Work ability 8 years after breast cancer: exploring the role of social support in a nation-wide survey.

INTRODUCTION: As the 5-year survival rate after breast cancer in Norway is 92%, the population of breast cancer survivors (BCSs) is increasing. Knowledge of work ability in this population is scarce. In a population-based cohort of BCSs, we explored work ability 8 years after diagnosis and the association between work ability and social support, and cancer-related variables including late effects and lifestyle factors. METHODS: In 2019, all Norwegian women < 59 years when diagnosed with stage I-III breast cancer in 2011 or 2012, were identified by the Cancer Registry of Norway and invited to participate in a survey on work life experiences. Work ability was assessed using the Work Ability Index (scale 0-10). Factors associated with excellent work ability (score ≥ 9) were identified using univariate and multivariate logistic regression analyses, and adjusted for socioeconomic-, health- and cancer-related variables. RESULTS: Of the 1951 eligible BCSs, 1007 (52.8%) responded. After excluding survivors with relapse (n = 1), missing information on work ability score (n = 49), or work status (n = 31), the final sample comprised 926 BCSs within working age at survey (< 67 years). Mean age at survey was 56 years and 8 years (SD 0.7) had passed since diagnosis. Work ability had been reduced from 8.9 (SD 2.3) at diagnosis to 6.3 (SD 3.1). One in three BCSs reported poor work ability (WAS ≤ 5), and seven out of ten reported that their physical work ability had been reduced due to cancer. Social support from colleagues during cancer therapy was associated with excellent work ability, which was not observed for social support provided by supervisors or the general practitioner. Cognitive impairment and fatigue were inversely associated with work ability. None of the cancer-related variables, including treatment, were associated with work ability 8 years after diagnosis. CONCLUSION: In this population-based sample, one in three BCSs reported poor work ability 8 years after diagnosis. Collegial social support during cancer therapy appears to be a protective factor for sustained work ability, whilst survivors struggling with fatigue and cognitive impairments may represent a particularly vulnerable group for reduced work ability.

Antioxidant-rich foods and response to altitude training: A randomized controlled trial in elite endurance athletes.

High doses of isolated antioxidant supplements such as vitamin C and E have demonstrated the potential to blunt cellular adaptations to training. It is, however, unknown whether intake of high doses of antioxidants from foods has similar effects. Hence, the aim of the study was to investigate whether intake of antioxidant-rich foods affects adaptations to altitude training in elite athletes. In a randomized controlled trial, 31 national team endurance athletes (23 ± 5 years) ingested antioxidant-rich foods (n = 16) or eucaloric control foods (n = 15) daily during a 3-week altitude training camp (2320 m). Changes from baseline to post-altitude in hemoglobin mass (Hbmass ; optimized CO rebreathing), maximal oxygen uptake (VO2max ; n = 16) or 100 m swimming performance (n = 10), and blood parameters were compared between the groups. The antioxidant group significantly increased total intake of antioxidant-rich foods (~118%) compared to the control group during the intervention. The total study population improved VO2max by 2.5% (1.7 mL/kg/min, P = .006) and Hbmass by 4.7% (48 g, P < .001), but not 100 m swimming performance. No difference was found between the groups regarding changes in Hbmass , VO2max or swimming performance. However, hemoglobin concentration increased more in the antioxidant group (effect size = 0.7; P = .045) with a concomitantly larger decrease in plasma and blood volumes compared to control group. Changes in ferritin and erythropoietin from pre- to post-altitude did not differ between the groups. Doubling the intake of antioxidant-rich foods was well tolerated and did not negatively influence the adaptive response to altitude training in elite endurance athletes.

Wetting behaviour of silicone- and resin-based root canal sealers.

