[Primary lung cancer; assessment of the disclosed 5-year survival rate by the Internet website].

The disclosed 5-year survival rate for lung cancer in the Internet website represents a various difference by each institution. The better inferiority of the survival has been listed in a table to compare with other institutions and has been reported in magazines and media with a lack of an enough inspection, i.e., with a sufficient considering of a risk adjustment such as patient's background, operative policy, postoperative adjuvant therapy, and statistical background. We report our outcome of the surgical treatment for primary lung cancer. Of 875 patients treated for lung cancer in our department for 23 years between January 1980 and December 2002, 115 patients containing of 42 cases in 1997 and of 48 ones in 1992 and of 25 ones in 1987 were selected and the accumulated survival analysis was treated by Kaplan-Meier method. Eighty males and 35 females were between 15 and 80-year-old (average 63.2 +/- 11.4). The pathological classification was adenocarcinoma (n=69), squamous cell carcinoma (n=32), and others (n=14). The operative procedures were pneumonectomy (n=14), bilobectomy (n=12), lobectomy (n=85), and wedge resection (n=4). The survival time was from 29 days to 182 months (median survival time was 1471+/- 1180 days, the averaged time was 49 months). The 5-year survival rate was 41.4 +/- 9.1% (n=25) in 1987, 35.6 +/- 6.2% (n=48) in 1992, and 56.0 +/- 7.0% (n=42) in 1987, respectively (log-rank test, p = 0.2555). The 10-year survival rate was 24.1 +/- 7.9% in 1987 and 8.5 +/- 3.6% in 1992, respectively. The 5-year survival rate was as follows: IA 81.0 +/- 8.6% (n=20), IB 73.7 +/- 10.1% (n=19), IIA 57.1 +/- 18.7% (n=7), IIB 55.6 +/- 16.6% (n=9), IIIA 28.6 +/- 7.6% (n=35), IIIB 15.4 +/- 10.0% (n=13), IV 16.7 +/- 10.8% (n=12), respectively. The 5-year survival rate was as follows: male 42.8 +/- 5.3% (n=80), female 63.2 +/- 7.3% (n=35), respectively (p = 0.0147). In regard to the histological classification, the 5-year survival rate was as follows: adenocarcinoma 47.2 +/- 5.9% (n=69), squamous cell carcinoma 50.8 +/- 8.9% (n=32), respectively (p = 0.9012). As a rule of the disclosure on the internet website, we report our survival data by accompanying with minimum parameters such as, patient's background, pathological types, gender, pathological stages, and mean survival rate with standard error. When we compare the 5-year survival rate with other institutes, in considering of a risk adjustment, we would carefully have to estimate the determined survival rate with a standard error.

An assessment of the immunological status of patients with renal cell carcinoma based on the relative abundance of T-helper 1- and -2 cytokine-producing CD4+ cells in peripheral blood.

OBJECTIVE: To assess the immunological status of patients with renal cell carcinoma (RCC), by analysing the proportion of cluster-of-differentiation 4-positive (CD4+) cells showing intracellular cytokine production, i.e. interferon-gamma derived from T-helper (Th) 1 and interleukin-4 derived from Th2 cells, among peripheral blood lymphocytes from these patients Patients, subjects and methods Peripheral blood samples (5 mL) were collected from 36 patients (mean age 61 years, range 44-78) with RCC before and after they underwent nephrectomy. The proportion of cytokine-producing CD4+ cells was determined by flow cytometric analysis after stimulating the cells with phorbol 12-myristate 13-acetate, ionomycin and brefeldin A, and staining the cells with fluorescein isothiocyanate-labelled anti-interferon-gamma, anti-interleukin-4 and anti-immunoglubulin-2b antibodies. The results were expressed as the percentage of cytokine-producing cells in the CD4+ population. As a control, peripheral blood obtained from 35 healthy volunteers (mean age 34 years, range 22-49) was also analysed. RESULTS: The proportion of CD4+ cells producing interferon-gamma and interleukin-4 was significantly higher (P < 0.04 and P < 0.001, respectively) in patients with RCC than in controls. The Th1/Th2 ratio (i.e. the ratio of CD4+ cells producing each cytokine) was significantly lower in patients with RCC (P < 0.001). There was a significant correlation in the controls between interferon-gamma and interleukin-4 production (r = 0.489, P < 0.01) but not in patients with RCC. The proportion of CD4+ cells producing interleukin-4 was significantly higher and the Th1/Th2 ratio significantly lower in patients with high-stage than in those with low-stage RCC (P < 0.05). The percentage of CD4+ cells producing interleukin-4 was significantly less after nephrectomy in those with low-stage RCC (P < 0.01) and the Th1/Th2 ratio significantly greater (P < 0.05) than before nephrectomy; there was no such trend in patients with high-stage RCC. Conclusion An evaluation of the production of interferon-gamma and interleukin-4 in CD4+ peripheral blood lymphocytes is useful for assessing the immunological status of patients with RCC; there is a change in the predominant response from Th1 to Th2 with increasing stage of RCC.

