Trait mindfulness and the mental and physical health of caregivers for individuals with cancer.

BACKGROUND: Mindfulness plays a role in moderating the negative mental and physical health outcomes associated with caregiving. The aims of this study were to examine the relationship between trait mindfulness and the (1) psychological functioning, (2) health behaviors, (3) and physical health of caregivers for individuals diagnosed with cancer. METHODS: Caregivers completed a battery of questionnaires and examinations assessing sociodemographic characteristics, trait mindfulness, depression, perceived stress, caregiver stress, sleep, diet, physical activity, tobacco use, alcohol use, blood pressure, and BMI. Demographics and cancer diagnostics were collected for the individuals whom caregivers supported. Linear regression, multivariate analyses, and moderator analyses were performed. RESULTS: Of the 78 caregivers, the mean age was 63.9 (S.D.=13.1); 59% identified as female; 97% identified as White. Regression analyses indicated that caregivers who reported higher levels of trait mindfulness reported significantly less perceived stress (b= -4.38, SE= 0.88, p <.001), lower levels of depression (b= -3.74, SE= 1.10, p = .001), greater caregiver quality of life (b= -9.05, SE=2.12, p < .001), better sleep quality (b= -0.98, SE=0.44, p = 0.03), and lower rates of tobacco use (b= -10.12, SE= 3.43, p =.003). Trait mindfulness was not significantly related to diet, alcohol use, blood pressure, or BMI. CONCLUSIONS: Higher levels of trait mindfulness are associated with positive mental and physical health measure for caregivers. Future research would benefit from further examining mindfulness-based interventions and their impacts in mitigating the negative toll of caregiving in the context of cancer.

Measuring beverage consumption in US children and adolescents: a systematic review.

Beverage consumption habits are associated with weight outcomes for children and adolescents. Many studies have examined youth's beverage consumption, but little is known about what methods are commonly used to assess youth beverage consumption and whether these strategies are valid and reliable. This study aimed to systematically review articles assessing beverage consumption among children and adolescents. We searched PubMed and Scopus for English-language articles published between February 2007 and February 2017 that measured and reported on American youth's (ages 2-18 years) beverage consumption. Searches yielded 17,165 articles, of which 589 articles describing 615 measures were extracted. We examined the types of assessment methods used, characteristics of these methods (e.g. validity, reliability, and literacy level), characteristics of study samples, and beverages assessed. The most common assessment methods were questionnaires/screeners (used by 65.4% of articles) and recalls (24.4%). About three-quarters of articles did not address validity (70.5%) or reliability (79.5%) of any measures used. Study populations were diverse: 54.7% of articles included low-income children, and 90.2% included non-White children. The most commonly assessed beverage category was sugar-sweetened beverages. Findings suggest that improved measurement techniques and reporting are both needed to track progress towards a goal of ensuring all youth have healthy beverage consumption.

Transcription factor AP2 is required for expression of the rat transforming growth factor-alpha gene.

DNase I footprinting of the rat TGF alpha promoter in the presence of crude cell nuclear extract revealed three sites of protein-DNA interaction (Fp-A, Fp-B, Fp-C) in the region from -222 to +73. Mutation of specific sites within the Fp-A and Fp-B regions reduced expression of a TGF alpha promoter-reporter gene (TGF alphaLUC) from 50-90% in transiently transfected CHO cells, indicating the importance of protein/DNA interactions at these sites. Since Fp-A contained a perfect AP2 consensus sequence (5'-GCCNNNGGC-3') as its center, we investigated the possibility that AP2 binding is important for TGF alpha promoter activity. A double-stranded oligonucleotide spanning Fp-A displayed a distinct mobility shift in the presence of nuclear extract that was inhibited by an excess of known functional AP2-binding sequence. Moreover, a similar mobility shift occurred in the presence of purified AP2 protein, and the further addition of AP2 antibody produced a supershifted complex. More refined DNase I footprinting of a smaller, oligonucleotide probe in the presence of purified AP2 protein revealed a protected region that included the putative AP2 binding site. Additionally, co-transfection of an AP2 expression vector increased TGF alphaLUC expression 25-fold in Drosophila Schneider cells. These various findings corroborate a role for AP2 in TGF alpha promoter activity. The Fp-B region contains a T5 motif that has been previously suggested to function as an atypical TATA box. An Fp-B oligonucleotide displayed a specific gel mobility shift in the presence of a TATA binding protein (TBP)-TFIIA complex, and the further addition of TBP antibody produced a supershift. These results confirm that protein binding within Fp-B is functionally important, and they also indicate that the T5 motif functions as a TBP binding site.

