Intracranial arachnoid cyst in pregnancy: case report, literature review and evaluation of neuraxial anaesthesia risk

Choosing the type of intrapartum anaesthesia for pregnant women with intracranial arachnoid cysts can be challenging due to a lack of research. We report the intrapartum anaesthetic management of a 25-year-old woman with a known 10 cm arachnoid cyst. By means of a literature review and discussion of safety surrounding neuraxial techniques, this report will help to inform obstetric anaesthesia practice. Overall, in the absence of raised intracranial pressure, neuraxial analgesia and anaesthesia during the intrapartum period appears to be a safe option.

Sex and Gender Disparities in Living Kidney Donation: A Scoping Review

Background

Women are more likely than men to be living kidney donors. We summarized the evidence concerning the reasons behind sex and gender disparities in living kidney donation (LKD).

Methods

A scoping review of quantitative and qualitative evidence on reasons for sex and gender disparities in LKD was conducted from inception to March 2023.

Results

Of 1123 studies screened, 45 were eligible for inclusion. Most studies were from North America, Europe, and Central Asia (n = 33, 73%). A predominance of women as living donors (55%-65%) was observed in 15 out of 18 (83%) studies. Reasons for sex and gender disparities in LKD included socioeconomic, biological, and cognitive or emotional factors. A gendered division of roles within the families was observed in most studies, with men being the primary income earner and women being the main caregiver. Fear of loss of income was a barrier to male donation. Human leukocyte antigen sensitization through pregnancy in female recipients precluded male partner donation, whereas female donation was supported by altruism and a positive attitude toward LKD.

Conclusions

Sex imbalance in LKD is prevalent, with a predominance of women as living donors. Such disparities are driven by societal and cultural perceptions of gender roles, pregnancy-induced sensitization, and attitudes toward donation and at least some of these factors are modifiable. Donor compensation to support predonation assessments and income loss, implementation of innovative desensitization treatments, promotion of paired kidney exchange program, and targeted educational initiatives to promote equitable living donation may help to close the gender gap in LKD.

The role of pandemic planning in the management of COVID-19 in England from an infection prevention and control perspective: results of a national survey

OBJECTIVES

This national survey aimed to explore how existing pandemic preparedness plans (PPP) accounted for the demands placed on infection prevention and control (IPC) services in acute and community settings in England during the first wave of the COVID-19 pandemic.

STUDY DESIGN

This was a cross-sectional survey of IPC leaders working within National Health Service Trusts or clinical commissioning groups/integrated care systems in England.

METHODS

The survey questions related to organisational COVID-19 preparedness pre-pandemic and the response provided during the first wave of the pandemic (January to July 2020). The survey ran from September to November 2021, and participation was voluntary.

RESULTS

In total, 50 organisations responded. Seventy-one percent (n = 34/48) reported having a current PPP in December 2019, with 81% (n = 21/26) indicating their plan was updated within the previous 3 years. Around half of IPC teams were involved in previous testing of these plans via internal and multi-agency tabletop exercises. Successful aspects of pandemic planning were identified as command structures, clear channels of communication, COVID-19 testing, and patient pathways. Key deficiencies were lack of personal protective equipment, difficulties with fit testing, keeping up to date with guidance, and insufficient staffing.

CONCLUSIONS

Pandemic plans need to consider the capability and capacity of IPC services to ensure they can contribute their critical knowledge and expertise to the pandemic response. This survey provides a detailed evaluation of how IPC services were impacted during the first wave of the pandemic and identifies key areas, which need to be included in future PPP to better manage the impact on IPC services.

Aberrantly low STAT3 and STAT5 responses are associated with poor outcome and an inflammatory gene expression signature in pediatric acute myeloid leukemia

