A comparison of alcohol and commercial tobacco use in populous American Indian/Alaska Native states.

BACKGROUND: Modern research suggests that the racial influence on smoking and drinking behaviors may not be as prevalent as once thought. This study utilizes national survey data to compare binge drinking and commercial cigarette smoking behaviors between American Indians/Alaskan Natives (AI/AN) and non-Hispanic Whites in the five most populous AI/AN U.S. states. METHODS: Data were analyzed from the Behavioral Risk Factor Surveillance System (BRFSS) from 2018 to 2022; White (n=79,405), AI/AN (n=11,007). Data analyses include frequency statistics, followed by two model evaluations comparing main effects of race/ethnicity and sex for both binge drinking and commercial cigarette smoking behaviors, and subgroup estimates of race/ethnicity by sex. An ANOVA was utilized to evaluate differences by race/ethnicity, sex, and race/ethnicity by sex subgroups by states. RESULTS: Males were over twice as likely to engage in binge drinking, with no significant differences found between people identifying as AI/AN and White individuals. Both White and AI/AN males were twice as likely to engage in binge drinking, compared to their White female counterparts. AI/AN individuals were over twice as likely to engage in commercial cigarette smoking compared to their White counterparts. CONCLUSIONS: Results showed no significance differences in AI/AN versus White individuals in binge drinking (controlling for sex, age, and income), while there were significant differences by sex (controlling for race/ethnicity, age, and income). People identifying as AI/AN were significantly more likely to engage in commercial cigarette smoking compared to White individuals, signifying the importance of racial/ethnical and covariate considerations when establishing public health interventions.

AmAMP1 from Acropora millepora and damicornin define a family of coral-specific antimicrobial peptides related to the Shk toxins of sea anemones.

A candidate antimicrobial peptide (AmAMP1) was identified by searching the whole genome sequence of Acropora millepora for short (<125AA) cysteine-rich predicted proteins with an N-terminal signal peptide but lacking clear homologs in the SwissProt database. It resembled but was not closely related to damicornin, the only other known AMP from a coral, and was shown to be active against both Gram-negative and Gram-positive bacteria. These proteins define a family of AMPs present in corals and their close relatives, the Corallimorpharia, and are synthesised as preproproteins in which the C-terminal mature peptide contains a conserved arrangement of six cysteine residues. Consistent with the idea of a common origin for AMPs and toxins, this Cys motif is shared between the coral AMPs and the Shk neurotoxins of sea anemones. AmAMP1 is expressed at late stages of coral development, in ectodermal cells that resemble the "ganglion neurons" of Hydra, in which it has recently been demonstrated that a distinct AMP known as NDA-1 is expressed.

Proximal ventricular shunt malfunctions in children: Factors associated with failure.

Ventricular shunt failures and subsequent revisions are a significant source of patient morbidity. We conducted a review of pediatric patients undergoing placement or revision of ventricular shunts at our institution between January 2007 and December 2008. Patients were followed through to July 2014. Data collected included patient demographics, shunt history and indication for procedure, approach taken for shunt placement, and location of shunt tip in relation to the foramen of Monro. Univariate and multivariate analyses were conducted to identify factors associated with proximal failure. A total of 87 procedures were identified in 40 patients, consisting of 23 initial placements and 64 revisions. Thirty-nine proximal catheter malfunctions were identified. Indications for shunt placement included Chiari II malformation (33%) and intraventricular hemorrhage (33%). Mean follow-up period was 5.5 years. Median time to shunt failure was 1.57 years. In the multivariate model, younger age at placement was associated with decreased time to proximal failure (hazard ratio [HR]=0.80 per increasing year of age, 95% confidence interval [CI] 0.64-0.98). Both anterior approach (HR=0.39, 95% CI 0.23-0.67) and farther distance to foramen of Monro (HR=0.02 per increasing 10mm, 95% CI 0.00-0.22) were associated with increased time to proximal failure when the catheter tip was located within the contralateral lateral ventricle. Optimizing outcomes in patients with shunt-dependent hydrocephalus continues to be a challenge. Despite unsatisfactory outcomes, particularly in the pediatric population, few conclusions can be drawn from studies assessing operative variables.