Liquid chromatographic-mass spectrometric-analyses of anaerobe protein degradation products.

A liquid chromatography-electrospray ionisation-mass spectrometry (LC-ESI-MS) method and a liquid chromatography-atmospheric pressure chemical ionisation-mass spectrometry (LC-APCI-MS) method was developed to identify metabolites from the anaerobe protein degradation to biogas. As consequence of a process failure the biogas production breaks down with increasing substrate loading, whereas different metabolites accumulate in the fermentation media. These compounds were identified as metabolites from the anaerobe degradation of the aromatic amino acids phenylalanine, tyrosine and tryptophan and accumulate in concentrations up to 300 mg/L when casein was used as model substrate.

Rates of Down syndrome at livebirth by one-year maternal age intervals in studies with apparent close to complete ascertainment in populations of European origin: a proposed revised rate schedule for use in genetic and prenatal screening.

Precision and accuracy in determining rates of Down syndrome at livebirth are indispensible to algorithms which determine eligibility for prenatal cytogenetic diagnostic services. We derived Down syndrome rates by single year of maternal age which we propose as a revised rate schedule for background risk. Data on European-origin populations were obtained from 5 sources judged most likely to have complete ascertainment of cases. A "constant plus exponent" regression model and variants extending the analysis to higher powers of maternal age were applied to several ranges of maternal age. Confidence intervals about the rates were calculated. This analysis results in rates significantly higher than those in widespread use though the confidence intervals show a need for caution in assuming precision. Sources of variation in rates are also considered.

Surgical decision-making in the treatment of pancreatic pseudocysts. Internal versus external drainage.

One hundred patients with documented pancreatic pseudocysts who underwent surgical drainage are reported on. Accurate assessment of the size and location of the pseudocyst using ultrasonography, endoscopic retrograde cholangiopancreatography, angiography, and upper gastrointestinal roentgenography is essential. After diagnosis, the next 4 to 7 weeks is a critical period, after which surgical intervention becomes mandatory if the cyst has not resolved. This period between diagnosis and operation is hazardous and demands close clinical follow-up. When oepration is required, the preferred procedure continues to be internal drainage because it is associated with less morbidity and a lower mortality. However, external drainage appears to be a suitable second choice. Fewer than 10 per cent of the patients in this series who underwent external drainage developed fistulas, and the overall rate of late morbidity was acceptable.

Motor innervation of the eustachian tube muscles in the guinea pig.

The brainstem location of motoneurons innervating eustachian tube-associated muscles in the adult guinea pig was determined using intramuscular injections of the neural tracer horseradish peroxidase (HRP). Following HRP injections into the tensor veli palatini and the eustachian tube belly of the medial pterygoid muscle, an ipsilateral column of HRP-labeled motoneurons was present medial to the dorsolateral division of the trigeminal motor nucleus. Following HRP injection into the levator veli palatini, labeled motoneurons were present in the ipsilateral dorsal division of nucleus ambiguus. The locations of the tensor veli palatini and levator veli palatini motoneurons are similar to those found in studies of other animals. A distinct eustachian tube belly of the medial pterygoid muscle was also identified. This sub-belly had a motoneuron pool distinct from the main medial pterygoid muscle group. The authors have provided the gross anatomical and neuroanatomical substrates upon which future studies of eustachian tube function in the guinea pig may be based.

Hearing preservation after acoustic neuroma resection with tumor size used as a clinical prognosticator.