Characterization of equine microsatellites and microsatellite-linked repetitive elements (eMLREs) by efficient cloning and genotyping methods.

We performed efficient cloning and genotyping methods for isolation of a large number of polymorphic microsatellites. The methods contain the time-efficient cloning method of constructing microsatellite-enriched libraries and the economic genotyping method of fluorescent labeling of PCR products. Eighty novel equine microsatellites cloned were efficiently isolated from the enrichment library and analyzed for genotype polymorphism. Of these, 72 microsatellites were analyzed with a good resolution. The average heterozygosity of all loci was 0.52, and the number of alleles ranged from one to 9 with an average of 4.5 alleles. The other eight loci showed multiple bands of PCR products, suggesting the occurrence of microsatellites in a repetitive element, in which the number of microsatellite repeats varies among different members of the repetitive element. We found five homologous groups at flanking regions in comparison with the flanking regions of microsatellites from DNA databases. One of them showed homology to equine repetitive element-2. In the other four homologous groups, the two groups were named equine microsatellite-linked repetitive element-1 (eMLRE-1) and equine microsatellite-linked repetitive element-2 (eMLRE-2) as novel equine repetitive elements identified from equine genome. These data should help the analysis of equine DNA sequences and the design of equine genome markers.

Elder acceptance of health monitoring devices in the home.

This study examined frail elders' acceptance of the concept of home monitoring devices. With the potential of such devices to ultimately assist many older persons, acceptance of the device in the individual's home is a critical component. Elders who view devices negatively--as unnecessary, unattractive, or intrusive--may be less likely to use the device if installed or less likely to allow them to be installed. For the participants in the current study, the results suggest strong acceptance of the concept of home health monitoring and the devices to make the system work. When questioned on device appearance a majority of the subjects felt that the devices would be acceptable in their homes, and initial reactions to the devices were primarily favorable. Equipment characteristics have been identified as one of the determining factors of perceived intrusiveness of home monitoring devices (Fisk, 1997). Study participants made several suggestions pertaining to device features and appearance. A common criticism related to device size, especially concerning the blood pressure cuff which was referred to as "gaudy" by one study participant. Participants offered suggestions such as making devices smaller, providing control for volume adjustment, and providing voice activation. At least one participant expressed a concern over device functioning in the event of distance traveling. Subjective comments such as "I think it would help many people," "It's very reasonable and important in several ways," and "...people would be more independent and safe," provided anecdotal support of device acceptance. Although a majority of the study participants had favorable responses to the devices and monitoring systems, many of their subjective comments reflected positive views regarding use by others as opposed to personal use. This finding may suggest that the participants did not personally identify with the need to use such devices but rather viewed the devices as relevant and acceptable for "the person who absolutely needs it." However, a majority of the participants identified "relieving personal worry" as a possible benefit of the home monitoring system which suggests personal identification with the potential benefits. The findings of study participants' willingness to pay, and a desire to maintain communications on a consistent basis with monitoring services, may demonstrate overall acceptance of the idea of home monitoring devices/services and establishes a need for continued research in product development. During the interviews, many of the subjects expressed enthusiasm and interest over the prospect of the home monitoring devices and systems with which they were relatively unfamiliar. This suggests a need for further consumer education regarding use of home monitoring devices and systems. Aside from the relatively small sample size, one limitation of this study relates to the study participants' understanding of the devices in relation to their current needs. The questionnaire results provided hypothetical acceptance of devices from a usefulness and aesthetic point of view. However, the findings may not totally reflect the study participants' actual willingness or desire to utilize the applicable devices in their homes. Further research is suggested in the area of assessment of potential consumer groups' perceptions of their current health status, functional limitations and needs, and more extensive research regarding perceptions of the potential benefits of using home monitoring devices. Further research in product development and clinical trials of existing home monitoring devices is also recommended.

