patients

Due to the increased risks associated with allogenic blood transfusion, blood management in surgical procedures, especially in orthopedic settings, should include reduction of perioperative blood loss. Preoperative nursing assessment will help define patients at increased risk for transfusion. Both nonpharmacologic and pharmacologic techniques can help minimize allogenic transfusion by reducing blood loss. One such method of managing anemia and reducing patient exposure to allogenic transfusion is the perioperative use of recombinant human erythropoietin--erythropoietin alfa--an innovative surgical blood management tool. Increased awareness by perioperative nurses of the use of erythropoietin alfa and patient implications can contribute to the overall blood conservation goal.

cDNA cloning, tissue distribution, and substrate characteristics of a cis-Retinol/3alpha-hydroxysterol short-chain dehydrogenase isozyme

We report here a mouse cDNA that encodes a 316-amino acid short-chain dehydrogenase that prefers NAD+ as its cofactor and recognizes as substrates androgens and retinols, i.e. has steroid 3alpha- and 17beta-dehydrogenase and cis/trans-retinol catalytic activities. This cis-retinol/androgen dehydrogenase type 2 (CRAD2) shares close amino acid similarity with mouse retinol dehydrogenase isozyme types 1 and 2 and CRAD1 (86, 84, and 87%, respectively). CRAD2 exhibits cooperative kinetics with 3alpha-adiol (3alpha-hydroxysteroid dehydrogenase activity) and testosterone (17beta-hydroxysteroid dehydrogenase activity), but Michaelis-Menten kinetics with androsterone (3alpha-hydroxysteroid dehydrogenase activity), 11-cis-retinol, all-trans-retinol, and 9-cis-retinol, with V/K0.5 values of 1.6, 0.2, 0.1, 0.04, 0.005, and not saturated, respectively. Carbenoxolone (IC50 = 2 microM) and 4-methylpyrazole (IC50 = 5 mM) inhibited CRAD2, but neither ethanol nor phosphatidylcholine had marked effects on its activity. Liver expressed CRAD2 mRNA intensely, with expression in lung, eye, kidney, and brain (2.9, 2, 1.6, and 0.6% of liver mRNA, respectively). CRAD2 represents the fifth isozyme in a group of short-chain dehydrogenase/reductase isozymes (retinol dehydrogenases 1-3 and CRAD1), closely related in primary amino acid sequence (approximately 85%), that are expressed in different quantities in various tissues, have different substrate specificities, and may serve different physiological functions. CRAD2 may alter the amounts of active and inactive androgens and/or convert retinols into retinals. These data expand insight into the multifunctional nature of short-chain dehydrogenases/reductases and into the enzymology of steroid and retinoid metabolism.

Use of large gamma-ray detector to measure 131I in milk and water at low levels

A lower limit of detection of 0.04 Bq L-1 for measuring 131I in milk or water with a gamma-ray spectrometer was achieved with a large 118% intrinsic germanium detector. Three-liter samples with 131I tracer in a reentrant beaker were counted within a lead shield for 12,000 to 55,000 s to demonstrate detection at this concentration. Samples of milk collected at dairies and counted for 28,000 s showed no 131I at this level (as expected), but 137Cs from fallout was detected in some samples near its detection limit of 0.03 Bq L-1.

Breast cancer survivors: psychosocial concerns and quality of life

PURPOSE

To describe the psychosocial concerns and quality of life of breast cancer survivors evaluated 2 and 3 years after primary treatment.

METHODS

A sample of 139 breast cancer survivors who had been interviewed during the first year after primary treatment participated in a mailed survey at 2 years (N = 69) and 3 years (N = 70) after initial surgery. A random sample of these survivors were also interviewed in person. The mailed questionnaire included standardized instruments to assess quality of life (QL), rehabilitation needs, and psychological distress. Additional survey questions were developed to examine post-surgical recovery, employment and insurance problems, social support, and existential concerns. The in-person interviews expanded on these questions and systematically compared these patients' rehabilitation needs to those which existed at the time of an interview 1 year after surgery.

