Instrumental activities of daily living in neuro-oncology: International validation of the EORTC IADL-BN32 questionnaire.

BACKGROUND: Neurocognitive impairments are common in patients with a brain tumour, and may negatively impact on functioning in daily life, particularly on instrumental activities of daily living (IADL). The EORTC IADL-BN32 questionnaire was developed to measure IADL in this patient population. METHODS: In this international validation study, we evaluated the EORTC IADL-BN32 questionnaire on several psychometric properties in a large sample of patients with a primary or metastatic brain tumour. We administered the 32-item questionnaire three times: at 'baseline', after 2 weeks and after 3 months. Procedures were in accordance with EORTC Quality of Life Group module development guidelines. RESULTS: In total, 326 patients participated in the study. A bifactor scale structure showed satisfactory model fit measures, with five multi-item scales and two single items, and an IADL sum score. The internal consistency of the multi-item scales ranged from good to excellent (range Cronbach's α: 0.86-0.97). We found significant differences in scale scores between patients with and without neurocognitive impairments or complaints, supporting the construct validity. Initial cross-cultural validity analyses showed indications of item response biases for certain items. Analyses indicated moderate to good test-retest agreement (intraclass correlation coefficient > 0.70) between baseline and the 2-week follow-up assessment for all but one scale. Deterioration of EORTC IADL-BN32 scale scores were consistent with clinically relevant deterioration on other functional measures with small to large effect sizes, however, subgroup sample sizes were small. CONCLUSION: Overall, the EORTC IADL-BN32 questionnaire exhibited adequate to excellent psychometric properties. Cross-cultural validity and responsiveness should be further explored.

Evolution of apomixis loci in Pilosella and Hieracium (Asteraceae) inferred from the conservation of apomixis-linked markers in natural and experimental populations.

The Hieracium and Pilosella (Lactuceae, Asteraceae) genera of closely related hawkweeds contain species with two different modes of gametophytic apomixis (asexual seed formation). Both genera contain polyploid species, and in wild populations, sexual and apomictic species co-exist. Apomixis is known to co-exist with sexuality in apomictic Pilosella individuals, however, apomictic Hieracium have been regarded as obligate apomicts. Here, a developmental analysis of apomixis within 16 Hieracium species revealed meiosis and megaspore tetrad formation in 1 to 7% of ovules, for the first time indicating residual sexuality in this genus. Molecular markers linked to the two independent, dominant loci LOSS OF APOMEIOSIS (LOA) and LOSS OF PARTHENOGENESIS (LOP) controlling apomixis in Pilosella piloselloides subsp. praealta were screened across 20 phenotyped Hieracium individuals from natural populations, and 65 phenotyped Pilosella individuals from natural and experimental cross populations, to examine their conservation, inheritance and association with reproductive modes. All of the tested LOA and LOP-linked markers were absent in the 20 Hieracium samples irrespective of their reproductive mode. Within Pilosella, LOA and LOP-linked markers were essentially absent within the sexual plants, although they were not conserved in all apomictic individuals. Both loci appeared to be inherited independently, and evidence for additional genetic factors influencing quantitative expression of LOA and LOP was obtained. Collectively, these data suggest independent evolution of apomixis in Hieracium and Pilosella and are discussed with respect to current knowledge of the evolution of apomixis.

A profile of perianesthesia nursing patient outcome research, 1994-1999.

The purpose of this research was to profile the current body of perianesthesia nursing research and extend the findings of previous integrative reviews completed on research from 1982 to 1993. The tables of contents from 18 nursing journals were examined and 31 studies met inclusion criteria. Findings indicated that some improvements were made by perianesthesia nurse researchers in using the scientific method. No studies replicated previously published research before 1994. Pediatric and elderly studies were scarce. Free-standing ambulatory surgery continues to be an under-represented research setting.

Risk factors for mortality in infants and young children on dialysis.