Use of assistive devices to address hearing impairment by older persons with disabilities.

Hearing impairment impacts on the lives of almost half of people over the age of 65. For many people, a hearing aid or other assistive device can enhance communication. However, there is a high rate of dissatisfaction with hearing aids among those who currently use, or have used them in the past. This study of 227 elders with hearing impairment sought to gain a description of their multiple needs relative to demographics, health status physical status, and psychosocial status. Furthermore, we compared along the same dimensions the 227 elders with hearing impairment with 495 frail elders who reported no hearing impairment. We found that hearing-impaired elders are older, have poorer eyesight and have a high level of co-morbidity, especially with arthritis and heart and circulatory conditions. We also found a higher rate of depression among those with hearing impairment. Although hearing aid use increased as the impact of impairment on activity increased, three-quarters of those who reported that hearing impairment had a large impact on daily life did not use a hearing aid. A factor relating to hearing aid use was race; being Caucasian, and living alone. Study participants listed their reasons for dissatisfaction or non-use of their hearing aids and provided suggestions for hearing aid design.

Effects of social support and education on health care costs for patients with fibromyalgia.

OBJECTIVE: The rising costs of health care are of great concern, particularly for the chronically ill. Interventions that promote health status and well being while teaching appropriate use of the health care system have led to cost savings among patients with osteoarthritis. We carried out social support and education interventions with patients with fibromyalgia (FM) and assessed the effect on health care costs, psychosocial variables, and health status. METHODS: Participants were 600 patients with FM who were members of a health maintenance organization. They were randomly assigned to one of 2 experimental groups (social support; social support and education) or to a no-treatment control group. Assessments were conducted at baseline and following a one year intervention. Health care cost data were obtained directly from participants' medical records. RESULTS: Results indicated significant reductions in all groups' costs of prescriptions, laboratory tests, and visits to a nurse, nurse practitioner and/or physicians' assistant. All groups also showed improvements on variables assessing effect of FM, self-efficacy, depression, and knowledge of FM. The social support and education group was less helpless after one year than the other groups; differential changes for all other variables were not significant. CONCLUSION: The study did not reveal differential changes in health care costs among participants in the experimental and control groups. These findings emphasize the importance of using objective health care utilization data when calculating health care costs, as well as the value of including a no-treatment control group to prevent erroneous conclusions about treatment efficacy.

Survey of the allelic frequency of a NOS2A promoter microsatellite in human populations: assessment of the NOS2A gene and predisposition to infectious disease.

Allelic frequencies of a (CCTTT)(n) pentanucleotide repeat in the NOS2A promoter region were determined in a total of 1393 unrelated individuals from five specific population groups in four continents: Africa, Europe, Asia, and the Caribbean. There were highly significant differences in allele frequencies between the ethnically diverse populations. The repeat variation may have implications for the selective pressure of malaria or other infectious diseases that may operate at the NOS2 locus.

Effectiveness of assistive technology and environmental interventions in maintaining independence and reducing home care costs for the frail elderly. A randomized controlled trial.

CONTEXT: Home environmental interventions (EIs) and assistive technology (AT) devices have the potential to increase independence for community-based frail elderly persons, but their effectiveness has not been demonstrated. OBJECTIVE: To evaluate a system of AT-EI service provision designed to promote independence and reduce health care costs for physically frail elderly persons. DESIGN: Randomized controlled trial. SETTING AND PARTICIPANTS: A total of 104 home-based frail elderly persons living in western New York were assigned to 1 of 2 groups (52 treatment, 52 control). INTERVENTION: All participants underwent a comprehensive functional assessment and evaluation of their home environment. Participants in the treatment group received AT and EIs based on the results of the evaluation. The control group received "usual care services." MAIN OUTCOME MEASURES: Functional status as measured by the Functional Independence Measure (FIM) and the Craig Handicap Assessment and Reporting Technique; pain as measured by the Functional Status Instrument; and health care costs including the costs. RESULTS: After the 18-month intervention period, the treatment groups showed significant decline for FIM total score and FIM motor score, but there was significantly more decline for the control group. Functional Status Instrument pain scores increased significantly more for the control group. In a comparison of health care costs, the treatment group expended more than the control group for AT and EIs. The control group required significantly more expenditures for institutional care. There was no significant difference in total in-home personnel costs, although there was a large effect size. The control group had significantly greater expenditures for nurse visits and case manager visits. CONCLUSION: The frail elderly persons in this trial experienced functional decline over time. Results indicate rate of decline can be slowed, and institutional and certain in-home personnel costs reduced through a systematic approach to providing AT and EIs.