AIM: To evaluate the wetting behaviour of three different classes of endodontic sealers, silicone (Roekoseal Automix)-, epoxy-resin (2Seal, AH Plus)- and methacrylate-based sealers (EndoRez, RealSeal, RealSeal SE, Seal 3D) on dentine specimens with and without chemical pre-treatment. METHODOLOGY: Eighty caries-free molar teeth were used for the preparation of 160 dentine discs. Half of the discs were rinsed with distilled water, and the remainder were treated with 3% NaOCl, followed by 17% EDTA and 2% CHX to simulate the final rinse under clinical-like conditions. For both irrigation methods, 10 droplets of each sealer were analysed. Data were statistically analysed using multivariate anova (general linear model, α = 0.05) that assessed the effects of material, irrigation procedure and time on the measured contact angle as well as their interaction. RESULTS: Contact angle was primarily influenced by the material (P < 0.05), followed by time (P < 0.05). Irrigation procedure had a significant influence (P < 0.05) on contact angle formation of all materials except EndoRez and AH Plus. EndoRez had the highest values, and Roekoseal Automix had the lowest values for all measurements. RealSeal SE had lower values after chemical treatment. CONCLUSIONS: The silicone-based sealer Roekoseal Automix had better wettability than epoxy-resin- or methacrylate-based sealers. The irrigation regime significantly favoured the wettability of 2Seal and RealSeal SE.

[Decision process in a multidisciplinary cancer team with limited evidence]. / Entscheidungsprozesse im Tumorboard bei eingeschränkter Evidenzlage.

BACKGROUND: The Head and Neck Cancer Tumor Board is a multispeciality comprehensive conference that brings together experts with different backgrounds to make group decisions about the appropriate treatment. Due to the complexity of the patient cases and the collaboration of different medical disciplines most of these decisions have to be made under uncertainty, i. e., with-out knowing all relevant factors and without being quite sure about the outcome. METHODS: To develop effective team decision making under uncertainty, it is necessary to understand how medical experts perceive and handle uncertainties. The aim of this field study was to develop a knowledge base by exploring additionally the factors that influence group decision making processes. A structured nonparticipant observational study was employed to address the research goal. Video data were analyzed by 2 independent observers using an observation checklist. A total of 20 videotaped case discussions were studied. Observations were complemented by a questionnaire gathering subjective evaluations of board members about the process and quality of their decisions (N=15). RESULTS: The results show that uncertainty is recognized by board members. Reasons for uncertainty may stem from the complexity of the cases (e. g. therapy options) or the assessment from different disciplines coming together at the board. CONCLUSION: With respect to handling uncertainty and guaranteeing an optimal decision making process potential for improvement could be defined. This pertains to the handling of different levels of competence, the promotion of a positive discussion culture as well as structuring of the decision making process.

[Computer assistance to improve therapy planning for head neck oncology]. / Computergestützte Assistenz zur Verbesserung der Therapie-Planung in der Kopf-Hals-Onkologie.

The ongoing development in therapies of head and neck malignomas has led to a further differentiation of treatment options. Complex surgical procedures, a wide variety of multi modal therapy options, changing radiation technologies (IMRT - Intensity-modulated radiation therapy) and numerous "targeted therapies" emphasize the need for a precise treatment plan. Beside this, imaging has seen significant improvements beyond the technical ones, e. g. with the implementation of PET/CT scanners. This increase in pre-therapeutic data volume, together with a diversification of treatment options calls for a further discussion of the basics of therapeutic decisions. Planning relevant data processing by computer assisted systems can aid in these decisions. This work describes the current status of relevant computer assisted systems undergoing first testing for head and neck cancer therapy planning. Here, the integration of 3-dimensional patient data plays a central role. This planning tool forms the integrated base for a further development in the areas of radiation planning, documentation and study management.

Differences in the inflammatory plasma cytokine response following two elite female soccer games separated by a 72-h recovery.

We investigated changes in a large battery of pro- and anti-inflammatory cytokines in elite female soccer players following two 90-min games separated by a 72-h active or passive recovery. Blood samples were taken from 10 players before, within 15-20 min, 21, 45 and 69 h after the first game and within 15-20 min after the second game. The leukocyte count was analyzed, together with several plasma pro- and anti-inflammatory cytokines, using a multiplex bead array system. After the first and second game, the total leukocytes and neutrophils increased significantly. Likewise, increases (P<0.05) in pro-inflammatory cytokines [interleukin (IL)-12, tumor necrosis factor-α (TNF-α), interferon-γ (INF-γ), IL-17], chemokines [monocyte chemotactic protein-1 (MCP-1), IL-8 and monokine induced by gamma interferon (MIG)], anti-inflammatory cytokines (IL-2R, IL-4, IL-5, IL-7, IL-10, IL-13, INF-α) and the mixed cytokine IL-6 were observed. Leukocyte and cytokine levels were normalized within 21 h. Active recovery (low-intensity exercises) did not affect the cytokine responses. A dampened cytokine response was observed after the second game as only IL-12, IL-6, MCP-1, IL-8 and MIG increased (P<0.05). In conclusion, a robust pro- and anti-inflammatory cytokine response occurs after the first but not the second soccer game. The implications of the dampened cytokine response in female players after the second game are unknown.