RESULTS

The 2 and 3 year participants in this follow-up study did not differ from each other on their prior assessments with standardized QL instruments during the first year after surgery, nor did they differ from the full study sample of 227 women. The scores on the Profile of Mood States and the Functional Living Index-Cancer were the same for the 2 and 3 year survivor groups and did not differ from the previous assessments at 1 year after initial treatment. The scores on the Cancer Rehabilitation Evaluation System showed a significant decline in Global Quality of Life, Sexual Functioning and Marital Functioning between the 1 year and 3 year evaluations. For the 2 year sample only Sexual Functioning showed a deterioration between the 1 and 2 year evaluations. Using the RAND 36-Item Health Survey 1.0, the breast cancer survivors were compared with patients from the Medical Outcomes Study. The breast cancer survivors demonstrated higher levels of functioning in many dimensions (role functioning, social functioning, pain, and general health) than the patients with chronic medical conditions. In spite of relatively good physical and emotional functioning on this generic measure of health status and quality of life, these breast cancer survivors reported a number of important and severe rehabilitation problems that persisted beyond one year after primary treatment. Especially frequent were problems associated with physical and recreational activities, body image, sexual interest, sexual function, and problems with dating for those who were single.

CONCLUSIONS

Breast cancer survivors appear to attain maximum recovery from the physical and psychological trauma of cancer treatment by one year after surgery. A number of aspects of QL and rehabilitation problems worsen after that time. Nevertheless, breast cancer survivors rate their QL more favorably than outpatients with other common medical conditions, and they identify many positive aspects from the cancer experience.

Evaluation of Monte Carlo simulation of photon counting efficiency for germanium detectors

The reliability of calculating the full-energy peak counting efficiency of germanium detectors by Monte Carlo simulation was evaluated by comparing MCNP-4 code results with measurements over a range of conditions. The measurements were performed for two detectors of 20% and 110% nominal efficiencies with a point source at two distances and with four different volume sources, including a reentrant beaker, placed on the end caps. The radionuclides were National Institute of Standards and Technology standard sources that emit photons between energies of 42.8 and 1,596.4 keV. Each detector was modeled in detail with respect to the dimensions of the detection volume and attenuation material in the can, dead-layer, and crystal holder foil. The measurements of the 42.8-keV photon were used to check dimensions and to change slightly the value of the dead-layer thickness so that the simulation agreed with measurements at this energy. After this adjustment, the average ratio of simulation results to measurements for 13 photon energies above 42.8 keV was between 0.97 and 1.03 for all sets of point and volume source comparisons. Ratios at individual energies were between 0.92 and 1.06 for the point source and between 0.94 and 1.09 for volume sources. The observed differences were consistent with the estimated standard deviations of simulation and of measurement, which ranged from 1 to 6% and typically were 2 to 3% except for larger uncertainties at low energies. On the basis of this comparison, simulation with the MCNP-4 code is equivalent to measurement with photon standards if the detector and source configuration can be modeled within a tenth of a millimeter.

Genetic variability and tradeoffs among reproductive traits in white clover (Trifolium repens)

There is much spatial and temporal variation for reproductive output in white clover (Trifolium repens L.), yet little is known about the control of this variation or whether there exist tradeoffs among components of seed yield. To examine these issues, seed yield components and vegetative biomass were measured on replicates of seven white clover genotypes planted in a common garden plot. Significant genetic differences among clones were found for biomass and for five of seven reproductive characters, including number of inflorescences, number of florets per inflorescence, number of fruits per infructescence, number of (late-maturing) seed per fruit, and seed weight in early-maturing fruits. Thus, there is considerable potential for natural or artificial selection to act on vegetative and reproductive characters in white clover. In addition to these genetic effects, we observed temporal variation for number of florets per inflorescence, number of fruits per infructescence, and seed weight in late-maturing fruits. Finally, analyses of phenotypic, genetic, and microenvironmental correlation coefficients revealed few pairs of traits with significant negative correlations. This suggests that few tradeoffs in resource allocation patterns existed for the phenotypic characters examined. Key words: Trifolium repens, genetic variation, seed yield components, tradeoffs, phenotypic correlation, genetic correlation.

Cardiorespiratory effects of perfluorocarbon-associated gas exchange at reduced oxygen concentrations

OBJECTIVE

To determine whether reducing FIO2 during perfluorocarbon-associated gas exchange would cause deterioration of hemodynamics, lung mechanics, or gas exchange in normal piglets.

DESIGN

A prospective, controlled animal trial.

SETTING

Experimental animal laboratory in a university setting.

SUBJECTS

Twelve normal, anesthetized piglets, 7 to 14 days old, and weighing 3.31 +/- 0.75 kg.