Cohort study examining long-term respiratory health, career duration and racing performance in racehorses that undergo left-sided prosthetic laryngoplasty and ventriculocordectomy surgery for treatment of left-sided laryngeal hemiplegia.

REASONS FOR PERFORMING STUDY: The risk of respiratory conditions, such as inflammatory airway disease (IAD) and exercise-induced pulmonary haemorrhage (EIPH), are thought to be higher in racehorses that undergo prosthetic laryngoplasty with ventriculocordectomy (PLVC) surgery to treat left-sided laryngeal hemiplegia (LLH) than in racehorses with normal laryngeal function. However, this has not been investigated formally owing to the difficulty of obtaining reliable follow-up data. OBJECTIVES: To determine the incidence of respiratory conditions (IAD and EIPH), duration of racing career, number of starts and number of starts for which stakes money was earned in racehorses that had undergone PLVC surgery to treat LLH, compared with racehorses that did not have LLH or undergo any laryngeal surgery. METHODS: A retrospective cohort study design was used, with surgical, clinical and race data of Thoroughbred racehorses obtained from the time of importation until retirement. The surgical cohort consisted of racehorses that had undergone PLVC for LLH and met specific inclusion criteria. Every surgical case was matched, according to trainer, year of import into Hong Kong and pre-import international handicap rating, to 2 unexposed racehorses. RESULTS: Respiratory conditions, such as excessive tracheal mucus and epistaxis due to severe EIPH, were significantly increased in the surgical cohort, compared with the matched unexposed cohort (P values <0.001 and <0.004, respectively). Racing career duration in the surgical cohort was significantly shorter than in the unexposed cohort, which was primarily due to retirement because of epistaxis. The number of race starts was fewer in the surgical than in the unexposed cohort after surgery/matching, but the number of starts for which stakes money was earned was not significantly different. CONCLUSIONS AND POTENTIAL RELEVANCE: Owners and trainers should be advised that racehorses with LLH that undergo PLVC surgery are at an increased risk of respiratory conditions (IAD and severe EIPH), which is likely to shorten their racing career compared to racehorses with normal laryngeal function. Racing performance in terms of race starts was significantly less in racehorses that had undergone PLVC surgery; however, the number of starts for which stakes money was earned was similar to those racehorses that were unexposed.

Fitness to fly testing in term and ex-preterm babies without bronchopulmonary dysplasia.

BACKGROUND: During air flight, cabin pressurisation produces an effective fraction of inspired oxygen (FiO(2)) of 0.15. This can cause hypoxia in predisposed individuals, including infants with bronchopulmonary dysplasia (BPD), but the effect on ex-preterm babies without BPD was uncertain. The consequences of feeding a baby during the hypoxia challenge were also unknown. METHODS: Ex-preterm (without BPD) and term infants had fitness to fly tests (including a period of feeding) at 3 or 6 months corrected gestational age (CGA) in a body plethysmograph with an FiO(2) of 0.15 for 20 min. A 'failed' test was defined as oxygen saturation (SpO(2)) <90% for at least 2 min. RESULTS: 41 term and 30 ex-preterm babies (mean gestational age 39.8 and 33.1 weeks, respectively) exhibited a significant median drop in SpO(2) (median -6%, p<0.0001); there was no difference between term versus ex-preterm babies, or 3 versus 6 months. Two term (5%) and two ex-preterm (7%) babies failed the challenge. The SpO(2) dropped further during feeding (median -4% in term and -2% in ex-preterm, p<0.0001), with transient desaturation (up to 30 s) <90% seen in 8/36 (22%) term and 9/28 (32%) ex-preterm infants; the ex-preterm babies desaturated more quickly (median 1 vs 3 min, p=0.002). CONCLUSIONS: Ex-preterm babies without BPD and who are at least 3 months CGA do not appear to be a particularly at-risk group for air travel, and routine preflight testing is not indicated. Feeding babies in an FiO(2) of 0.15 leads to a further fall in SpO(2), which is significant but transient.

Anorectal fissures: an under-recognized cause of low back pain? Case report.