The relapse rate for children with acute myeloid leukemia is nearly 40% despite aggressive chemotherapy and often stem cell transplant. We sought to understand how environment-induced signaling responses are associated with clinical response to treatment. We previously reported that patients whose AML cells showed low G-CSF-induced STAT3 activation had inferior event-free survival compared to patients with stronger STAT3 responses. Here, we expanded the paradigm to evaluate multiple signaling parameters induced by a more physiological stimulus. We measured STAT3, STAT5 and ERK1/2 responses to G-CSF and to stromal cell-conditioned medium for 113 patients enrolled on COG trials AAML03P1 and AAML0531. Low inducible STAT3 activity was independently associated with inferior event-free survival in multivariate analyses. For inducible STAT5 activity, those with the lowest and highest responses had inferior event-free survival, compared to patients with intermediate STAT5 responses. Using existing RNA-sequencing data, we compared gene expression profiles for patients with low inducible STAT3/5 activation with those for patients with higher inducible STAT3/5 signaling. Genes encoding hematopoietic factors and mitochondrial respiratory chain subunits were overexpressed in the low STAT3/5 response groups, implicating inflammatory and metabolic pathways as potential mechanisms of chemotherapy resistance. We validated the prognostic relevance of individual genes from the low STAT3/5 response signature in a large independent cohort of pediatric AML patients. These findings provide novel insights into interactions between AML cells and the microenvironment that are associated with treatment failure and could be targeted for therapeutic interventions.

95 Lack of Evidence for Reduced Efficacy of Medical Therapy for Heart Failure in Older Adults

Introduction

There are almost a million people with heart failure (HF) in the UK; the incidence increases sharply with age. Older adults receive less evidence-based therapy with few trials specifically examining therapeutic efficacy in older age groups representative of a contemporary UK HF population. Concern that efficacy is less in older adults may underlie under-prescription. With important recent advances in HF therapy, we reviewed the contemporary evidence base for any signal of different efficacy in older adults.

Methods

We reviewed recent RCTs of medical therapy for heart failure alongside meta-analyses updated with recent therapies including Angiotensin-Neprilysin inhibitors and SGLT2 inhibitors. For those trials in which effect size was presented for age subgroups we compared the effect size.

Results

Of 68 randomised controlled trials, 10 presented effect sizes for different age groups. The median average cut-off between younger and older age groups was 66 years (IQR 65 to 72.5 years) and the highest cut-off used was 75 years. The median hazard ratio was 0.77 (IQR 0.67 to 0.80) for the younger age group and 0.76 (IQR 0.73 to 0.88) for the older age group. In 8 of the 10 trials, the effect size in the oldest age group was statistically significant on its own including Sacubitril-Valsartan and Dapagliflozin.

Conclusion

When considering the medical therapeutic armamentarium for heart failure as a totality, there is no evidence it is any less effective in older adults than younger adults. The recent Zannad et al cross-trial analysis supported this showing significant additional life years in the patients over 80 years on HF therapy. Whilst there may be practical and frailty-related reasons for not prescribing life-prolonging therapy, the proportional survival benefits of these medications is similar in older adults. This should be utilised where practically possible and discussed with patients when making an informed choice.

International Survey to Establish Prioritized Outcomes for Trials in People With Coronavirus Disease 2019

OBJECTIVES

There are over 4,000 trials conducted in people with coronavirus disease 2019. However, the variability of outcomes and the omission of patient-centered outcomes may diminish the impact of these trials on decision-making. The aim of this study was to generate a consensus-based, prioritized list of outcomes for coronavirus disease 2019 trials.

DESIGN

In an online survey conducted in English, Chinese, Italian, Portuguese, and Spanish languages, adults with coronavirus disease 2019, their family members, health professionals, and the general public rated the importance of outcomes using a 9-point Likert scale (7-9, critical importance) and completed a Best-Worst Scale to estimate relative importance. Participant comments were analyzed thematically.

SETTING

International.

SUBJECTS

Adults 18 years old and over with confirmed or suspected coronavirus disease 2019, their family members, members of the general public, and health professionals (including clinicians, policy makers, regulators, funders, and researchers).

INTERVENTIONS

None.

MEASUREMENTS

None.

MAIN RESULTS

In total, 9,289 participants from 111 countries (776 people with coronavirus disease 2019 or family members, 4,882 health professionals, and 3,631 members of the public) completed the survey. The four outcomes of highest priority for all three groups were: mortality, respiratory failure, pneumonia, and organ failure. Lung function, lung scarring, sepsis, shortness of breath, and oxygen level in the blood were common to the top 10 outcomes across all three groups (mean > 7.5, median ≥ 8, and > 70% of respondents rated the outcome as critically important). Patients/family members rated fatigue, anxiety, chest pain, muscle pain, gastrointestinal problems, and cardiovascular disease higher than health professionals. Four themes underpinned prioritization: fear of life-threatening, debilitating, and permanent consequences; addressing knowledge gaps; enabling preparedness and planning; and tolerable or infrequent outcomes.