Three hundred sixty-four patients referred to the Chicago Otology Group for acoustic tumor removal between 1981 and 1995 were reviewed in a retrospective fashion. Of this group, 60 patients were candidates for hearing preservation surgery and thus underwent one of two surgical approaches to remove the tumor and preserve hearing. Eighteen patients had tumor removal via the middle cranial fossa approach, and 42 patients had tumor removed via the retrosigmoid approach. Of the 42 patients who underwent retrosigmoid removal, 33% had hearing preserved overall. Of the 18 patients in the middle fossa group, 44% had hearing preserved overall. The average tumor size of patients with preserved hearing in the retrosigmoid group was 1.4 cm, and in the middle fossa group was 0.74 cm. Of significance was the fact that in both groups of patients with a tumor of 1.5 cm or less there was a 50% chance of hearing preservation. In the group of patients with tumors larger than 1.5 cm there was only a 16% chance of preserving hearing. We propose that these data can be used for better counseling of patients preoperatively as to the chances of hearing preservation and the type of approach appropriate for each case.

Conservative management of patients with small acoustic tumors.

Of 432 patients referred for treatment of their cerebellopontine angle tumors, 53 with acoustic neuromas were managed initially without intervention but with adequate follow-up. Mean presenting tumor size in this subgroup of patients was 0.98 cm (range, 0.2 to 3.0 cm), and average growth rate was 0.16 cm per year. Twenty-one patients demonstrated tumor growth with a mean follow-up interval of 1.9 years. Of these 21 patients, 14 underwent microsurgical excision, 4 received radiation, 2 continued to be observed and 1 was lost to follow-up. The remaining 32 (60%) had no demonstrable growth with a mean follow-up of 2.13 years. Of these patients, 29 continue to be followed and 3 were lost to follow-up. Of the information evaluated, the only statistically significant relationship is with larger tumor size in elderly patients--most likely reflecting the propensity to opt for conservative treatment in elderly patients. Tumor growth rate was unrelated to presenting tumor size or patient age, which suggests that conservative treatment may be appropriate in selected patients.

Craniofacial resection. An analysis of 73 cases.

OBJECTIVE: To determine the morbidity and mortality associated with a large series of patients undergoing craniofacial resection at one institution. The series is also analyzed with respect to pathology, disease recurrence, and role of adjuvant therapy. DESIGN: Retrospective review with a mean follow-up of 3 years (range, 6 months to 8 years). SETTING: Tertiary care, urban referral center. PATIENTS: The study included 73 consecutive patients (39 male and 34 female). Ages ranged from 13 to 78 years with a mean of 53.1 years. All patients had benign or malignant tumors of the paranasal sinuses. MAIN OUTCOME MEASURES: Morbidity associated with craniofacial resection was categorized as follows: early (within 30 days of surgery) or late (> 30 days); neurologic, ocular, or infectious. RESULTS: Overall morbidity rate was 63%, and the mortality rate was 2.7%. Of the patients who had complications develop, 26 had development of major morbidities and there were two mortalities. The most common complications were transient alteration in mental status (15 patients), diplopia (11 patients), cerebrospinal fluid leak (10 patients), and osteomyelitis of the frontal bone flap (eight patients). CONCLUSIONS: Craniofacial resection is an effective surgical treatment for paranasal sinus tumors. The mortality rate is acceptable and morbidity appears directly related to experience with the procedure. Infectious complications were the most devastating.

Surface sensibility of the floor of the mouth and tongue in healthy controls and in radiated patients.

Increased areas of anesthesia in the oral cavity have been shown to significantly impair oral function in normal individuals. In patients who undergo oral cavity reconstruction, loss of sensation plays a major role in producing disturbances in postoperative oral function. Free tissue transfer techniques have permitted the problem of sensory loss to be addressed through the use of sensate cutaneous free flaps, in which microneural anastomoses are performed between a sensory nerve supplying the flap and a recipient nerve in the head and neck. To critically assess the results of such reconstructions, the effect of sensory restoration on oral cavity rehabilitation must be studied. As a first step toward this goal, normal values for sensory discrimination of the floor of mouth and tongue are needed. Previous studies of oral sensation failed to examine the ventral tongue and floor of mouth. The purpose of this study is to determine the surface sensibility of these regions in healthy patients and in patients who received radiation therapy to the oral cavity. Sensation was evaluated using static and moving two-point discrimination in 90 healthy subjects divided equally into three age groups: 20 to 40 years, 41 to 60 years, and 61 to 80 years. In addition, 20 patients who received radiation therapy were studied. The mucosa of the dorsal and ventral aspects of the lateral tongue, tongue tip, and floor of mouth was examined. The tongue tip is the most sensitive area, followed by the dorsal lateral tongue, ventral lateral tongue, and floor of mouth. The effects of age and radiation therapy on sensory discrimination are discussed.(ABSTRACT TRUNCATED AT 250 WORDS)

Association of generalized joint hypermobility with history, signs, and symptoms of temporomandibular joint dysfunction in children.