INTRODUCTION: Low back pain is one of the most common complaints for which patients seek medical attention. The differential for such a complaint is wide and therefore requires a thoughtful and thorough work-up. Anorectal disorders are an often-overlooked cause of low back pain. CASE PRESENTATION: We discuss the case of a 46-year-old male with history of dull aching back pain in the midline at the lumbosacral junction. The pain extended to the left of midline, into the region of the sacroiliac joint. There was no radiation into the buttock or leg. Physical exam was unremarkable. Upon soliciting further history, the patient reported a long history of anal pruritus and occasional hematochezia. Colonoscopy subsequently revealed anal fissures in various stages of healing. He was treated with Metamucil capsules and oral nifedipine with significant improvement of his symptoms. CONCLUSION: Low back pain is a challenging chief complaint to the primary care diagnostician due to its wide differential. In a careful and thorough work-up of this complaint, disorders of the anus and rectum should not be overlooked as possible culprits.

A sorption kinetics model for arsenic adsorption to magnetite nanoparticles.

INTRODUCTION: Arsenic is a well known water contaminant that causes toxicological and carcinogenic effects. In this work magnetite nanoparticles were examined as possible arsenic sorbents. The objective of this work was to develop a sorption kinetics model, which could be used to predict the amount of arsenic adsorbed by magnetite nanoparticles in the presence of naturally occurring species using a first-order rate equation, modified to include adsorption, described by a Langmuir isotherm. DISCUSSION: Arsenate and arsenite adsorption to magnetite nanoparticles was studied, including the effect of naturally occurring species (sulfate, silica, calcium magnesium, dissolved organic matter, bicarbonate, iron, and phosphate) on adsorption. CONCLUSION: The model accurately predicts adsorption to magnetite nanoparticles used in a batch process to remove arsenic from spiked Houston, TX tap water, and contaminated Brownsville, TX groundwater.

Prospective study of breast MRI in BRCA1 and BRCA2 mutation carriers: effect of mutation status on cancer incidence.

Annual MRI screening is recommended as an adjunct to mammography for BRCA1 and BRCA2 mutation carriers. Prophylactic oophorectomy has been shown to decrease breast cancer risk in BRCA1/2 mutation carriers. Here, we aimed to examine the combined effects of MRI and oophorectomy. For this purpose, 93 BRCA1/2 mutation carriers were screened with yearly mammograms and yearly MRI scans. Study endpoints were defined as date of breast cancer diagnosis, date of prophylactic mastectomy, or date of most recent contact. Of 93 women, with a median age of 47, 80 (86%) had prophylactic oophorectomy. Fifty-one women (55%) had BRCA1 mutations. A total of 283 MRI scans were performed. Eleven breast cancers (9 invasive, 2 ductal carcinoma in situ) were detected in 93 women (12%) with a median follow-up of 3.2 years (incidence 40 per 1,000 person-years). Six cancers were first detected on MRI, three were first detected by mammogram, and two were "interval cancers." All breast cancers occurred in BRCA1 mutation carriers (incidence 67 per 1,000 person-years). Apart from BRCA1 vs. BRCA2 mutation status, there were no other significant predictors of breast cancer incidence. Most invasive breast cancers were estrogen receptor negative (7 of 9) and lymph node negative (7 of 9). There have been no systemic recurrences with a median follow-up of 19 months after cancer diagnosis. Finally, it was concluded that all breast cancers occurred in BRCA1 mutation carriers, in most cases despite oophorectomy. These data suggest that surveillance and prevention strategies may have different outcomes in BRCA1 and BRCA2 mutation carriers.

A patient notification exercise following infection control failures in a dental surgery.