Exotic orbits of two interacting wave sources.

As shown recently, it is possible to create, on a vibrating fluid interface, mobile emitters of Faraday waves [Y. Couder, S. Protière, E. Fort, and A. Boudaoud, Nature 437, 208 (2005)]. They are formed of droplets bouncing at a subharmonic frequency which couple to the surface waves they emit. The droplet and its wave form a spontaneously propagative structure called a "walker." In the present paper we investigate the large variety of orbital motions exhibited by two interacting walkers having different sizes and velocities. The various resulting orbits which can be circular, oscillating, epicycloidal, or "paired walkers" are defined and characterized. They are shown to result from the wave-mediated interaction of walkers. Their relation to the orbits of other localized dissipative structures is discussed.

Inosine-5'-monophosphate dehydrogenase is a rate-determining factor for p53-dependent growth regulation.

We have proposed that reduced activity of inosine-5'-monophosphate dehydrogenase (IMPD; IMP:NAD oxidoreductase, EC 1.2.1.14), the rate-limiting enzyme for guanine nucleotide biosynthesis, in response to wild-type p53 expression, is essential for p53-dependent growth suppression. A gene transfer strategy was used to demonstrate that under physiological conditions constitutive IMPD expression prevents p53-dependent growth suppression. In these studies, expression of bax and waf1, genes implicated in p53-dependent growth suppression in response to DNA damage, remains elevated in response to p53. These findings indicate that under physiological conditions IMPD is a rate-determining factor for p53-dependent growth regulation. In addition, they suggest that the impd gene may be epistatic to bax and waf1 in growth suppression. Because of the role of IMPD in the production and balance of GTP and ATP, essential nucleotides for signal transduction, these results suggest that p53 controls cell division signals by regulating purine ribonucleotide metabolism.

[In vivo imaging of the corneal nerve plexus : From single image to large scale map]. / In-vivo-Bildgebung des kornealen Nervenplexus : Vom Einzelbild zur großflächigen Darstellung.

The sub-basal nerve plexus (SNP) of the cornea provides the possibility of in vivo and non-invasive examination of peripheral nerve structures by corneal confocal microscopy (CCM). Thus morphological alterations of the SNP can be directly detected and quantified. A single CCM image is insufficient for a well-founded diagnosis because of the inhomogeneous distribution of the nerve fibers; therefore, there is a demand for techniques for large area imaging of the SNP. This article provides an overview of published approaches to the problem. Current developmental work at the Karlsruhe Institute of Technology and the University of Rostock Eye Clinic is expected to lead to a simplified handling of the technology and a further improvement in the image quality.

Hierarchical crack pattern as formed by successive domain divisions. I. Temporal and geometrical hierarchy.

Crack patterns, as they can be observed in the glaze of ceramics or in desiccated mud layers, are formed by successive fractures and divide the two-dimensional plane into distinct domains. On the basis of experimental observation, we develop a description of the geometrical structure of these hierarchical networks. In particular, we show that the essential feature of such a structure can be represented by a genealogical tree of successive domain divisions. This approach allows for a detailed discussion of the relationship between the formation process and the geometric result. We show that--with some restraints--it is possible to reconstruct the history of the system from the geometry of the final pattern.

Hierarchical crack pattern as formed by successive domain divisions. II. From disordered to deterministic behavior.

Hierarchical crack patterns, such as those formed in the glaze of ceramics or in desiccated layers of mud or gel, can be understood as a successive division of two-dimensional domains. We present an experimental study of the division of a single rectangular domain in drying starch and show that the dividing fracture essentially depends on the domain size, rescaled by the thickness of the cracking layer e. Utilizing basic assumptions regarding the conditions of crack nucleation, we show that the experimental results can be directly inferred from the equations of linear elasticity. Finally, we discuss the impact of these results on hierarchical crack patterns, and in particular the existence of a transition from disordered cracks at large scales--the first ones--to a deterministic behavior at small scales--the last cracks.

Constitutive property of the local organization of leaf venation networks.