This study determined the prevalence of signs and symptoms of temporomandibular joint dysfunction (TMD) in children with and without generalized joint hypermobility (GJH). Twenty children with GJH, ages 4-19, and 20 age- and sex-matched control children completed a TMD signs/symptoms history and underwent an examination consisting of palpation of the joints and associated musculature for tenderness, clicking, or crepitation. Children with historical or clinical findings were designated positive for TMD signs/symptoms. Maximum vertical opening, expressed as a percentage of lower facial height, and maximum mandibular lateral excursion (in mm) were recorded. Fifteen (75%) of the GJH participants and ten (50%) of the controls were positive for TMD findings. There were statistically significant differences between the groups for the presence of total positive findings (P < 0.001) and for responses to palpation of muscle or joint (P = 0.03). There were no significant differences in positive responses to the history alone, joint palpation alone, or muscle palpation alone. There were no significant differences between the groups in jaw excursions. This study suggests that children with GJH may be more likely to demonstrate some signs and symptoms of TMD than children with normal joint mobility.

Investigation of the accumulation of aromatic compounds during biogas production from kitchen waste.

This paper presents laboratory scale studies on the anaerobic degradation of kitchen waste, with a high protein and fat content, using a quasi-continuous co-digestion process. The increased accumulation of non-degraded intermediates as an indication of process imbalances was examined in experiments where the substrate load was gradually increased. In addition to the critical rise of known toxic metabolites like ammonia, hydrogen sulphide or volatile fatty acids, aromatic acids accumulated with increasing substrate loading. These metabolites could be identified as intermediates from the anaerobe degradation of the aromatic amino acids phenylalanine, tyrosine and tryptophan. In most experiments the important finding was the early detection of aromatics, especially phenylacetic acid, even before the monitoring of volatile fatty acid concentrations gave an indication of a process imbalance. This demonstrates the potential use aromatic acids as indicators for an upcoming process failure.

Variants within the 5'-flanking region and the intron I of the bovine growth hormone gene.

In order to identify DNA variants potentially involved in the regulation of the expression of the bovine growth hormone gene, the 5'-flanking, the 5'-untranslated and the signal peptide coding regions of 15 cows (four German Friesian, two German Simmental, two Jersey, two Galloway, two Scottish Highland, two Charolais and one Ceylon Dwarf Zebu) were analysed. For each animal a region of about 1.2 kb was amplified by polymerase chain reaction (PCR) and sequenced. Six sites of variable nucleotides were identified in the 5'-flanking region of the gene and one in the intron I. Some of these variable sites are also potential binding sites for trans-acting factors (CAAT/enhancer binding protein (C/EBP), polyoma virus enhancer A binding protein 3 (PEA3), thyroid hormone response element (TRE)) and therefore possibly involved in the expression of the growth hormone gene. PCR amplification of specific alleles (PASA) tests for two of the sites (G2, G3) were established and the genotypes for these variants were analysed in 190 cows. The frequencies of the C alleles of the sites G2 and G3 were 0.63 and 0.76, respectively.

The imprecision in rates of Down syndrome by 1-year maternal age intervals: a critical analysis of rates used in biochemical screening.

Current algorithms to determine eligibility for prenatal cytogenetic diagnostic services depend critically on the accuracy and precision of the underlying rates of cytogenetic abnormality used in the calculations. We examine the maternal age-specific rates of Down syndrome livebirths in eight studies of European-origin populations, pooled rates from which are widely used for baseline calculations in biochemical screening. These studies vary significantly in such factors as methods of ascertainment of cases, likelihood of complete ascertainment, and methods of correction, if any, for underascertainment. Restriction of analysis to those two studies among the eight whose methods suggest the greatest likelihood of complete ascertainment for Down syndrome generates rates significantly higher than those in widespread use. Confidence intervals about previously reported and currently derived rates indicate that even with large-scale data, there is considerable residual uncertainty in derived rates.