INTERVENTIONS

After the induction of anesthesia, tracheostomy and catheterization, piglets were stabilized. They were mechanically ventilated with a tidal volume of 15 mL/kg, inspiratory time of 25%, positive end-expiratory pressure of 4 cm H2O, and a respiratory rate of 20 to 28 breaths/min to obtain a baseline PaCO2 between 34 and 45 torr (4.7 and 6.0 kPa). Each animal was studied during continuous positive-pressure breathing, and during perfluorocarbon-associated gas exchange. They were ventilated at an FIO2 of 1.0 for 15 mins. FIO2 was randomly varied among 0.75, 0.5, and 0.3 every 15 mins, then returned to 1.0. At each FIO2, measurements of gas exchange, lung mechanics, and hemodynamics were made. After continuous positive-pressure breathing, perfluorocarbon-associated gas exchange was instituted by replacing the gaseous functional residual capacity of the lungs with perfluorooctylbromide. Animals were then ventilated and measurements were taken.

MEASUREMENTS AND MAIN RESULTS

At each FIO2, measurements of gas exchange (arterial blood gases and saturation), lung mechanics (mean airway pressure, static end-inspiratory pressure, and peak inspiratory pressure), and hemodynamics (heart rate, and mean arterial, right atrial, pulmonary artery occlusion, and pulmonary arterial pressures) were recorded. In six piglets, cardiac output was measured at each FIO2 by thermodilution. Cardiac index, indexed oxygen delivery and consumption, and indexed pulmonary vascular resistance were derived using standard formulas. Piglets were well saturated at all FIO2 settings during continuous positive-pressure breathing. However, during perfluorocarbon-associated gas exchange, arterial saturation decreased to 72% at an FIO2 of 0.3. Cardiac index and oxygen consumption were not affected by reducing FIO2 during perfluorocarbon-associated gas exchange, and were not significantly different than during continuous positive-pressure breathing. Oxygen delivery was reduced at an FIO2 of 0.3 during perfluorocarbon-associated gas exchange, but oxygen consumption remained in the flow independent portion of the curve despite arterial desaturation. Pulmonary arterial pressure was higher during perfluorocarbon-associated gas exchange than during continuous positive-pressure breathing. Pulmonary arterial pressure and indexed pulmonary vascular resistance were significantly higher during perfluorocarbon-associated gas exchange at an FIO2 of 0.3 than at any other FIO2 settings.

CONCLUSIONS

Piglets showed no adverse effects on lung mechanics during perfluorocarbon-associated gas exchange. Hemodynamics were well supported at all FIO2 settings, and arterial blood was fully oxygenated during perfluorocarbon-associated gas exchange at an FIO2 of > or = 0.5.

Fluorodeoxyglucose uptake in vitro: aspects of method and effects of treatment with gemcitabine

Rat prostate adenocarcinoma cells were used to evaluate different incubation procedures for the measurement of fluorodeoxyglucose (FDG) uptake and to measure the effects on chemotherapy.

METHODS

The cells were incubated for 10 or 60 min in media with different glucose concentrations. Furthermore, the cells were treated for 4 hr with different doses of gemcitabine. FDG uptake was measured immediately and 4 hr after treatment. The FDG transport was determined with a zero-trans assay, as well as the messenger RNA (mRNA) content of the glucose transporter type 1 (GLUT1) and the hexokinase assay (HK).

RESULTS

A decrease in FDG uptake with increasing cell number after 60 min of incubation in all media was found. The shorter incubation time yielded more stable uptake data. The glucose content in the medium decreased with increasing cell number and incubation time, which showed that the glucose-to-FDG ratio is not constant in assays that use glucose-containing media. Treatment with gemcitabine resulted in an increase in FDG uptake with increasing dose and time after the end of therapy. Incubation experiments with 3H-inulin revealed that the changes were not caused by unspecific membrane alterations. The affinity (Km) of the transport system remained unchanged, whereas the maximum velocity (Vmax) increased. However, the mRNA content for GLUT1 and HK was unchanged.

CONCLUSION

With these data in mind, an uptake procedure was suggested in a glucose-free medium with an end concentration of 0.1 mM FDG or a zero-trans assay to determine Vmax and Km of the transport system. In FDG-PET studies on patients with tumors, these in vitro data may be helpful to monitor and optimize the therapeutic outcome by combining the chemotherapeutic agent with low doses of deoxyglucose.

Failure of hyperfractionated radiotherapy to reduce bone growth arrest in rats

PURPOSE

Radiotherapy of the craniospinal axis is causing an age dependent growth arrest in children. The purpose of this paper was to examine in an animal model, whether hyperfractionated radiotherapy, given with twice daily fractions in conventional overall treatment time, would cause less growth arrest of the spinal column than a regular treatment schedule.