The factors associated with a greater mortality risk in infants and young children undergoing dialysis have not been clearly determined. We report the results of a North American Pediatric Renal Transplant Cooperative Study designed to assess risk factors in patients aged younger than 6 years at initiation of dialysis therapy. Sixty-four nonsurvivors were matched with 110 survivors for age at dialysis initiation, primary renal disease, and year of entry onto the database. Questionnaires on 137 patients (51 nonsurvivors, 86 survivors) were completed by participating centers. Seventy-five percent (103 of 137 patients) of the patients were aged younger than 2 years at dialysis initiation; 42% (58 of 137 patients) had renal aplasia, dysplasia, and/or hypoplasia or obstructive uropathy; 62% were boys; and 62% were white. One-year patient survival rates were 83% in infants beginning dialysis at younger than 3 months of age, 89% in 3- to 23-month-olds, and 95% in 2- to 5-year-olds (P = 0.001). Comorbid nonrenal disease occurred in 37 of 51 nonsurvivors (74%) versus 46 of 84 survivors (55%; P = 0.027). Nonsurvivors had pulmonary disease and/or hypoplasia more often (14 of 37 nonsurvivors; 37.8% versus 8 of 46 survivors; 17.4%; P = 0.04). Oliguria or anuria was present in 23 of 33 nonsurvivors (70%) aged younger than 2 years versus 26 of 64 survivors (41%; P = 0.007). Infection accounted for 15 of 51 deaths (29.4%). In summary, these results suggest that age at dialysis initiation; presence of nonrenal disease, particularly pulmonary disease and/or hypoplasia; and oliguria or anuria in children aged younger than 2 years are identifiable as risk factors for mortality in these young patients.

Effect of fish oil, arginine, and doxorubicin chemotherapy on remission and survival time for dogs with lymphoma: a double-blind, randomized placebo-controlled study.

BACKGROUND: Polyunsaturated n-3 fatty acids have been shown to inhibit the growth and metastasis of tumors. This double-blind, randomized study was designed to evaluate the hypothesis that polyunsaturated n-3 fatty acids can improve metabolic parameters, decrease chemical indices of inflammation, enhance quality of life, and extend disease free interval and survival time for dogs treated for lymphoblastic lymphoma with doxorubicin chemotherapy. METHODS: Thirty-two dogs with lymphoma were randomized to receive one of two diets supplemented with menhaden fish oil and arginine (experimental diet) or an otherwise identical diet supplemented with soybean oil (control diet). Diets were fed before and after remission was attained with up to five dosages of doxorubicin. Parameters examined included blood concentrations of glucose, lactic acid, and insulin in response to glucose and diet tolerance tests; alpha-1 acid glycoprotein; tumor necrosis factor; interleukin-6; body weight; amino acid profiles; resting energy expenditure; disease free interval (DFI); survival time (ST); and clinical performance scores. RESULTS: Dogs fed the experimental diet had significantly (P < 0.05) higher mean serum levels of the n-3 fatty acids docosahexaenoic acid (C22:6) and eicosapentaenoic acid (C20:5) compared with controls. Higher serum levels of C22:6 and C20:5 were associated with lesser (P < 0.05) plasma lactic acid responses to intravenous glucose and diet tolerance testing. Increasing C22:6 levels were significantly (P < 0.05) associated with longer DFI and ST for dogs with Stage III lymphoma fed the experimental diet. CONCLUSIONS: Fatty acids of the n-3 series normalize elevated blood lactic acid in a dose-dependent manner, resulting in an increase in DFI and ST for dogs with lymphoma.

Duration of effects of dietary fish oil supplementation on serum eicosapentaenoic acid and docosahexaenoic acid concentrations in dogs.