Persistent spectral-hole burning in the wide-gap semiconductor SiC doped with vanadium.

Persistent spectral-hole burning was performed in the gamma line of V(4+) in the wide-gap semiconductor 6HSiC. Spectral holes burned at 11 K were stable to temperatures of at least 320 K for several days. The hole-burning mechanism consists of two-step photoionization of V(4+) (self-gated spectral-hole burning). The spectral holes could be erased optically, either by pumping of electrons back from stable traps or, presumably, by a charge-transfer transition from the valence band to the V(5+) ions.

Elevated maternal age-specific rates of Down syndrome liveborn offspring of women of Mexican and Central American origin in California.

BACKGROUND: Maternal age-specific rates of Down syndrome livebirths are widely utilized in personal and policy decisions concerning provision of and election of prenatal cytogenetic diagnostic services. The only extensive reference data available are on those of primarily European ancestral origin. In the absence of definitive evidence of any ethnic, racial or environmental influence upon rates (other than those associated with age) these rate schedules have been widely applied to those of all national origins. METHODS: Available material age-specific data on livebirths from intensive studies on those of Hispanic (primarily of Mexican and Central American background) and of other origin in populations in the U.S.A. with likely complete ascertainment were analysed. The numbers observed were compared with (i) those predicted from established published rate schedules in those of primarily European origin, and (ii) with the observations on livebirths of non-Hispanic European origin in the same population as the Hispanic live births. RESULTS: In comparisons with the numbers predicted from published rates, observed numbers of case among Hispanic live births were increased by 19 per cent (SE 0.06) in younger mothers, 23 per cent in older mothers (SE 0.07) and 20 per cent (SE 0.04) in those of all ages. Comparisons with observed rates in those of Hispanic origin with those observed in non-Hispanic births in the same time intervals and populations indicated that the excess rates in Hispanics were not attributable to some local factor increasing rates in all ethnic groups at least among those under 35. CONCLUSIONS: Data on mothers of Mexican and Central American origin residing in the U.S.A. indicate maternal age-specific rates of Down syndrome in live births about 20 per cent greater than those in published rate schedules on Down syndrome, widely used in decisions concerning election or provison of prenatal diagnostic services. The reason for this difference remains unknown.

International variation in reported livebirth prevalence rates of Down syndrome, adjusted for maternal age.

Reported livebirth prevalence of Down syndrome (DS) may be affected by the maternal age distribution of the population, completeness of ascertainment, accuracy of diagnosis, extent of selective prenatal termination of affected pregnancies, and as yet unidentified genetic and environmental factors. To search for evidence of the latter, we reviewed all published reports in which it was possible to adjust both for effects of maternal age and for selective termination (where relevant). We constructed indices that allowed direct comparisons of prevalence rates after standardising for maternal age. Reference rates were derived from studies previously identified as having near complete ascertainment. An index value significantly different from 1 may result from random fluctuations, as well as from variations in the factors listed above. We found 49 population groups for which an index could be calculated. Methodological descriptions suggested that low values could often be attributed to under-ascertainment. A possible exception concerned African-American groups, though even among these most acceptable studies were compatible with an index value of 1. As we have reported elsewhere, there was also a suggestive increase in rates among US residents of Mexican or Central American origin. Nevertheless, our results suggest that "real" variation between population groups reported to date probably amounts to no more than +/-25%. However, reliable data in many human populations are lacking including, surprisingly, some jurisdictions with relatively advanced health care systems. We suggest that future reports of DS livebirth prevalence should routinely present data that allow calculation of an index standardised for maternal age and adjusted for elective prenatal terminations.

Villous adenomas of the duodenum.

A patient with multiple villous adenomas of the duodenum is described. Endoscopy plays an essential role in the management of these neoplasms. If no evidence of invasive malignancy is found on multiple endoscopic biopsies, wide local excision is the initial procedure of choice. Invasive malignancy found in either the endoscopic biopsy or the surgical specimen is indication for pancreaticoduodenectomy.