METHODS AND MATERIALS

The time-dose-fraction schedule for the treatment of the craniospinal axis of children with medulloblastomas was used as model for the treatment of the spine in rats. The entire spine of weanling rats received either 3570 cGy in 21 daily fractions of the 170 cGy, 5 times per week over 27 days, or 3630 cGy in 33 fractions of 110 cGy, given twice daily with 6-hr intervals over 21 days.

RESULTS

Both fraction schedules were isoeffective and caused a growth inhibition of 9.5%. The growth arrest was complete after 1870-2420 cGy. The alpha/beta ratio for the growing rat vertebrae was 3400 cGy. This result contrasts with the growth sparing effect observed with hyperfractionation of accelerated treatment schedules.

CONCLUSION

Growing bone is a fast proliferating tissue. Hyperfractionation with 110 cGy BID compared to 170 cGy given once a day, has no sparing effect on bone growth in rats if given in conventional overall treatment time.

Describing the health-related quality of life impact of HIV infection: findings from a study using the HIV Overview of Problems--Evaluation System (HOPES)

This study aimed to describe the results of findings from data collected with an HIV-specific health-related quality of life tool, and to examine the relationship between clinical and biological factors and health-related quality of life (HRQL). Data were collected as a cross-sectional, patient-completed assessment of health-related quality of life. Laboratory data were abstracted from the medical chart. Patients (n = 318) with HIV infection including asymptomatic (37%), ARC (20%), AIDS (25%), and AIDS with cancer (18%) were receiving health services at one of the medical centres serving HIV-infected patients in the Los Angeles community, including UCLA, community physicians, Veterans Affairs Medical Centers, and a county hospital. Additional data were contributed by the Johns Hopkins University Medical Center CMV Retinitis Clinic. Symptomatic patients and patients with the lowest CD4 counts reported poorer HRQL than asymptomatic patients and patients with higher CD4 counts. However, medical and demographic variables explained only 35% of the variability of HRQL ratings in this sample of HIV-infected patients. While clinical status and Karnofsky performance status may be used to estimate the impact of HIV infection on HRQL, they are not a substitute for independent assessment of HRQL by the patient.

Radium needle used to calibrate germanium gamma-ray detector

A standard platinum-iridium needle that contains 374 MBq 226Ra was tested as a source for calibrating a portable germanium detector used with a gamma-ray spectrometer for environmental radioactivity measurements. The counting efficiencies of the 11 most intense gamma rays emitted by 226Ra and its short-lived radioactive progeny at energies between 186 and 2,448 keV were determined, at the full energy peaks, to construct a curve of counting efficiency vs. energy. The curve was compared to another curve between 43 and 1,596 keV obtained with a NIST mixed-radionuclide standard. It was also compared to the results of a Monte Carlo simulation. The 226Ra source results were consistent with the NIST standard between 248 and 1,596 keV. The Monte Carlo simulation gave a curve parallel to the curve for the combined radium and NIST standard data between 250 and 2,000 keV, but at higher efficiency.

Assessing the needs and quality of life of patients with HIV infection: development of the HIV Overview of Problems-Evaluation System (HOPES)

OBJECTIVE

To develop and evaluate the psychometric properties (reliability, validity etc.) of a comprehensive Quality of Life (QOL) tool, for patients infected with the human immunodeficiency virus (HIV), that was adapted from a previously validated cancer tool.

DESIGN

Cross-sectional, patient completed written surveys and interviews.

SETTING

The Medical Centers serving HIV infected patients in the Los Angeles community including UCLA, community physicians, Veterans Affairs Medical Centers, and a County hospital: and additional data contributed from Johns Hopkins University Medical Center CMV Retinitis Clinic.

PATIENTS

Patients (n = 318) with HIV infection including asymptomatic (37%), ARC (20%), AIDS (25%) and AIDS with Cancer (18%) receiving health services at one of the above sites.

MEASUREMENTS

The patients self-administered the newly developed instrument, the HOPES (HIV Overview of Problems-Evaluation System), other QOL related tools including the Medical Outcomes Study instrument adapted for HIV (MOS-HIV) the Profile of Mood States (POMS), the Perceived Adjustment to Chronic Illness Scale (PACIS), and the Physical Activity Scale (PAS). Brief interview to assess the Karnofsky Performance Status Score (KPS). Measured sociodemographic characteristics included age, sex, race, HIV risk factor, education etc. Assessed medical history, current medications, HIV clinical classification.