OBJECTIVE: To determine how long serum concentrations of omega-3 fatty acids remain elevated after cessation of dietary fish oil supplementation. ANIMALS: 12 healthy Beagles. PROCEDURE: Baseline serum concentrations of linoleic acid, linolenic acid, arachidonic acid (AA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) were measured. Dogs were then fed a diet supplemented with soybean oil or fish oil for 8 weeks, and serum fatty acid concentrations were measured while dogs were fed the experimental diets and for 18 weeks after they were switched to a maintenance diet. RESULTS: For dogs fed the fish oil diet, serum EPA and DHA concentrations were significantly increased by week 1 and remained increased for 7 (DHA concentration) or 3 (EPA concentration) weeks after dietary fish oil supplementation was discontinued. CONCLUSIONS: In dogs, supplementation of the diet with fish oil may have effects for several weeks after dietary supplementation is discontinued. CLINICAL RELEVANCE: Studies of the effects of fish oil supplementation that use a crossover design should allow for an appropriate washout period.

Physiological role of nitric oxide in regulation of renal function in humans.

The physiological role of endogenous nitric oxide in regulation of renal function in humans is unclear. Eight healthy men received an inhibitor of nitric oxide synthase, N(G)-monomethyl-L-arginine (L-NMMA, 3 mg/kg), and saline placebo intravenously on two occasions. L-NMMA significantly increased mean arterial pressure (+7%) and total peripheral resistance (+36%). However, because renal plasma flow did not decrease significantly, the increase in renal vascular resistance (+21%) was significantly less than the increase in total peripheral resistance. Glomerular filtration rate (-19%), filtration fraction (-10%), urine flow rate (-18%), sodium (-28%), and free water excretion (-25%) all decreased significantly. Fractional distal, but not proximal, sodium reabsorption increased. L-NMMA also significantly decreased plasma nitrate and urinary excretion of nitrate and dopamine. There were no significant changes in plasma renin activity, plasma endothelin, and aldosterone or in platelet number and ex vivo aggregation. L-NMMA had a plasma half-life of 75 min. Basal generation of nitric oxide appears to contribute less to vascular tone in the kidney than systemically but may alter afferent arteriolar tone. Decreased fractional sodium excretion supports an important physiological role for nitric oxide in inhibition of tubular sodium reabsorption, possibly mediated by the renal dopaminergic system.

Cystometrography provides a previously unrecognized opportunity for successful management of urinary leaks after renal transplantation.

We report 3 cases of urinary leakage occurring in male kidney transplant recipients within 6 weeks of renal transplantation. Voiding cystometrography showed that high voiding detrusor pressure was the contributing factor. Endoscopic bladder outlet surgery restored normal detrusor voiding pressure and led to spontaneous resolution of urinary leakage without recurrence in all cases.

Energy expenditure in dogs with lymphoma fed two specialized diets.

BACKGROUND: Cancer-caused cachexia has been reported to be caused in part by an increase in energy expenditure, and diets with nutrient profiles containing 30-50% nonprotein calories as fat instead of carbohydrate may exacerbate this state of inefficient energy utilization. METHODS: Indirect calorimetry was performed on 22 dogs with high-grade lymphoblastic lymphoma that were randomized into a blind study and fed isocaloric amounts of a high-fat diet (Diet A) or a high-carbohydrate diet (Diet B) before and after remission was attained with up to five doses of doxorubicin chemotherapy (30 mg/m2 intravenously). Indirect calorimetry was also performed on 30 normal dogs for comparison. RESULTS: During the initial evaluation period, the resting energy expenditure (REE/kg0.75, P < 0.05) and respiratory quotient (RQ, P < 0.05) were significantly lower than in the controls. Six weeks after the start of the study, the REE/kg0.75 and oxygen consumption (VO2/kg0.75) were significantly (P < 0.05) lower in both groups of dogs with lymphoma compared with the controls. The RQ determined 6 weeks after the start of the study for the dogs fed Diet A was significantly (P < 0.05) lower compared with that in the controls evaluated at the same time. When the two groups of dogs with lymphoma were compared with each other, there was no significant difference in any of the outcomes. The REE/kg0.75 and VO2/kg0.75 values were significantly lower (P < 0.05) in the group fed Diet A after the third evaluation period compared with the second evaluation. The REE/kg0.75 and VO2/kg0.75 values were significantly lower (P < 0.05) in the group given Diet B at the fourth evaluation period compared with the fifth. CONCLUSIONS: These data suggest that energy expenditure of dogs with lymphoma decreases transiently in response to chemotherapy and remission, but these values are less than those determined in normal dogs and not altered significantly by diet.