CONCLUSIONS

Life-threatening respiratory and other organ outcomes were consistently highly prioritized by all stakeholder groups. Patients/family members gave higher priority to many patient-reported outcomes compared with health professionals.

Core Outcomes Set for Trials in People With Coronavirus Disease 2019

OBJECTIVES

The outcomes reported in trials in coronavirus disease 2019 are extremely heterogeneous and of uncertain patient relevance, limiting their applicability for clinical decision-making. The aim of this workshop was to establish a core outcomes set for trials in people with suspected or confirmed coronavirus disease 2019.

DESIGN

Four international online multistakeholder consensus workshops were convened to discuss proposed core outcomes for trials in people with suspected or confirmed coronavirus disease 2019, informed by a survey involving 9,289 respondents from 111 countries. The transcripts were analyzed thematically. The workshop recommendations were used to finalize the core outcomes set.

SETTING

International.

SUBJECTS

Adults 18 years old and over with confirmed or suspected coronavirus disease 2019, their family members, members of the general public and health professionals (including clinicians, policy makers, regulators, funders, researchers).

INTERVENTIONS

None.

MEASUREMENTS

None.

MAIN RESULTS

Six themes were identified. "Responding to the critical and acute health crisis" reflected the immediate focus on saving lives and preventing life-threatening complications that underpinned the high prioritization of mortality, respiratory failure, and multiple organ failure. "Capturing different settings of care" highlighted the need to minimize the burden on hospitals and to acknowledge outcomes in community settings. "Encompassing the full trajectory and severity of disease" was addressing longer term impacts and the full spectrum of illness (e.g. shortness of breath and recovery). "Distinguishing overlap, correlation and collinearity" meant recognizing that symptoms such as shortness of breath had distinct value and minimizing overlap (e.g. lung function and pneumonia were on the continuum toward respiratory failure). "Recognizing adverse events" refers to the potential harms of new and evolving interventions. "Being cognizant of family and psychosocial wellbeing" reflected the pervasive impacts of coronavirus disease 2019.

CONCLUSIONS

Mortality, respiratory failure, multiple organ failure, shortness of breath, and recovery are critically important outcomes to be consistently reported in coronavirus disease 2019 trials.

Liquid Chromatographic Method for Determining Capsaicinoids in Capsicums and Their Extractives: Collaborative Study

Sixteen laboratories participated in an AOAC–American Spice Trade Association (ASTA) collaborative study of a liquid chromatographic (LC) method for determining capsaicinoids in capsicums and their extractives. Capsicums are extracted with ethanol by refluxing and then filtered. Capsaicinoids in the filtrate are separated by re- versed-phase LC and detected spectrophotometri� cally with external standard quantitation. Participants analyzed 6 ground capsicum and 3 oleoresin products as 12 samples from a mixed scheme of blind duplicates and Youden matched pairs. Average repeatability and reproducibility standard deviations (sr and sR, respectively) and average relative standard deviations (RSDr and RSDR, respectively) for ground red pepper were as follows: sr, 610 Scoville heat units (SHU); sR, 1730 SHU; RSDr, 1.7%; RSDR, 4.9%. For ground chili peppers, the values were sr, 60 SHU; sR, 160 SHU; RSDr, 4.0%; RSDR, 10.6%. For oleoresin red pepper, the averages were sr, 46820 SHU; sR, 54990 SHU; RSDr, 8.5%; RSDR, 11.2%. The LC method has been adopted first action by AOAC INTERNATIONAL.

Magnetic resonance imaging for three-dimensional printing of the bony orbit: is clinical use imminent?

