Environmental Factors Variably Impact Tea Secondary Metabolites in the Context of Climate Change.

Climate change is impacting food and beverage crops around the world with implications for environmental and human well-being. While numerous studies have examined climate change effects on crop yields, relatively few studies have examined effects on crop quality (concentrations of nutrients, minerals, and secondary metabolites). This review article employs a culturally relevant beverage crop, tea (Camelia sinensis), as a lens to examine environmental effects linked to climate change on the directionality of crop quality. Our systematic review identified 86 articles as relevant to the review question. Findings provide evidence that shifts in seasonality, water stress, geography, light factors, altitude, herbivory and microbes, temperature, and soil factors that are linked to climate change can result in both increases and decreases up to 50% in secondary metabolites. A gap was found regarding evidence on the direct effects of carbon dioxide on tea quality, highlighting a critical research area for future study. While this systematic review provides evidence that multiple environmental parameters are impacting tea quality, the directionality and magnitude of these impacts is not clear with contradictory evidence between studies likely due to confounding factors including variation in tea variety, cultivar, specific environmental and agricultural management conditions, and differences in research methods. The environmental factors with the most consistent evidence in this systematic review were seasonality and water stress with 14 out of 18 studies (78%) demonstrating a decrease in concentrations of phenolic compounds or their bioactivity with a seasonal shift from the spring and /or first tea harvest to other seasons and seven out of 10 studies (70%) showing an increase in levels of phenolic compounds or their bioactivity with drought stress. Herbivory and soil fertility were two of the variables that showed the greatest contradictory evidence on tea quality. Both herbivory and soil fertility are variables which farmers have the greatest control over, pointing to the importance of agricultural management for climate mitigation and adaptation. The development of evidence-based management strategies and crop breeding programs for resilient cultivars are called for to mitigate climate impacts on crop quality and overall risk in agricultural and food systems.

Patent nasopalatine ducts: an update of the literature and a series of new cases.

PURPOSE: The objective of this review is to present an update and summary of clinical findings of cases with a patent nasopalatine duct (NPD) reported in the literature from 1881 to 2016. METHODS: Previous articles and reviews about patent NPDs were studied and copies of all original publications were obtained for data verification. Furthermore, a literature search was conducted. In addition, the study sample was complemented with four cases recently seen in our institution. RESULTS: Ten out of 67 published cases were to be excluded for this analysis due to misinterpretation or misreporting in previous articles. Overall, 57 cases with NPD patency could be analyzed. Males outnumbered females in a ratio of 2:1. The mean age (when this information was available) was 34.1 ± 17.6 years (range 6-69 years). NPDs were located bilaterally (60%), unilaterally (20%) or centrally (20%). Complete or partial patency was reported in 73.9 and 26.1%, respectively. 74.1% of patients presented a variety of clinical signs and symptoms. The ability of the patient to produce a squeaky or whistling sound was the most frequent clinical finding (23.8%). CONCLUSIONS: Caution must be exercised when reading review articles about NPD patency since wrong data have been copied in several subsequent publications. Since epidemiological data are missing with regard to patent NPDs, age and gender predilections are not warranted. Bilateral occurrence and full patency were prevailing features in the evaluated case reports of patent NPDs.

Frequency of the Amsterdam criteria in a regional German cohort of patients with colorectal cancer.