Vertebral aneurysmal bone cyst. A case report and review.

The case of a 16-year-old boy with an aneurysmal bone cyst of the fourth lumbar vertebra and a herniated nucleus pulposus of the L4-5 disc is presented. Symptoms included progressive lower back pain and bilateral lower extremity weakness. Roentgenographic studies were consistent with a vertebral aneurysmal bone cyst with an expansile lesion that compromised the neural canal and an L4-5 herniated nucleus pulposus. Surgical treatment included tumor excision, L4-5 discectomy, lumbar decompression, and posterolateral and anterior lumbar fusion. Postoperatively, the lower back pain and lower extremity symptoms resolved. The patient continues to do well at 1-year follow-up.

Neurofibromatous dermal hypoplasia: a clinical, pharmacological and ultrastructural study.

Dermal hypoplasia is reported in three patients with neurofibromatosis. The areas of dermal hypoplasia failed to react to vasodilator stimuli and responded poorly to a vasoconstrictor stimulus. Histology of these lesions showed neurofibromatous tissue and at an ultrastructural level cells resembling perineurial cells were wrapped around dermal vessels. The poor vascular responses seen in these areas of neurofibromatous dermal hypoplasia might be due to the perineurial cells acting as a barrier to diffusion of the pharmacological agents and as a physical perivascular splint.

A method for quantitation of hepatic, pancreatic, and intestinal function in conscious Yucatan miniature swine.

A right laparotomy was performed in anesthetized miniature swine. A hepatic vein was catheterized through the diaphragmatic surface of the left lateral lobe of the liver or through the cut surface of the right lateral lobe following a partial lobectomy. Continuous wave Doppler flow cuffs were applied to the hepatic artery and portal vein. Portal vein catheterization was accomplished through a stab incision made through the center of a preplaced purse string suture. Catheters and flow cuff wires exited the abdomen at the dorsal limit of the incision and were placed in nylon packs. Sterile surgery of the right ventro-lateral cervical region allowed catheterization of the right external jugular vein and carotid artery. These catheters were passed subcutaneously to the dorsum of the neck and inserted into another nylon pack. This method allowed repetitive experiments on conscious miniature swine after recovery from surgery. It allowed accurate quantitative determination of hepatic extraction of hormones as well as extraction of production of metabolites. Rates of intestinal absorption and pancreatic hormone secretion also could be assessed.

Metabolic alterations related to reverse portal vein flow in an endotoxic pig.

Chronic hepatic artery and portal vein flowcuffs, in concert with hepatic vein and portal vein catheters, were placed in a Yucatan miniature pig. One week following surgery an endotoxin infusion was initiated. During endotoxemia there was a period of reverse portal vein flow while hepatic artery flow continued. This aberration resulted in unusual portal vein substrate and hormone concentrations. As endotoxemia progressed, the pig became hypoglycemic and hyperlactemic. Specific activity of [6-3H] - glucose was constant during developmental hypoglycemia, while insulin secretion rate was minimal indicating a significant endotoxin-induced, insulin-like activity. Hepatocytes isolated from the pig's liver at termination had inhibited gluconeogenic capacity.

Congenital dyserythropoietic anaemia with unusual cytoplasmic inclusions.

A case of congenital dyserythropoietic anaemia is described which appears to be at variance with the accepted classification. The morphological findings are of normoblastic hyperplasia with marked cytoplasmic vacuolation. Electron microscopy shows these to be myelin figures in all stages of erythroid differentiation.