OBJECTIVES: To investigate the association between treatment by a dental healthcare worker (HCW) and patient infection with a blood-borne virus (BBV). DESIGN: Nested case control study. SETTING: A patient notification exercise (PNE) arising from a hepatitis C virus positive HCW that was undertaken because of deficiencies in infection control practice. METHODS: Cases were individuals with a BBV infection identified as a result of the PNE. Controls were randomly selected individuals with negative tests for BBVs. Detailed information on dental treatment was obtained from patient notes. Information on risk factors for BBV infection was obtained using a structured questionnaire administered by telephone interview. RESULTS: Thirty patients had evidence of infection with a BBV. The mean number of visits for treatment was 20.5 in cases and 18.6 in controls; the difference 1.8 (95% CI -5.4 to 9.1) was not statistically significant (p = 0.62). Transmission of hepatitis C in the dental setting was excluded by sequencing of the viral genome or establishing alternative risk factors. CONCLUSION: There was no evidence of transmission of hepatitis C virus from the HCW to patients, or transmission of a BBV from patient to patient. To ensure consistent practice within the UK the National Institute for Health and Clinical Excellence should produce guidance on PNEs for the NHS.

Isolation from poultry litter and characterization [corrected] of Staphylococcus spp. capable of growth in high phosphate conditions [corrected].

AIMS: To isolate and characterize micro-organisms from poultry litter capable of growing under phosphate concentrations typical of poultry litter. METHODS AND RESULTS: Poultry litter extracts were plated onto brain-heart infusion medium (BHI) containing an additional 0.75 mol l(-1) phosphate (BHI-P). Colonies were screened for the presence of inclusion granules with five being selected for further study. All strains displayed identical biochemical characteristics consistent with Staphylococcus spp. and grouped with Staphylococcus spp. by comparative 16S rDNA analysis. Thus all five strains were identified as such. All strains displayed elevated intracellular phosphate levels when cultured in BHI-P broth (0.417-0.600 microg phosphate mg(-1) protein) vs BHI broth (0.075-0.093 microg phosphate mg(-1) protein). When grown using an austere semi-defined medium or BHI-P, Staph. sp. #7 displayed similar elevated intracellular phosphate levels compared with growth in BHI. CONCLUSIONS: Poultry litter contains novel Staphylococcus spp. capable of robust growth when exposed to phosphate levels comparable with that typically found in poultry litter. Data suggest intracellular phosphate levels in these strains increase in response to increasing phosphate in the medium or austere medium conditions. Intracellular phosphate did not reach levels comparable with known hyper-accumulating micro-organisms. SIGNIFICANCE AND IMPACT OF THE STUDY: These data suggest poultry litter possesses a resident microflora that thrives and accumulates intracellular phosphate in response to high phosphate conditions.

Nutritional deprivation increases intracellular phosphate and polyphosphate in poultry litter microflora.

AIMS: To determine if mixed microflora from poultry litter accumulates phosphate when deprived of carbon and energy or nitrogen sources. METHODS AND RESULTS: Microbial enrichments from poultry litter capable of metabolizing ammonia, amino acids, and glucose were subjected to nutritional deprivation and the effects on intracellular phosphate levels were determined. Results indicate deprivation of glucose yields a 38 and 50% increase in intracellular phosphate and polyphosphate levels, respectively. Deprivation of nitrogen sources did not result in significant intracellular phosphate accumulation. CONCLUSIONS: Micro-organisms normally present in poultry litter respond to carbohydrate deprivation by accumulating intracellular phosphate. SIGNIFICANCE AND IMPACT OF THE STUDY: Poultry litter typically contains significant levels of phosphate which contribute to environmental pollution when applied to land. Phosphate is highly mobile in soils and often drains into local watersheds following rain events. This study raises the possibility that poultry litter micro-organisms may have the capacity to sequester phosphate, which could delay or diminish phosphate run-off.

MRI directed multidisciplinary team preoperative treatment strategy: the way to eliminate positive circumferential margins?