Estimates of the colon cancer burden associated with hereditary nonpolyposis colorectal cancer (HNPCC) vary from less than 1 % to more than 5 %. Amsterdam criteria fulfilled within a kindred (classic Amsterdam and Amsterdam II criteria) are widely used to identify patients prone to HNPCC. The present study was initiated to assess the frequency of the Amsterdam criteria within a regional German cohort of 207 patients with a history of colorectal cancer (CRC). Data on individual and family cancer histories were available in 154 patients (73 women, 81 men; mean age at diagnosis 62.4 +/- 13.3 years). A total of 843 first degree relatives have been identified within the kindreds of whom 121 had verified cancers. In 28 of 154 families (18 %), at least one first degree relative of the index patient had CRC. With respect to a typical family history, five kindreds (3.2 %) were likely to suffer from HNPCC on a clinical basis (4 kindreds met the classic Amsterdam criteria and one kindred the Amsterdam II criteria). Testing for microsatellite instability could additionally be performed in 4 of 5 patients who met the Amsterdam criteria and revealed DNA instability in 3 cases. Moreover, a missense mutation of MSH2 (Gly965Asp) was detected in one patient with microsatellite instability. Based on the classic Amsterdam and Amsterdam II criteria approximately 3 % of a regional German cohort of patients with CRC are likely to suffer from HNPCC. However, the final diagnosis of HNPCC can only be established by detection of pathogenic germline mutations within the DNA mismatch repair genes.

A comparison of the erosive potential of different beverages in primary and permanent teeth using an in vitro model.

The aim of this study was to compare the erosive potential of different beverages and foodstuffs in primary and permanent teeth. Sixty primary and 60 permanent human teeth were immersed for 3 min in the solution under study (5 teeth per treatment group). Surface microhardness was measured before and after exposure. Initial (baseline) surface microhardness was lower for primary teeth than for permanent teeth. In both primary and permanent teeth, Sprite showed the highest decrease in surface microhardness, whereas yogurt showed an increase in surface microhardness in the primary teeth. Overall decrease was 27.2 +/- 17.5 KHN (mean +/- SD) for primary and 25.9 +/- 15.6 KHN for permanent teeth. The comparison of the erosive susceptibility in this in vitro model showed that primary teeth were not more susceptible to erosion compared to permanent teeth.

Progression of and risk factors for dental erosion and wedge-shaped defects over a 6-year period.

It has been shown that dental erosion is not a very rare condition. Careful observation and clinical experience led us to hypothesize a progression of these lesions with time despite dietary counselling and oral hygiene instruction. The purpose of this study was to determine the progression rate and risk factors of dental erosion and wedge-shaped defects over a 6-year period. In the year 1987, 204 randomly selected persons living in Bern from two age groups (26-30 and 46-50 years) were examined for frequency and severity of dental erosion and wedge-shaped defects. In the year 1993, 55 persons could be re-examined by the same dentist using the same indices. Further, detailed case histories of the patients were recorded and the flow rate and buffering capacity of the saliva were determined. The results indicated a distinct progression of erosion on facial and occlusal surfaces and wedge-shaped defects over the 6-year period. The increase in the defects was more marked in the older age group. Surprisingly, nutritional habits did not change despite thorough informative discussion about erosive foodstuff with every patient during the first session. Multiple linear regression analysis revealed consumption of nutritional acids and age as significant risk factors explaining 28% of the variability of the progression of erosions. The significant factors for the progression of wedge-shaped defects were identified to be frequency of tooth brushing and age, explaining 21% of the variability of the progression of wedge-shaped defects. In summary, there was a definite statistically significant progression of non-carious dental hard tissue defects in our sample. This progression was correlated with age (erosion and wedge-shaped defects), consumption of dietary acids (erosion) and frequency of toothbrushing (wedge-shaped defects).

Quality of life in breast cancer.

PURPOSE: Currently, 1,721,700 women are living with breast cancer in the United States. As the number of survivors of breast cancer continues to rise, so must our knowledge about unique quality-of-life concerns. This article reports the results of a study on quality of life in women with breast cancer and validates the model of quality of life in this population. DESCRIPTION OF STUDY: To explore these concerns and to validate a breast cancer quality-of-life model, 21 survivors of breast cancer, across three age strata (younger than 40 years, 40 to 60 years, and older than 60 years), were interviewed and asked to complete quantitative surveys on pain and quality of life. RESULTS: Across all age groups, unique issues of survivorship include those related to physical, psychological, social, and spiritual well-being. In the domain of physical well-being, the areas of worst outcome were in menstrual changes and fertility, fatigue, and pain. In the domain of psychological well-being, predominant needs were in the areas of fear of the spread of cancer, distress from surgery, recurrence, fear of second cancer, impact on self-concept, and fear of future tests. The social well-being subscale identified the greatest disruption in the area of family distress. The spiritual well-being subscale showed greatest disruption in the area of uncertainty, although other aspects of this domain were usually rated in a positive direction (e.g., importance of religious activities). CLINICAL IMPLICATIONS: The data demonstrated the need for further research, assessment, and intervention across each of the quality-of-life domains. There is a significant need to address physical problems; however, the psychological domain demonstrated the greatest area of distress. The multidimensional needs of breast cancer survivors emphasize the need for multidisciplinary collaboration.