The aim of this study was to examine the accuracy of three dimensionally (3D) printed models of the bony orbit derived from magnetic resonance imaging (MRI) for the purpose of preoperative plate bending in the setting of orbital blowout fracture. Retrospective computed tomography (CT) and MRI data from patients with suspected orbital fractures were used. Virtual models were manually generated and analysed for spatial accuracy of the fracture margins. 3D-printed models were produced and orbital fan plates bent by a single operator. The plates were then digitized and analysed for spatial discrepancy using reverse engineering software. Seven orbital blowout fractures were evident in six orbits. Analysis of the virtual models revealed high congruence between blowout fracture margins on CT and MRI (n=7, average deviation 0.85mm). Three zygomaticomaxillary complex fractures were seen, for which MRI did not demonstrate the same accuracy. For plates bent to the 3D-printed models of blowout fractures (n=6), no significant difference was found between those bent to CT versus those bent to MRI when compared for average surface and average border deviation (Wilcoxon signed rank test). Orbital blowout fractures can be defined on MRI with clinically acceptable accuracy. 3D printing of orbital biomodels from MRI for bending reconstructive plates is an acceptable and accurate technique.

The relationship between an electronic mental health stigma campaign and suicidal thoughts and behaviours: a two-arm randomized controlled trial in the Australian construction industry

Males employed in the construction industry are at greater risk of suicide than other employed males. It is plausible that a high level of stigma against mental health problems explains the elevated rates of suicide among this group. This study sought to test the effectiveness of an electronic mental health stigma intervention on suicide ideation, communication about suicide and attempts. Participants were randomly assigned to receive either a series of brief contact interventions over a 6-week period or a wait list control. Suicidal ideation, communication about suicide and suicide attempts were assessed using the Suicidal Behaviors Questionnaire-Revised at post-intervention. We used linear regression to assess effectiveness at post-intervention, adjusting for relevant covariates using both conventional methods and a propensity score approach. Results indicate that the intervention had no significant impact on suicidal thoughts, communication or suicide attempts. There was some indication that individuals in the intervention group reported a slight increase in attempts and communication about suicide. These observations underscore an urgent need for more research to understand the complex and nuanced relationship between stigma and suicide in non-clinical populations.

Ototoxicity of Carboplatin Delivered Locally in a Monkey Brainstem

Ototoxicity is a common side effect of platinum-based chemotherapy. Intratumoral drug delivery theoretically could reduce the ototoxic effects of systemic drug infusions. However, local delivery to central nervous system (CNS) tumors might promote ototoxicity through drug release into cerebrospinal fluid (CSF). This report describes an examination of the cytoarchitecture of vestibular cells of cynomolgus monkeys that had chronic brainstem infusions with the maximum tolerated dose (MTD) of carboplatin. The brainstems of adult monkeys were infused for 30 days at 0.42 μl/h with 0.025 to 0.25 mg/kg (MTD) of carboplatin. The vestibular sensory epithelia of eight drug-treated animals were isolated for microscopic examination of vestibular hair cells and support cells. Local infusions produced chronic elevated CSF levels of platinum, neurological symptoms, and radiographic evidence of pontine injury. Histology revealed significant cell damage at the infusion sites. Microscopic examinations of vestibular support cells and hair cells demonstrate a small reduction in cell counts in the drug-treated monkeys compared to a noninfused control animal. Parametric and nonparametric tests show no effect of dose in predicting the vestibular cell counts. In this single study of eight monkeys, a dose-dependent reduction of vestibular hair cells or support cells was not observed in animals infused with brainstem infusions of 0.025 to 0.25 mg/kg of carboplatin.

Delivering an infection control link nurse programme: implementation and evaluation of a flexible teaching approach

Infection control nurses work to ensure practice is evidence-based, thereby minimising infection risks. There is, however, a gap between theory and practice in infection control at clinical level. Link nurse groups have been used in an attempt to ensure practice is evidence-based.

This article describes a research study that examined the efficacy of an infection control link nurse programme, which had an educational programme based upon adult learning theory, delivered using an action-research approach. Results of the study are described in subsequent articles.

Delivering an infection control link nurse programme: improving practice

This is the second in a series of articles describing a research study that examined the efficacy of an infection control link nurse programme, which had an educational programme based upon adult learning theory, delivered using an action research approach. This article describes the results of a quantitative study that aimed to identify if the utilisation of this programme led to improvements in infection control practice at clinical level. Implications for practice are discussed.

Methionine-restricted diet inhibits growth of MCF10AT1-derived mammary tumors by increasing cell cycle inhibitors in athymic nude mice

Background

Dietary methionine restriction (MR) improves healthspan in part by reducing adiposity and by increasing insulin sensitivity in rodent models. The purpose of this study was to determine whether MR inhibits tumor progression in breast cancer xenograft model and breast cancer cell lines.