Histopathological audit of positive circumferential resection margins (CRMs) can be used as a surrogate measure of the success of rectal cancer treatment. We audited CRM involvement in rectal cancer patients and the impact of the multidisciplinary team (MDT) on implementing a magnetic resonance imaging (MRI)-based preoperative treatment strategy. Data were collected on all newly diagnosed rectal cancer patients treated in our network between January 1999 and December 2002. Data were analysed for MRI prediction and histopathological assessment of CRM together with the MDT meeting treatment decisions. The CRM+ve rate of those discussed at MDT vs those not discussed were compared. We re-audited the CRM+ve rates 1 year after introducing a policy of mandatory preoperative MRI-based MDT discussion. Of the 298 patients diagnosed with rectal cancer, 39 (13%) were deemed palliative, 178 underwent surgery alone and 81 underwent neoadjuvant therapy. Of these, 62 out of 178 patients underwent surgery alone without MRI-based MDT discussion resulting in positive CRM in 16 cases (26%) as compared to 1 out of 116 (1%) in those patients with MDT discussion of MRI. Overall CRM+ve rate in all nonpalliative patients with or without MDT discussion was 12.5% (32 out of 256), significantly lower than the <20% rate (P<0.001) quoted in national guidelines. Re-audit in 98 consecutive patients following a change of policy produced a lower CRM+ve rate of 3% (1 out of 37) for all surgery alone patients and an overall CRM+ve rate of 7% (5 out of 70). In conclusion, MDT discussion of MRI and implementation of a preoperative treatment strategy results in significantly reduced positive CRM in rectal cancer patients.

Beliefs and practices of patients with advanced cancer: implications for communication.

The aim of this study was to investigate the beliefs that patients with advanced cancer held about the curability of their cancer, their use of alternatives to conventional medical treatment, and their need to have control over decisions about treatment. Of 149 patients who fulfilled the criteria for participation and completed a self-administered questionnaire, 45 patients (31%) believed their cancer was incurable, 61 (42%) were uncertain and 39 (27%) believed their cancer was curable. The index of need for control over treatment decisions was low in 53 patients (35.6%) and high in only 17 patients (11.4%). Committed users of alternatives to conventional medical treatments were more likely to believe that their cancer was curable (P<0.001) and to have a higher need for control over decisions about treatment (P<0.004). The mean need for control scores were highest in patients who believed that their cancer was curable, or who were uncertain about the curability of their cancer, but who acknowledged that their oncologist had reported that the cancer was incurable. The diverse beliefs, attitudes and actions of these patients were consistent with a range of psychological adaptations to a life-threatening illness, some realistic and others illusory. Illusory responses influence what communication can achieve in daily oncology practice.

Illusions in advanced cancer: the effect of belief systems and attitudes on quality of life.

Patients with advanced cancer frequently express positive attitudes and can be unduly optimistic about the potential benefits of treatment. In order to evaluate an illusory domain in the context of advanced cancer, we developed a scale of will to live and characterized the beliefs that patients held about the curability of their cancer, and how committed they were to using alternative treatments. A measure of quality of life was used as the dependent variable in order to assess the association between these attributes. After a preliminary exploration confirmed the presence of an illusory domain, these concepts were prospectively tested in 149 ambulant patients with advanced cancer who attended for palliative systemic treatment, radiation treatment or supportive care. The scale of global quality of life was reliable (Cronbach's alpha coefficient 0.72). The distribution of the scores of will to live was skewed, with no respondent scoring poorly, and the scale was reliable (Cronbach's alpha coefficient 0.82). The scale of belief in curability showed diverse beliefs. In some cases, there was a discrepancy between respondents' beliefs in curability and what they believed to be the report by their doctors. There was also an association between a committed use of alternative treatments and a belief in the curability of the cancer (p<0.001). In a multiple regression analysis, both will to live and performance status remained associated with better quality of life scores after adjustment for other relevant variables (p<0.05 and <0.001, respectively). These results suggest that positive illusory beliefs can be measured and are an important component of adaption for some patients with advanced cancer. Furthermore, this illusory domain may influence the perception and measurement of quality of life.

CDP840. A prototype of a novel class of orally active anti-inflammatory phosphodiesterase 4 inhibitors.

The discovery, synthesis and biological activity of a series of triarylethane phosphodiesterase 4 inhibitors is described. Structure-activity relationship studies are presented for CDP840 (29), a potent, chiral, selective inhibitor of PDE 4 (IC(50) 4nM). CDP840 is non-emetic in the ferret at 30mgkg(-1) (po), active in models of inflammation and reverses ozone-induced bronchial hyperreactivity in the guinea pig.

Effect of breast surgery on serum levels of insulin-like growth factors (IGF-I, IGF-II, and IGF binding protein-3) in women with benign and malignant breast lesions.