The leaf venation of dicotyledons forms complex patterns. In spite of their large variety of morphologies these patterns have common features. They are formed of a hierarchy of structures, which are connected to form a reticulum. Excellent images of these patterns can be obtained from leaves from which the soft tissues have been removed. A numerical image processing has been developed, specially designed for a quantitative analysis of this type of network. It provides a precise characterization of its geometry. The resulting data reveals a surprising property of reticula's nodes: the angles between vein segments are very well defined and it is shown that they are directly related by the radii of the segments. The relation between radii and angles can be expressed very simply using a phenomenological analogy to mechanics. This local organization principle is universal; all leaf venation patterns studied show the same behavior. The results are compared with physical networks such as fracture arrays or soap froth in terms of hierarchy and reorganization.

The equivalence of compressor pressure-flow relationships with respect to jet nebulizer aerosolization characteristics.

Manufacturers of aerosolized medications, approved by the Food and Drug Administration, specify the nebulizer(s) and compressor to be used with their product, in an attempt to achieve efficacy comparable to that obtained in the clinical trials. The need to limit the compressor to that used in the trials has not been investigated in detail. We suggest a technique to determine the equivalency of different compressors such that a chosen nebulizer's performance is not significantly altered. Aerosol particle size (MMD) was measured with a laser; compressor flow and pressure were measured with a mass flow meter and pressure gauge, respectively. For all models of nebulizer, increased flow or driving pressure caused a decrease in aerosol MMD. The flow resistance of nebulizer models varied, and the flow output of compressors decreased as imposed nebulizer resistance increased. However, for any specific compressor-nebulizer combination there is a unique flow and pressure, and the nebulizer generates a given MMD. We demonstrate methods to choose alternate compressors that may be used to drive a nebulizer and yet keep the nebulizer's MMD and performance within predetermined limits. Once an acceptable range of variance in a nebulizer's MMD is defined, alternate compressors may be safely chosen. We recommend that these techniques be used by manufacturers of medications and of compressors to safely determine the acceptability of several rather than a single model compressor to drive a chosen nebulizer. The techniques assure consistency of the nebulizer's clinically demonstrated performance characteristics.

Benfotiamine increases glucose oxidation and downregulates NADPH oxidase 4 expression in cultured human myotubes exposed to both normal and high glucose concentrations.

The aim of the present work was to study the effects of benfotiamine (S-benzoylthiamine O-monophosphate) on glucose and lipid metabolism and gene expression in differentiated human skeletal muscle cells (myotubes) incubated for 4 days under normal (5.5 mM glucose) and hyperglycemic (20 mM glucose) conditions. Myotubes established from lean, healthy volunteers were treated with benfotiamine for 4 days. Glucose and lipid metabolism were studied with labeled precursors. Gene expression was measured using real-time polymerase chain reaction (qPCR) and microarray technology. Benfotiamine significantly increased glucose oxidation under normoglycemic (35 and 49% increase at 100 and 200 µM benfotiamine, respectively) as well as hyperglycemic conditions (70% increase at 200 µM benfotiamine). Benfotiamine also increased glucose uptake. In comparison, thiamine (200 µM) increased overall glucose metabolism but did not change glucose oxidation. In contrast to glucose, mitochondrial lipid oxidation and overall lipid metabolism were unchanged by benfotiamine. The expression of NADPH oxidase 4 (NOX4) was significantly downregulated by benfotiamine treatment under both normo- and hyperglycemic conditions. Gene set enrichment analysis (GSEA) showed that befotiamine increased peroxisomal lipid oxidation and organelle (mitochondrial) membrane function. In conclusion, benfotiamine increases mitochondrial glucose oxidation in myotubes and downregulates NOX4 expression. These findings may be of relevance to type 2 diabetes where reversal of reduced glucose oxidation and mitochondrial capacity is a desirable goal.

Four sided domains in hierarchical space dividing patterns.

The cracks observed in the glaze of ceramics form networks, which divide the 2D plane into domains. It is shown that, on the average, the number of sides of these domains is four. This contrasts with the usual 2D space divisions observed in Voronoi tessellation or 2D soap froths. In the latter networks, the number of sides of a domain coincides with the number of its neighbors, which, according to Euler's theorem, has to be six on average. The four sided property observed in cracks is the result of a formation process which can be understood as the successive divisions of domains with no later reorganization. It is generic for all networks having such hierarchical construction rules. We introduce a "geometrical charge," analogous to Euler's topological charge, as the difference from four of the number of sides of a domain. It is preserved during the pattern formation of the crack pattern.