MAIN RESULTS

The sociodemographic and medical characteristics of the sample resemble those of the general population with HIV infection in this geographic area: 96% male, 28% nonwhite, 84% homosexual contact as risk factor, 75% receiving antiretroviral therapy. The adaptation of the cancer QOL instrument to HIV appears to have face and content validity according to patients and health professionals who care for HIV infected patients. Analyses of the psychometric properties found that the HOPES has a similar structure to its parent instrument following factor analyses which results in five summary scales representing the Physical, Psychosocial, Medical Interaction, Sexual and Significant Other/Partners domains in addition to a Global Score. Internal consistency of 35 subscales is high with a mean alpha coefficient of 0.82. Correlations of the HOPES summary scales with other QOL instruments are in the predicted directions. Comparing patients within the HIV clinical diagnostic categories on the HOPES Global, Physical, and Psychosocial Summary Scales indicates that Asymptomatic Patients have better QOL than symptomatic patients. This finding is also found in the other QOL instruments which provides evidence of construct validity.

CONCLUSIONS

The HOPES is an excellent tool for identifying the problems and needs of patients with HIV infection and for assessing their quality of life. It is reliable, valid and acceptable to patients. The tool may be especially useful in developing a normative data base.

Effect of alcohol chain length on tubule formation in 1,2-bis(10,12-tricosadiynoyl)-sn-glycero-3-phosphocholine

Aqueous dispersions of 1,2-bis(10,12-tricosadiynoyl)-sn-glycero-3-phosphocholine, on cooling below the chain melting temperature, form hollow cylindrical structures known as 'tubules'. We have studied the formation of tubules in methanol/water, ethanol/water and n-propanol/water. For each alcohol, there is a defined window of alcohol/water ratios in which the lipid precipitates with the tubule morphology. As the chain length of alcohol is increased, the window shifts towards lower alcohol fraction. Light scattering studies show that at very low lipid concentrations the tubules self-assemble directly from the isotropic phase where as for lipid concentrations greater than 4 mg/ml an intermediate L alpha phase is observed. These results indicate that the mechanism of tubule formation may be dependent on lipid concentration.

Models of insulin action on metabolic and growth response genes

In ongoing studies aimed at elucidating the mechanism of insulin action on the expression of genes that modulate glucose utilization and cell growth, we have focused on the inductive effect of insulin on transcription of glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and the early growth response gene, Egr-1. Insulin acutely stimulates the expression of both genes in 3T3 adipocytes; however, in primary adipocytes, chronic insulin exposure has opposing effects on the expression of these genes. GAPDH mRNA is decreased in the epididymal fat cells of diabetic animals and is increased over control levels when insulin is replaced, while Egr-1 mRNA levels are increased in diabetic animals. These observations, coupled with the finding that insulin-stimulated Egr-1 gene transcription is impaired in a Chinese hamster ovarian (CHO) cell line that displays normal metabolic responses but impaired ability to regulate DNA synthesis, support the conclusion that insulin regulation of Egr-1, a growth response gene, and GAPDH, a metabolic response gene, are mediated by distinct pathways. We present evidence that supports the role of protein phosphorylation in mediating the effect of insulin on activation of Egr-1 and GAPDH gene transcription.

Biocompatibility of lipid microcylinders: effect on cell growth and antigen presentation in culture

The authors are developing a lipid-based microcylinder for the controlled release of biological response modifiers and as templates for cellular migration and differentiation. These structures are comprised of a photopolymerizable phosphatidylcholine (1,2-ditricosa-10,12-diynoyl-sn-glycero-3-phosphocholine) and form spontaneously as a result of a thermotropic phase transition in aqueous solution or in a cosolvent solution of 70:30 ethanol:water. The hollow cylinders are helically wrapped lipid bilayers, variable in length (50-250 microns, depending on conditions of formation) and are 0.5-1.0 microns in diameter. The interaction has been examined of three types of lipid microcylinders: (1) monomeric, (2) photopolymerized by exposure to 254 nm light, and (3) surface-modified by incorporation of 6 mol% gangliosides, with different human cell lines and peripheral blood leucocytes to evaluate the biocompatibility of these structures. The proliferative status of U937 (a histiocytic monocyte), K562 (an erythroleukaemic cell), and Jurkat's derivative (a T-lymphoblast) as measured by pulsed tritiated thymidine was unaffected by the presence of up to 100 micrograms/ml of lipid microcylinders after 3 d in culture. Adherent human peripheral blood monocytes were shown to form adhesive contacts with the lipid microcylinders. An 'association' index from this interaction shows that after 3 d in culture, the association was much lower for those microcylinders that had incorporated ganglioside compared with monomeric or polymerized structures. The lipid microcylinders do not activate T-cells isolated from human peripheral blood, nor do they inhibit the activation of T-cells by phorbol esters or other mitogens.(ABSTRACT TRUNCATED AT 250 WORDS)