Methods

Athymic nude mice were injected with MCF10AT1 cells in Matrigel® and fed a diet containing either 0.86 % methionine (control fed, CF), or 0.12 % methionine (MR) for 12 weeks. Plasma amino acid concentrations were measured by UPLC, and proliferation and apoptosis were examined using RT-PCR, immunohistochemistry, and Cell Titer 96® Aqueous One Solution Cell Proliferation assay.

Results

Mice on the MR diet had reduced body weight and decreased adiposity. They also had smaller tumors when compared to the mice bearing tumors on the CF diet. Plasma concentrations of the sulfur amino acids (methionine, cysteine, and taurine) were reduced, whereas ornithine, serine, and glutamate acid were increased in mice on the MR diet. MR mice exhibited decreased proliferation and increased apoptosis in cells that comprise the mammary glands and tumors of mice. Elevated expression of P21 occurred in both MCF10AT1-derived tumor tissue and endogenously in mammary gland tissue of MR mice. Breast cancer cell lines MCF10A and MDA-MB-231 grown in methionine-restricted cysteine-depleted media for 24 h also up-regulated P21 and P27 gene expression, and MDA-MB-231 cells had decreased proliferation.

Conclusion

MR hinders cancer progression by increasing cell cycle inhibitors that halt cell cycle progression. The application of MR in a clinical setting may provide a delay in the progression of cancer, which would provide more time for conventional cancer therapies to be effective.

Electronic supplementary material

The online version of this article (doi:10.1186/s12885-016-2367-1) contains supplementary material, which is available to authorized users.

Swimming in an Unsteady World

When animals swim in aquatic habitats, the water through which they move is usually flowing. Therefore, an important part of understanding the physics of how animals swim in nature is determining how they interact with the fluctuating turbulent water currents in their environment. We addressed this issue using microscopic larvae of invertebrates in "fouling communities" growing on docks and ships to ask how swimming affects the transport of larvae between moving water and surfaces from which they disperse and onto which they recruit. Field measurements of the motion of water over fouling communities were used to design realistic turbulent wavy flow in a laboratory wave-flume over early-stage fouling communities. Fine-scale measurements of rapidly-varying water-velocity fields were made using particle-image velocimetry, and of dye-concentration fields (analog for chemical cues from the substratum) were made using planar laser-induced fluorescence. We used individual-based models of larvae that were swimming, passively sinking, passively rising, or were passive and neutrally buoyant to determine how their trajectories were affected by their motion through the water, rotation by local shear, and transport by ambient flow. Swimmers moved up and down in the turbulent flow more than did neutrally buoyant larvae. Although more of the passive sinkers landed on substrata below them, and more passive risers on surfaces above, swimming was the best strategy for landing on surfaces if their location was not predictable (as is true for fouling communities). When larvae moved within 5 mm of surfaces below them, passive sinkers and neutrally-buoyant larvae landed on the substratum, whereas many of the swimmers were carried away, suggesting that settling larvae should stop swimming as they near a surface. Swimming and passively-rising larvae were best at escaping from a surface below them, as precompetent larvae must do to disperse away. Velocities, vorticities, and odor-concentrations encountered by larvae fluctuated rapidly, with peaks much higher than mean values. Encounters with concentrations of odor or with vorticities above threshold increased as larvae neared the substratum. Although microscopic organisms swim slowly, their locomotory behavior can affect where they are transported by the movement of ambient water as well as the signals they encounter when they move within a few centimeters of surfaces.

Physico-chemical changes in Ca, Sr and Al-doped La–Mn–O perovskites upon thermochemical splitting of CO2via redox cycling

Thermochemical CO₂-splitting via redox cycling of Ca, Sr and Al-doped La–Mn perovskites induces irreversible changes in the texture and chemical composition of these oxides.

