Effect of airplane travel on women treated for breast cancer

Abstract #1119

Background: Many patient materials promulgate lifestyle adaptations purported to minimize risk of lymphedema. One factor often mentioned is development or exacerbation of lymphedema due to airplane travel. The aim of this study was to describe prospectively the effect of airplane travel on women treated for breast cancer, traveling to Caloundra, Qld., Australia to attend a dragon boat regatta.
 Methods: Pre and post data were obtained from 63 women traveling from Canada to Australia, and from 12 women traveling within Australia. 54% were treated for breast cancer on their dominant side, 63% underwent mastectomy with or without reconstruction, 77% underwent axillary node dissection, and 21% wore a compression sleeve during flight; 94% trained at a moderate to vigorous intensity for the regatta. Single frequency bioimpedance analysis (BIA; XCA; Impedimed Inc.®) was used to determine the inter-limb difference in upper limb extracellular fluid. BIA is highly reliable and has high sensitivity and specificity for increased extracellular fluid accumulation. Change in ratio >0.05 for women without lymphoedema is of clinical significance. Women were measured within 2 weeks of their flight to Caloundra, immediately on arrival in Caloundra, and for 46 women, within 6 weeks of return to Canada.
 Results: Airplane travel did not have a significant effect on the upper limb BIA ratio, either between the pre and post flight (t75= -0.355; p=0.72) or between the pre and follow-up measures (t44=.241; p=0.811).
 
 Overall, the BIA post ratio increased from the pre measure by ≤0.02 in 48 women; 0.02 to <0.05 in 12 women; 0.05 to <0.10 in 10 women; and >0.10 in 5 women (Fig 1). In Figure 1, symbols in grey-shaded area represents women who did not have lymphedema prior to flight but presented with it post flight and the dashed lines indicate previously established cut-offs for criteria for detection of lymphedema. Dotted line on each graph is the line of agreement. The 6 symbols in the grey shaded area (Fig 1) represent women from the international group; their change in BIA ranged from 0.05 to 0.28. Follow-up measures were available on 5 of these women, and indicated that 4 were below the cut-offs for lymphedema. All 6 women had undergone mastectomy and axillary clearance of their lymph nodes and for 5, surgery was on their dominant side. Only 3 of the women wore a compressive sleeve on the plane.
 Discussion: For the majority of women who undertake moderate to vigorous upper limb exercise, airplane travel did not have a significant impact on extracellular fluid ratio. Acknowledgment: Impedimed for funding and equipment.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1119.

The role of the health care team in the implementation of the National Kidney Foundation-Dialysis Outcomes Quality Initiative: a case study

The National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI) provides an opportunity to review multidisciplinary practice in end-stage renal disease settings across the country. The role of the nephrology nurse, nephrology technician, renal dietitian, and nephrology social worker are reviewed through a case presentation referencing NKF-DOQI Guidelines. Each discipline provides an overview of its respective assessments and interventions focused on improving the patient's outcome.

Serum bicarbonate is an independent determinant of protein catabolic rate in chronic hemodialysis

Serum bicarbonate is an independent determinant of protein catabolic rate in chronic hemodialysis. Recent biochemical studies suggest that metabolic acidosis induces an increase in protein catabolic rate. Therefore, we retrospectively examined the relationship between serum total CO2, normalized protein catabolic rate (NPCR), midweek BUN, KT/V, and serum albumin in 70 chronic hemodialysis patients over a period of 4-6 months (total of 270 determinations). Multiple regression analysis indicated an independent and inverse association of tCO2 with NPCR (p < 0.0001). Subsequent analysis of the data indicated a nonlinear relationship between serum CO2 and NPCR. Indeed, the slope of the regression abruptly increased from -0.015 +/- 0.005 to -0.108 +/- 0.032 when analyzed for serum CO2 < or = 15 mEq/l. We conclude that metabolic acidosis may modulate protein kinetics in patients receiving maintenance hemodialysis. Moreover, this relationship appears to be exaggerated at moderate to severe reductions in tCO2. Thus, this analysis suggests that decreases in tCO2 have a detrimental effect on protein catabolism in stable patients maintained on chronic hemodialysis.

Effect of insulin-dependent diabetes on plasma lipoproteins in diabetic pregnancy

A reduction in total plasma cholesterol concentration has been reported in insulin-dependent diabetic (IDDM) pregnant women in early gestation. To determine if this reduction extends throughout gestation and which lipoprotein fractions may be responsible, we measured plasma triglyceride, cholesterol (C), high density lipoprotein cholesterol (HDL-C) and HDL2 and HDL3-C subfractions between 6 and 36 weeks' gestation in normal and IDDM women. Total plasma C was significantly lower in IDDM pregnant subjects between 20 and 36 weeks' gestation as compared to nondiabetic controls, while plasma triglyceride concentrations were not significantly different in this interval. Very low and low density lipoprotein (VLDL, LDL) C concentrations were not statistically significantly different from controls at any of the times studied, while HDL-C was lower throughout diabetic pregnancy as compared to controls, significantly so between 20 and 36 weeks' gestation. The lower HDL-C in IDDM women was associated with a significantly lower HDL3-C level. Plasma apoprotein A-I and A-II concentrations, markers of the HDL2 and HDL3 subclasses, respectively, were measured to corroborate the HDL subfraction changes. Apo A-I and A-II increased significantly between 12 and 28 weeks' gestation in control but not in diabetic pregnant subjects, consistent with a higher HDL3 in normal than in diabetic pregnant subjects. It appears that plasma triglyceride, VLDL and LDL-C, and HDL2-C concentrations are similar in IDDM and normal pregnancy, while total-C, HDL-C and HDL3-C and its associated apoproteins are lower than in normal subjects in late gestation. The mechanism of these changes and their significance for fetal growth and development deserve further study.

Induction of retrovirus gene expression by aflatoxin B1 and 2-acetylaminofluorene

The abilities of 2-acetylaminofluorene (AAF) and aflatoxin B1 (AFB) to induce the expression of endogenous murine retrovirus in AKR mouse embryo fibroblasts were examined. AFB was able to induce virus expression at concentrations as low as 0.067 microM, although the induction efficiency was increased at higher doses. AAF gave somewhat more variable results. In some experiments induction was observed with as little as 0.1 microM while in other experiments induction was not observed at concentrations as high as 100 microM. Addition of an S9 metabolizing system enhanced the ability of AAF to induce virus expression but also increased the background induction frequency. These results are discussed in relation to the mechanism of virus induction and the potential usefulness of virus induction as an assay for carcinogenic potential.