The effects of social support and education on health care costs after three years.

OBJECTIVE: To determine whether experimentally developed social support, education about appropriate use of the health care system, and their combination are effective in reducing health care costs for people with osteoarthritis at a 3-year followup assessment. METHOD: Three hundred sixty-three health maintenance organization members with osteoarthritis were randomly assigned to 1 of 3 intervention groups or to a control group. Two hundred fifty-six participants completed the 3-year assessment. Health status and health care use were assessed upon entering the study, and after 1, 2, and 3 years. RESULTS: Health care costs in the combined experimental groups were lower than those in the control group by $1,279/participant/year in year 3. There were no significant changes in health status between participants' entry into the study and the year 3 assessment. The 3 interventions had nearly equal effects on health status and health care costs. Implementation costs were least for the social support intervention, but the group that combined education and social support had less attrition and greater persistence. CONCLUSION: Interventions that target appropriate use of the health care system can be highly cost-effective without adversely affecting health status.

Assessment of left atrial operative mean stiffness using simultaneous recordings of left ventricular pressure and M-mode echocardiography of the left atrium and mitral valve.

Left atrial (LA) operative mean stiffness was measured using simultaneous recordings of the left ventricular (LV) pressure and M-mode echocardiography of the LA and mitral valve. The LA operative passive mean stiffness value was obtained during LV systole using LV pressure at the mitral valve opening and the pre-atrial contraction where the LV and LA pressure curves cross each other. Before the LA stiffness measurement, the LA volume calculated by biplane left atriography was compared with the dimension of the LA M-mode echocardiogram at three points (maximum volume, pre-atrial contraction and minimum volume) in another 23 patients (5 normal subjects, 4 patients with angina pectoris, 14 patients with myocardial infarction), and the regression equation was obtained by power fitting (y = ax3+ b). Using this equation, the LA volumes were calculated and used for the measurement of LA operative mean stiffness. Eleven normal subjects (C group), 14 patients with myocardial infarction (ejection fraction: EF > or = 55%; NF group), and 12 patients with myocardial infarction (EF < 55%; F group) were studied. The measured operative mean stiffness values based on the LA dimension and LV pressure [K(D)] were 0.69 +/- 0.40, 1.0 +/- 0.37, and 2.0 +/- 0.61 mmHg/mm, respectively (p < 0.01 in C vs F). The mean stiffness values calculated with LA volume [K(V)] were 0.48 +/- 0.23, 0.42 +/- 0.19, and 0.66 +/- 0.25 mmHg/ml, respectively (p < 0.05 in NF vs F). In F group, both the K(D) and K(V) values were high. The K(D) value can thus be used clinically as an easily obtained index of the LA operative mean stiffness. The high LA operative mean stiffness in F group appeared to be related to the increased LA pressure at the mitral valve opening. This method of measurement of the LA operative mean stiffness can be easily applied and used as a routine measurement providing additional information regarding left ventricular function.

Assessment of right ventricular contractile function in patients with left ventricular dysfunction by a simplified echocardiographic subtraction method.