Training infection control and hospital hygiene professionals in Europe, 2010: agreed core competencies among 33 European countries

The harmonisation of training programmes for infection control and hospital hygiene (IC/HH) professionals in Europe is a requirement of the Council recommendation on patient safety. The European Centre for Disease Prevention and Control commissioned the 'Training Infection Control in Europe' project to develop a consensus on core competencies for IC/HH professionals in the European Union (EU). Core competencies were drafted on the basis of the Improving Patient Safety in Europe (IPSE) project's core curriculum (CC), evaluated by questionnaire and approved by National Representatives (NRs) for IC/HH training. NRs also re-assessed the status of IC/HH training in European countries in 2010 in comparison with the situation before the IPSE CC in 2006. The IPSE CC had been used to develop or update 28 of 51 IC/HH courses. Only 10 of 33 countries offered training and qualification for IC/HH doctors and nurses. The proposed core competencies are structured in four areas and 16 professional tasks at junior and senior level. They form a reference for standardisation of IC/HH professional competencies and support recognition of training initiatives.

Are educational interventions to prevent catheter-related bloodstream infections in intensive care unit cost-effective?

BACKGROUND

There is increasing interest in evidence-based educational interventions in central venous catheter care. It is unclear how effective these are at reducing the risk of bloodstream infections from the use of intravascular catheters (catheter-BSIs) and the associated costs and health benefits.

AIM

To estimate the additional costs and health benefits from introducing such interventions and the costs associated with catheter-BSIs.

METHODS

A comprehensive epidemiological and economic review was performed to develop the parameters for an economic model to assess the cost-effectiveness of introducing an educational intervention compared with clinical practice without the intervention. The model follows the clinical pathway of cohorts of patients from their admission to an intensive care unit (ICU), where some may acquire catheter-BSI, and estimates the associated costs, mortality and life expectancy.

FINDINGS

The additional cost per catheter-BSI episode was £3940. The results of this model demonstrate that introducing an additional educational intervention to prevent catheter-BSI improved patient life expectancy and reduced overall costs.

CONCLUSION

Introducing evidence-based education is likely to reduce the incidence of catheter-BSI and the model results suggest that the cost of introducing the interventions will be outweighed by savings related to reduced ICU bed occupancy costs.

Achieving consensus on current and future priorities for farmed fish welfare: a case study from the UK

The welfare of farmed fish has attracted attention in recent years, which has resulted in notable changes within the aquaculture industry. However, a lack of communication between stakeholders and opposing ethical views are perceived as barriers to achieving consensus on how to improve farmed fish welfare. To address these issues, we developed an interactive approach that could be used during stakeholder meetings to (1) improve communication between different stakeholder groups, (2) build consensus on priorities for farmed fish welfare and (3) establish mechanisms to address welfare priorities. We then applied this approach during a meeting of stakeholders to identify current and future priorities for farmed fish welfare in the UK. During the meeting in the UK, stakeholders initially identified 32 areas that they felt were in need of development for future improvements in farmed fish welfare. These were further refined via peer review and discussion to the seven most important "priority" areas. Establishing a "better understanding of what good fish welfare is" emerged as the highest priority area for farmed fish welfare. The second highest priority area was "the need for welfare monitoring and documentation systems", with mortality recording proposed as an example. The other five priority areas were "[improved understanding of] the role of genetic selection in producing fish suited to the farming environment", "a need for integration and application of behavioural and physiological measures", "the need for a more liberal regime in Europe for introducing new medicines", "a need to address the issues of training existing and new workers within the industry", and "ensuring best practise in aquaculture is followed by individual businesses". Feedback from attendees, and the meeting outputs, indicated that the approach had been successful in improving communication between stakeholders and in achieving consensus on the priorities for farmed fish welfare. The approach therefore proved highly beneficial for future improvements in fish welfare in the UK.

Fate of wild-caught Antechinus flavipes released after physiological experiments

Animals may be released into the wild for introduction, translocation or rehabilitation programs. Often, released animals do not survive or reproduce as well as wild conspecifics. Another circumstance whereby animals may be released is the return to the wild of research subjects, and although these animals may be expected to fare better than those from introduction, translocation or rehabilitation programs, there is little information regarding their subsequent survival and reproduction. We examine here the survivorship and reproductive success of five (one male, four female) yellow-footed antechinus (Antechinus flavipes) released back into the wild after being held in captivity for approximately one week for physiological experiments. Three of the four female Antechinus were recaptured after release and, on inspection, all three had 10 pouch young. Survivorship after release of antechinus held in captivity (0.75) was not different from the population as a whole, which ranged between 0.5 and 1.0. We therefore present unequivocal evidence that Antechinus released into the wild after physiological experiments can successfully survive and reproduce. This information is important for wildlife managers and animal ethics committees when considering the fate of ex-research animals.