Self-assembling phospholipid filaments

Aqueous dispersions of double-chain phospholipids spontaneously assemble into closed bilayers called vesicles (or liposomes). Although the vesicles are in general topologically spherical, cylindrical and helical liposomes have sometimes been observed. We present here video-enhanced microscopic studies of a diacetylenic phospholipid dispersed in ethanol/water, which reveal the existence of unusual bilayer morphologies. On cooling the dispersion from the isotropic phase, we have observed the formation of long (of the order of hundreds of micrometres), thin (0.2-2 microns) filaments, which fluctuate strongly. When the temperature is decreased further, the filaments rapidly retract into a mass of lipid. At constant temperature, on the other hand, the filaments transform into torus or ring-like vesicles. Such non-spherical structures have been predicted theoretically but not previously observed experimentally.

Effect of various methods of restoring flexor sheath integrity on the formation of adhesions after tendon injury

The effect of three different methods of restoring flexor sheath integrity on the formation of adhesions around traumatized flexor tendons was studied by use of a chicken animal model. The three methods were: I, Primary sheath repair; II, a fascia patch; and III, a synthetic polytetrafluoroethylene surgical membrane patch. These were compared with controls in which the flexor sheath was excised. Adhesion formation was assessed both biomechanically by measuring the parameter work of flexion, (which represents the resistance to tendon gliding caused by adhesions), and also histologically. At 3 and 6 weeks there was no significant difference in the work of flexion between either the sheath repair or fascia patch digits, and the sheath excised controls. However, use of the synthetic polytetrafluorethylene patch did result in tendon gliding, which was significantly better than the controls. In contrast, at 12 weeks all three methods of sheath reconstruction had similar tendon gliding biomechanics, and all were significantly better than the controls. Histologically, at 3 weeks, the biologic barriers sheath repair and fascia patch were associated with a layer of granulation tissue, which adhered to the underlying tendon. This was similar to the appearance of the sheath excised control digits. The synthetic patch was not associated with a significant inflammatory reaction at this time period and was clearly separated from the tendon. However, by 6 and 12 weeks the granulation tissue in all three sheath reconstruction groups had undergone remodeling to a greater degree than had the controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of postural changes, nitroglycerin and verapamil on diastolic ventricular function as determined by radionuclide angiography in normal subjects

Whereas improvement in diastolic function indexes in response to therapeutic interventions has been attributed to a beneficial effect of the intervention, measurements of diastolic function appear to be influenced by changes in loading conditions, heart rate and sympathetic tone. To determine the effect of body position and short-term pharmacologic intervention on radionuclide angiographically determined left ventricular peak filling rate, high temporal resolution time-activity curves and absolute left ventricular volumes obtained by equilibrium-gated blood pool scans were evaluated in 12 normal subjects in the supine position at rest and in response to several postural and pharmacologic manipulations. This study confirmed the reproducibility of the technique and demonstrated that in normal subjects, peak filling rate varies in response to changes in body position and to short-term administration of sublingual nitroglycerin and intravenous verapamil. Peak filling rate ranged from 3.3 to 5.1 end-diastolic volumes (EDV)/s with a variability of 13.7% during five baseline supine measurements in the 12 subjects. Compared with values in the supine position (mean +/- SEM = 4.38 +/- 0.24 EDV/s), peak filling rate increased +16 +/- 6% to 4.75 +/- 0.27 EDV/s in the upright position (p less than 0.05) but did not change significantly with leg elevation. Peak filling rate at baseline and during postural changes correlated significantly with ejection fraction (r = +0.49), with stroke volume (r = +0.26) and inversely with end-systolic volume (r = -0.41), but did not correlate with heart rate or blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