Mock surveys: a proactive approach to the accreditation visit.

Preparing for an accreditation visit is a challenge for the nurse manager. In this article, the authors describe the methods and tools developed to assist the Duke University Medical Center Gastrointestinal Endoscopy Unit in preparing for the Joint Commission on Accreditation of Healthcare Organizations review process.

Effect of prophylactic fluconazole on the frequency of fungal infections, amphotericin B use, and health care costs in patients undergoing intensive chemotherapy for hematologic neoplasias.

Fungal infections are a major problem in patients with hematologic malignancy. Attempts to reduce their frequency with antifungal agents have not been successful. A double-blind, controlled, single-center trial was conducted with 96 consecutive patients undergoing 154 episodes of chemotherapy. Patients received 400 mg of fluconazole or placebo until bone marrow recovery or initiation of intravenous amphotericin B infusions. End points were amphotericin B use, fungal infection, stable neutrophil count > 0.5 x 10(9)/L, toxicity precluding further fluconazole use, and death. By Kaplan-Meier estimation, the time to initiation of amphotericin B therapy was shorter in 76 patients treated with placebo than in 75 treated with fluconazole (P = .003). Also, fluconazole reduced the number of febrile days by 20% (P = .002) and prevented oropharyngeal candidiasis (1/75 vs. 9/76, P = .018). The frequency of deep mycoses (8/76 vs. 8/75) and outcome were unaffected. Fluconazole did not have a favorable effect on infection-related health care costs and was associated with prolonged severe neutropenia (P = .01).

Patient teaching methods and materials.

As a result of the current healthcare politics, nurses are taking a closer look at methods to support self-care and wellness. In this article, the author discusses methods, materials, cost, and problems of patient education. There are barriers to effective patient education. Nurses need to overcome these barriers and choose the most effective method and materials for teaching patients.

Chimeric interleukin 2 receptor alpha chain antibody derivatives with fused mu and gamma chains permit improved recruitment of effector functions.

In order to investigate the feasibility of shuffling effector functions of monoclonal antibodies, we constructed chimeric antibodies with fused heavy chains. The derivatives studied are based on a monoclonal antibody directed against the alpha chain of the human Il2-R. Derivatives studied were the IgG1 and IgM isotypes; IgM delta, lacking the ability of multimerization due to a deletion; IgMc gamma 1 and IgGlc mu, with fused mu and gamma 1 chains and vice versa. IgG1, IgM delta and IgMc gamma 1 were secreted as monomers, IgM and IgG1c mu as polymers. The Ki values for competition with radio-iodinated Il2 with respect to binding to the Il2-R were markedly lower for polymeric than for monomeric derivatives (300-400 pM versus 2500-6500 pM). Recruitment of complement mediated by the deposition of C3 fragments, either of heterologous (rabbit) or homologous (human) origin, was mediated only by the polymeric derivatives IgM and IgG1c mu. ADCC was mediated by monomeric IgG1 and polymeric IgG1c mu, the latter derivative being active at concentrations 100-fold lower than the former. Together, the results demonstrate that both CDC and ADCC effector functions can be combined on a polymeric antibody derivative with fused gamma 1 and mu chains. In addition, such a derivative, due to its polymeric nature, has a high binding affinity. These properties may be important for the elimination of target cells in vivo.