P3b versus P3a: an event-related potential investigation of the glucose facilitation effect

The ingestion of a glucose containing drink has been shown to improve performance on a variety of cognitive tasks. There is debate, however, as to whether glucose especially benefits hippocampal memory functioning or whether it has a more global effect on attentional systems. The present study used event related potential methodology (ERPs) to investigate further glucose-mediated cognitive processes. Each participant acted as his/her own control in a repeated measures design, receiving one of two possible treatments (25 g glucose vs. placebo) in a counterbalanced order. After a two hour fasting period participants completed a visual three-stimulus oddball task. This paradigm involves an individual detecting an infrequent target stimulus randomly embedded in a train of repetitive background or standard stimuli. Detection of the target results in a large P3b ERP component (memory updating effect). The infrequent presentation of a novel and irrelevant stimulus, randomly interspersed with the target and standard stimuli, generates a P3a response (orientation of attention effect). These components were used as markers to establish whether the glucose enhancement effect was restricted to the neuro-cognitive processes related to memory. Consistent with behavioural work, glucose moderated the magnitude and latency of the P3b ERP component. However, glucose also interacted with attentional systems (P3a and an earlier P2), although this effect was non-significant. This work converges with recent fMRI findings indicating the sensitivity of the medial-temporal lobes and the pre-frontal cortex to glucose administration.

A phase I study of clofarabine in combination with cyclophosphamide and etoposide: A new regimen in pediatric patients with refractory or relapsed acute leukemia

9529

Background: Clofarabine is a promising new agent in the treatment of childhood leukemia as evidenced by single agent activity in previous phase I and II studies. We conducted a pilot phase I study of clofarabine used in combination with cyclophosphamide and etoposide to determine the maximum tolerated dose (MTD) and dose limiting toxicities (DLT). Methods: Patients between 1 and 21 years old with relapsed or refractory acute lymphoblastic leukemia (ALL) and acute myelogenous leukemia (AML) were enrolled. A standard 3+3 design was followed to determine the safe dose when used in combination. All drugs were administered by IV infusion daily for 5 consecutive days in induction and 4 days in consolidation. Patients received up to 2 induction cycles depending on the response, followed by consolidation cycles (maximum of 8 total cycles). The initial doses (cohort 1) were as follows: clofarabine: 20 mg/m2/day, etoposide 75 mg/m2/day and cyclophosphamide 340 mg/m2/day. Once etoposide and cyclophosphamide were escalated to their target dose (100 mg/m2/day and 440 mg/m2/day respectively in cohort 3), clofarabine was then increased to 30 mg/m2/day in cohorts 4 and would be increased to 40 mg/m2/day in cohort 5. Results: Thirteen patients (10 ALL; 3 AML) were enrolled in the first 4 dose cohorts to this date. The median number of prior regimens was 2. Response data (based on investigator assessment) are available for the first 8 patients: 6 patients (including 1 patient with AML) achieved either complete remission (CR) or complete remission without platelet recovery (CRp), for an overall response rate of 75%. Four patients proceeded to HSCT. One patient in cohort 4 experienced a DLT which resolved (grade 3 elevation of lipase) and possible veno-occlusive disease leading to cohort expansion. Common toxicities noted include febrile neutropenia and fever. Conclusions: The phase I study is ongoing until determination of MTD for this combination but these early results indicate that this combination shows significant activity in children with refractory or relapsed acute leukemias and is well-tolerated.

No significant financial relationships to disclose.

Association of parma wallabies (Macropus parma) with sedge swamps in Gibraltar Range National Park

Parma wallabies (Macropus parma) have a patchy distribution on the coast and ranges of central and northern New South Wales from Goulburn northward to the Queensland border. In Gibraltar Range National Park they are found in dry sclerophyll forest with a heath understorey, a departure from their apparent preference for wet forest types. Distance to swamp was by far the best correlate of M. parma distribution.