The bioaccumulation factor for phosphorus-32 in edible fish tissue

Information used to derive the bioaccumulation factor for 32P in edible portions of fish was reviewed to evaluate the currently recommended values of 100,000 in fresh water and 29,000 in sea water that are applied in calculating radiation doses to persons from nuclear-power reactor effluents. A generic phosphorus bioaccumulation factor of 70,000 was obtained for larger rivers and estuarine waters on the basis of geometric mean phosphorus concentrations of 2 mg/g wet weight in fish muscle and 0.03 mg/l dissolved in water. A 20-fold lower bioaccumulation factor was inferred for 32P because radioactive decay is much faster than phosphorus turnover. A phosphorus turnover rate in muscle of 0.2% per day was estimated as a long-term average for edible-size fish, although more rapid turnover has been observed for brief periods. Large deviations from the generic bioaccumulation factor will occur for different phosphorus concentrations in water and turnover rates in fish. Site-specific determinations are also needed because 32P is bioaccumulated at lower trophic levels in the food web, not in the fish. Hence, the availability of concentrating organisms determines the bioaccumulation factor. Several other conditions that affect the 32P bioaccumulation factor have not been quantified and are suggested for study.

Behavior of radionuclides in sanitary landfills

his study was undertaken to evaluate the possibility of disposing low-level radioactive waste in sanitary landfills with leachate containment to prevent environmental releases. To meet this objective, two simulated landfills, each 200 l. in volume and containing 55 kg of municipal refuse, were operated in the laboratory with simulated rainfall additions for a 9-month period to observe the extent to which radio-cobalt, -cesium, -strontium and tritium were leached into the liquid phase. One of the units was operated with leachate recycle, the other as a single pass control. Liquid samples were analyzed weekly for 3H, 58Co, 85Sr and 134Cs tracers. Weekly analyses were also performed for approximately 30 parameters to define the degree of stabilization of the waste. Major parameters included BOD, COD, pH and concentrations of specific organics, metals and gases. Concentrations of stable cobalt, strontium and cesium were also measured periodically. Soluble radioactivity levels in both systems were reduced by factors of 50 for 58Co, 5 for 85Sr and 7 for 134Cs, taking radioactive decay and dilution into account. Some radionuclide removal from the liquid phase was associated with major chemical changes in the landfills that occurred within 80 days for the control system and within 130 days for the recycle unit. Observed acid, sulfide, and CO2 concentrations suggested mechanisms for removing some of the radionuclides from leachate. Detection of 3H in the off-gas indicated that less than 1% of tritiated waste became airborne. The waste in the leachate recycle unit was more completely stabilized than in the control unit.

Search for building materials as sources of elevated radiation dose

A systematic approach to finding materials that cause elevated gamma radiation exposure rates or 222Rn progeny working levels in buildings was tested in the Atlanta area. With the proposed procedure, exposure rates in planned structures would be derived from a radiation survey of the material performed with a NaI(T1) detector. Working level values under specified conditions would be inferred from an additional measurement of 226Ra concentration in the material. To quantify the procedure, surveyed building materials were analyzed for radionuclide content and categorized according to an exposure rate index related both to the survey meter count rate and the radionuclide concentration. An available calculational model was used to predict from the index the exposure rate in a room totally enclosed by radioactive material. An additional model was developed for application to structures where the radioactive material is only in the floor or walls. 222Radon concentrations in an enclosed space were also predicted according to an available model. Exposure rates were measured in newly constructed buildings to test the approach. Measurements in older buildings found elevated gamma-ray emission from concrete blocks made with phosphate slag from a phosphorus producer in Alabama. Buildings with walls of these blocks were used to test the prediction of 222Rn concentrations in building air due to 226Ra in construction material. The calculational models predicted that the 226Ra concentration of approx. 20 pCi/g in these blocks would result in increases of the average exposure rates by 10 mu R/hr and of 222Rn concentrations by 0.2 pCi/l. under specified conditions. Observed levels were consistent with these predictions, but the major fraction of 222Rn in room air was attributed to inflow from the ground beneath the building.