Bubbles under stress.

We present an experimental and theoretical investigation of a system composed of two soap bubbles strained between two parallel solid surfaces. The two-bubble cluster can be found in several configurations. The existence and stability of each of these states is studied as a function of the distance between the two facing surfaces. The change of this distance can induce a transition from one configuration to another; we observe that most transitions are subcritical, showing that the system is often trapped in states where the minimum of free energy is only local. The hysteretic transitions are responsible for the dissipation of elastic energy. The existence of more than one stable states for given boundaries conditions combined with the absence of thermalization means that the history of the system has to be taken into account and that there is no unique stress-strain relation. In the present system, because of its simplicity, a complete quantitative analysis of these general processes is obtained. The presented results may contribute to a better understanding of the dynamics of more complex systems such as foams or granular materials where similar processes are at work.

[Erythema nodosum: 112 cases. Epidemiology, clinical aspects and histopathology]. / Erythema nodosum: 112 Fälle. Epidemiologie, Klinik und Histopathologie.

In a retrospective study we analyzed the cases of 112 patients with erythema nodosum treated during the period 1983-1993 in the Department of Dermatology, University Hospital of Basel, Switzerland. The aim of the study was to investigate the epidemiology, incidence of different etiologies, relevance of laboratory investigations and the histopathologic features in our patients, 83% of whom were females. The peak incidence occurred between the ages of 18 and 34 years. The commonest cause of erythema nodosum was infection. Other etiologic factors were adverse drug reactions, sarcoidosis, Crohn's disease, non-Hodgkin lymphoma, pregnancy, discoid lupus erythematosus, Sharp syndrome and aspartame. Only 47% of patients showed the classic bilateral distribution of the nodes on the extensor surface of the lower extremities. 77% of infection-induced erythema nodosum healed after 7 weeks, the longest course being 18 weeks. In contrast, 30% of idiopathic erythema nodosum lasted more than 6 months. Patients in whom erythema nodosum was associated with non-Hodgkin lymphoma had an extremely protracted course. Erythema nodosum associated with non-Hodgkin lymphoma may precede the diagnosis of lymphoma by months. In 4 cases erythema nodosum was the initial sign of sarcoidosis. In 30% of biopsies we found single vessels with leukocytoclastic vasculitis. The histologic pattern failed to provide etiologic pointers.

Airborne contact dermatitis from methylchloroisothiazolinone in wall paint. Abolition of symptoms by chemical allergen inactivation.

Preservatives such as isothiazolinones in paints have been reported to cause airborne contact dermatitis. The patients whom we report experienced acute dermatitis on air-exposed skin and respiratory symptoms after staying in recently painted rooms. Kathon (methylchloroisothiazolinone/methylisothiazolinone) added as preservative to the wall paint was identified as causative agent. In one individual symptoms rapidly disappeared after treatment of the painted walls with inorganic sulfur salt, which leads to inactivation of the allergenic properties of methylchloroisothiazolinone/methylisothiazolinone. We describe the patients, the clinical course and review the literature pertinent to such cases. In addition we report on the chemical analyses of the decorating paints used, and on experiments on emission and air concentration of methylchloroisothiazolinone/methylisothiazolinone from a painted surface before and after inactivation by sodium bisulfite.

Trichorhinophalangeal syndrome type III.

Trichorhinophalangeal syndrome (TRPS) type III is a newly defined clinical entity. This symptom complex is inherited as an autosomal dominant trait and clinically characterized by growth retardation, craniofacial abnormalities, severe brachydactyly and sparse hair. In addition, absence of mental retardation and cartilaginous exostoses are required for the diagnosis of TRPS III. To further delineate this newly recognized entity, we report on a patient from a Turkish family segregating TRPS III in 7 family members. The patient had a very short stature (147 cm, < 3rd standard deviation), a thin upper lip and a prominent lower lip, a pear-shaped nose, stubby fingers and toes with cone-shaped epiphyses and sparse scalp hair. Scanning electron microscopy findings and results of energy-dispersive X-ray microanalysis are presented in such a patient for the first time.