Major Degradation Product Identified in Several Pharmaceutical Formulations against the Common Cold

Different pharmaceutical preparations against the common cold contain acetaminophen, phenylephrine hydrochloride, and chlorpheniramine maleate. A degradation product had been discovered in these preparations after short- and long-term stability studies. This degradation product was isolated and found to be an adduct of phenylephrine and maleic acid. An account of the isolation and characterization of this compound was published. Our interest in this area led us to synthesize the compound, and we found that the synthesized compound does not have the same spectroscopic properties described in the original paper. Our subsequent work identified the structure of the degradation product as a "Michael addition" product of phenylephrine and maleic acid.

Community-onset methicillin-resistant Staphylococcus aureus in an urban HIV clinic

OBJECTIVES

To determine the proportion of skin/soft tissue infections (SSTIs) and to determine risks for MRSA infection caused by methicillin-resistant Staphylococcus aureus (MRSA) in HIV-infected out-patients.

METHODS

We conducted a prospective study of SSTIs in HIV-infected out-patients. A questionnaire was used to record MRSA risk factors and treatment. In vitro testing for antibiotic susceptibility, inducible clindamycin resistance, panton-valentine leucocidin (PVL) toxin, and the staphylococcal chromosomal cassette mec (SCCmec) type was performed using standardized methods. Treatment outcomes included resolution of primary site of infection, nonresolution of infection and reinfection and were confirmed at clinic visit and/or telephone follow-up.

RESULTS

Forty-one of 44 patients had an SSTI caused by MRSA. African-Americans comprised 21 of 41 MRSA patients. The median CD4 count of MRSA patients was 411 cells/microL. Four patients required hospitalization and three patients had secondary bacteraemia. Twenty-one of 41 MRSA patients had healthcare-associated (HCA) MRSA risk factors including a history of prior MRSA infection (n=9) and hospitalization within 6 months (n=11). Other prevalent MRSA risk factors included receipt of systemic antibiotics within 6 months (n=21) and previous incarceration (n=19). Twenty-two patients had a significant non-HIV-related comorbid illness. The majority of isolates were susceptible to trimethoprim-sulfamethoxazole, tetracycline, and clindamycin. Inducible clindamycin resistance was detected in 0 of 16 erythromycin-resistant, clindamycin-susceptible MRSA isolates. Twenty-one of 24 isolates tested positive for SCCmec type IV. Twenty-four of 24 isolates tested positive for the PVL gene. Antibiotic treatment was discordant (bacteria nonsusceptible to antibiotic used) in eight MRSA patients. The primary SSTI resolved in 37 of 40 MRSA patients. Recurrence of infection at a site other than the primary site was relatively common (11 patients).

CONCLUSIONS

We found a high rate of MRSA causing SSTI in community-dwelling patients. The majority of isolates were positive for PVL and SCCmec IV, which is typical of community-associated MRSA isolates causing SSTIs in the general population. Inducible clindamycin resistance was not detected. Most patients had MRSA risk factors. The initial site of infection resolved in most cases but subsequent MRSA infection was relatively common.

Hais cuaj txub kaum txub--to speak of all things: a Hmong cross-cultural case study

Cross-cultural medicine is a field that describes how disparate value and belief systems concerning health and disease affect the delivery of health care. This report describes the conflict between a Hmong immigrant family and the Western medical establishment over the care of their child with end stage renal disease [ESRD]. The health care providers, social service agencies and medical center failed to adequately respond to the needs of the family. The medical staff [nephrologist, nurse coordinator, dietician, social worker, and CPS worker] worked with a transcultural nurse, Hmong community health worker and the family, to design and negotiate a treatment plan that would be acceptable to the family and the health care team. Trust was reestablished between the family and the healthcare providers and the medical outcome for the child improved.

Separating individual skin conductance responses in a short interstimulus-interval paradigm

We describe a new method for measuring skin conductance responses, designed to overcome the problem of overlapping skin conductance responses. The method relies on the assumptions that the underlying sudomotor nerve signal has a shorter time-constant than the skin conductance signal itself, and that the sudomotor bursts arrive as discrete, separated events. By converting the skin conductance signal into a time-series with a shorter time-constant, we are able to extract the separated peaks in the estimated underlying driver signal. The separated driver peaks are then used to re-estimate each individual skin conductance response. The method is automated and applied to a normative database of 735 subjects, for which skin conductance was measured during an auditory oddball paradigm.