Radium and uranium concentrations in Georgia community water systems

The first cycle of statewide radionuclide concentration measurements of public drinking water supplies was completed in accord with the Federal and Georgia Safe Drinking Water Acts. The recommended pattern of analysis is initial screening for gross alpha-particle activity, followed by measuring 226Ra if the gross alpha-particle activity is above 5 pCi/l. and then measuring 228Ra if the 226Ra concentration is above 3 pCi/l; and uranium analysis if the gross alpha-particle activity exceeds 15 pCi/l. Surface water supplies for more than 100,000 persons are analyzed for 3H and 90Sr and screened for gross beta-particle activity, with additional analytical requirements if the latter is above 50 pCi/l. Specified supplies downstream for nuclear facilities are analyzed for 3H, 90Sr and 131I, and further analyses are required if the gross beta-particle activity is above 15 pCi/l. More thorough screening was applied for 1400 public water supplies in Georgia, of which about 90% use groundwater. Radium concentrations exceeded the maximum contaminant level (MCL) of 5 pCi/l. in 24 groundwater supplies, mostly due to elevated 226Ra. The gross alpha-particle activity minus uranium concentrations exceeded the 15 pCi/l. MCL in 3 additional samples. No MCL was exceeded in surface water. The S.D.s of analytical results estimated from replicate analyses were approximately twice those based on counting statistics, suggesting that screening levels should be lowered to assure detection of 226Ra at MCL values.

Transportation of radioactive material in Georgia

A 3-yr study of radioactive materials transportation examined the magnitude of radioactive materials shipments in terms of numbers of packages and motor vehicle trips and types of materials; compliance with regulations for packaging, labelling, handling, external radiation exposure, and surface contamination; and dose to workers as measured with personnel dosimeters. Much of the information was obtained at the Atlanta airport and its vicinity, a package distribution center for the southeastern U.S., and at the Barnwell, S.C. radioactive waste burial site, the destination of most shipments of radioactive waste from or through Georgia. Approximately 12,000 packages in radioactive material categories I, II and III were handled in Georgia each year. Motor vehicles made approximately 3300 trips per year. Some instances of noncompliance were observed, but few of them had the potential for elevated radiation exposure of persons. Several incidents associated with radioactive material transport are reported, of which one may have resulted in slightly elevated exposures to persons. Among drivers and handlers who worked with radioactive material shipments, dosimeters showed that less than one-half of them received radiation doses above background levels. The highest doses were found for drivers who transported large numbers of 99Mo generators.

Monitoring the critical radiation exposure pathways at a BWR nuclear power station

Iodine-131 in milk and gamma radiation from radionuclides in air in the environment of a 3-unit nuclear power station were measured at the levels predicted for airborne effluent. These measurements were part of a modified environmental radiological monitoring program to confirm the population doses computed from radionuclide release rates and environmental transfer models. The limits of detection were lowered relative to conventional monitoring programs by analyzing 21 L samples of milk for 131I and by determining external gamma radiation with a system that combined use of thermoluminescent dosimeters, pressurized ionization chambers, and NaI(T1) survey meters. For monitoring periods slightly longer than 6 months, during a time when fallout from atmospheric nuclear tests contributed very little, the average measured 131I concentration in milk was 0.1 pCi/L for cows on a nearby pasture and 0.02 pCi/L for cows at a more distant control location, compared to predicted values of 0.07 and 0.02 pCi/L, respectively; the average radiation exposure from airborne radionuclides measured at 16 nearby dosimeter locations was 7 mR, compared to the average of predicted values of 4 mR.

Gas-Liquid Chromatographic Method for the Analysis of Microencapsulated Diazinon Insecticide: Collaborative Study

The determination of diazinon insecticide in Knox Out 2FM formulation was studied collaboratively by 18 laboratories. Knox Out 2FM is a flowable microencapsulated insecticide formulation containing 23 wt% active ingredient. Analytical samples are first treated by grinding in a tissue grinder and then extracted in situ with acetonitrile. This preparative step breaks the capsules and allows the active ingredient to dissolve in the solvent. Single determinations on each of 2 closely matched samples were made by flame ionization gas-liquid chromatography. The standard deviation by analysts was 0.18 wt% and the coefficient of variation was 0.76%. The combined laboratory and analyst variation gave a standard deviation of 0.59 wt% and a coefficient of variation of 2.49%. The method has been adopted official first action.

Superior gluteal artery laceration, a complication of iliac bone graft surgery

In the 2 cases cited, laceration of the superior gluteal artery occurred when removing bone from the posterior ilium. A review of the anatomy shows how the superior gluteal artery, as it exists the sciatic notch, can be compressed locally and exposed for clipping or ligation. The internal iliac artery can be occluded by embolization of a Fogerty catheter. The bony origin of the gluteus maximus is a good landmark to help avoid entering the sciatic notch and a special retractor provides the necessary exposure.

Foreign body (palm thorn) in knee joint

A child who lives in a semitropical or tropical zone and has monarticular symptoms involving the knee joint and a history of playing in the vicinity of plams should be examined for the possibility of a palm thorn within the joint. The diagnosis, made after careful elimination of more common entities, can only be confirmed by surgical exploration.