BACKGROUND: There is evidence that insulin-like growth factors play a role in the development of breast cancer. Antiestrogens reduce circulating levels of IGF-I, but the influence of other breast cancer treatments, including surgery, is unknown and is investigated in this study. METHODS: Circulating serum concentrations of IGF-I, IGF-II, and IGF binding protein-3 (IGFBP-3) were measured before and after breast surgery in 31 patients with breast cancer and 12 controls with benign breast lesions. Serum albumin was measured as a marker of the nonspecific metabolic effect of surgery. RESULTS: Serum IGF-I, IGF-II, IGFBP-3, and albumin fell 24 hours after surgery for breast cancer but largely normalized again over the next 7 days. The fall in IGF-I and IGFBP-3 was not significant when the change in serum albumin was used as a covariate, suggesting a nonspecific effect of surgery. However, the reduction in IGF-II remained significant when adjusted for albumin and was greater after lumpectomy of malignant tumors (-8 +/- 2%) compared with benign disease (2 +/- 2%, P = .001). The fall in IGF-II was significantly related to the size of the removed tumor. CONCLUSIONS: Breast cancer may directly influence the serum concentration of IGF-II, possibly by direct tumor production.

Serum levels of insulin-like growth factor binding protein-3 in benign and malignant breast disease.

BACKGROUND: The insulin-like growth factors IGF-I and IGF-II and their major binding protein IGFBP-3 influence the growth of breast cancer cells in vitro. Some benign non-breast tumours appear to be associated with increased serum IGFBP-3 levels which would tend to reduce bioactive-free IGF concentrations. The present study investigates whether this pattern also occurs in neoplastic breast disease. METHODS: Serum IGF-I, IGF-II and IGFBP-3 were measured by specific radioassay in 12 women with benign breast disease, 31 patients with breast cancer and in age-matched controls. RESULTS: The mean (+/-SD) serum IGFBP-3 concentration was higher in benign breast disease (3.6+/-0.7 mg/L) than in controls (2.7+/-0.6 mg/L) or in breast cancer patients (2.7+/-0.5 mg/L) (P = 0.001). Serum IGF-I and IGF-II levels were not significantly different among the groups. However, the index of free unbound IGF measured as the molar ratio of IGF-I plus IGF-II divided by IGFBP-3 was significantly lower in benign breast disease than in the other subjects. CONCLUSIONS: Either the production or clearance of IGFBP-3 is altered in benign breast disease so that there is less free IGF available to cells. This may serve to protect against malignant transformation in patients with benign breast disorders.

Occult fractures of the greater tuberosity of the humerus: radiographic and MR imaging findings.

OBJECTIVE: The purpose of this study is to discuss the clinical implications of diagnosing a one-part greater tuberosity fracture on radiography and to describe associated rotator cuff findings on MR imaging. CONCLUSION: One-part greater tuberosity fractures are traditionally treated conservatively. Because clinical findings simulate those of rotator cuff abnormalities, some patients with missed or nonvisible fractures may be referred for MR imaging for further examination. In our study, MR imaging revealed no associated cuff abnormalities that required early surgery. Diagnosis of such a fracture on radiography may obviate the need for unnecessary MR imaging and arthroscopic surgery.

Validation of a malnutrition screening tool for patients receiving radiotherapy.

Nutrition screening identifies individuals who are malnourished or at risk of becoming malnourished and who may benefit from nutrition support. The aim of this study was to validate a new malnutrition screening tool (MST) in cancer patients undergoing radiotherapy. The MST was compared with the subjective global assessment (SGA) of nutritional status. One hundred and six patients attending two cancer care centres in Australia were independently rated as well nourished or malnourished using SGA and at risk or not at risk of malnutrition using the MST. Convergent validity of the MST was established by determining the ability of the MST to predict SGA. According to SGA, 89% of the patients were well nourished and 11% were moderately malnourished. According to the MST, 28% of patients were at risk of malnutrition. The MST had a sensitivity of 100% and a specificity of 81%. The positive predictive value was 0.4 and the negative predictive value was 1.0. The MST is easy to use and is a strong predictor of nutritional status. The malnutrition screening tool is a simple, quick, valid tool that can be used to identify radiation oncology outpatients who are at risk of malnutrition.