A simplified version of the modified echocardiographic subtraction method for measuring right ventricular (RV) volume was used to assess the indices of RV contractile function, the end-systolic pressure-volume (RV Emax) ratio and the +dP/dt(max)-end-diastolic volume (EDV) relationship. RV volumes determined by the simplified subtraction method and the modified subtraction method were compared in 18 patients. Subsequently, RV contractile function was assessed in 13 patients with normal left ventricular (LV) function (control group: ejection fraction > 56%, as determined by left ventriculography), and 10 patients (group F; five with myocardial infarction, three with dilated cardiomyopathy, two with ischemic cardiomyopathy) with depressed LV function (ejection fraction < or = 55% by left ventriculography). During the application of lower body negative pressure of -20 mmHg, B-mode echocardiograms (apical four-chamber view) and RV or pulmonary artery pressure were recorded simultaneously. The regression equation between RV volumes obtained by the simplified subtraction method and the modified subtraction method was y = 0.99x + 4.5, and the correlation coefficient (r) was 0.985 (p < 0.001). The RV Emax of group F was not significantly less than that of the control group (0.40 +/- 0.16 vs 0.44 +/- 0.17 mmHg/ml, not significant). The correlation coefficients of RV Emax in each group were large (control group 0.92 +/- 0.09, group F 0.90 +/- 0.07). The +dP/dtmax-EDV ratio of group F was significantly less than that of the control group (2.05 +/- 0.74 vs 3.40 +/- 1.85 mmHg/ml.sec, p < 0.05). The correlation coefficient of the +dP/dtmax-EDV ratio was 0.91 +/- 0.06 in the control group and 0.85 +/- 0.15 in group F. The indices of RV contractile function could be assessed using the simplified subtraction method. RV function in patients with LV dysfunction appeared to be depressed.

Health care costs for volunteers and non-volunteers in an intervention for people with osteoarthritis.

OBJECTIVE: To determine whether older people who volunteered for a health intervention study used the health care system differently from a randomly selected group of eligible non-volunteers. METHODS: Three hundred sixty-three volunteers and 92 non-volunteers were compared; both groups were members of a large health maintenance organization (HMO). RESULTS: Volunteers were more educated and had been members of the HMO longer. Volunteers used the health care system significantly more at all time periods, but their cost per contact was significantly lower than that for non-volunteers. Non-volunteers were more likely to have a comorbid condition and had fewer arthritis-related health care contacts. CONCLUSIONS: There will always be problems in generalizing results of studies with volunteers, but volunteers are, nevertheless, the most appropriate controls if the experimental participants are also volunteers. Designs should ideally include both volunteer and non-volunteer controls.

Racial differences of frail elders in assistive technology.

This study compared differences in coping strategies, such as the use and ownership of assistive devices and home modifications, for 64 black and 441 white frail elders from the University at Buffalo Consumer Assessment Study. Controlling age, income, and education, there was no difference between black and white elders on health and functional status. Black elders on average own and use fewer assistive devices than white elders. There is no difference between the two groups in the number of home modifications, although black elders experience more home environmental problems than white elders. The majority of black elders rent their residence and thus lack the authority and ability to make the necessary adjustments to their home environmental problems. Predictor variables for assistive device use and environmental problems varied for black and white elders.

The use of phones by elders with disabilities: problems, interventions, costs.

Recognizing the important role the telephone plays in the life of frail elders, this study sought to gain a better understanding of the problems these elders encounter in using their phones to meet their needs. Starting with a sample of 354 frail elders, it was determined that 35, or just under 10%, were having some difficulty in the use of their phones. Twenty-two of these 35 subjects were randomly selected for an assessment of their impairments and phone setups in their homes. Interventions were provided to 19 of the 22 subjects, with two subjects refusing an intervention. At a 6-week follow-up call, all subjects were satisfied with the new phone or phone-related equipment. At a 6-month follow-up, 95% of subjects expressed satisfaction with the intervention. Phone usage increased by 50% for subjects provided a phone intervention. Average cost of equipment was $70.45; cost of personnel time was significantly higher. Recommendations are made for addressing the phone-related problems of frail elders.

Inter-rater agreement and stability of functional assessment in the community-based elderly.

The purpose was to examine the inter-rater agreement and test-retest stability of the Functional Independence Measure (FIM) and the Instrumental Activities of Daily Living Scale (IADL) from the Multidimensional Functional Assessment of Older Adults. These two instruments were administered to 20 older persons living in the community. Two experienced raters administered the assessment instruments over either a short (7-10 days) or long (4 to 6 week) interval. The intraclass correlation (ICC) was used to analyze the data. ICC values were computed for agreement between and within raters and across short and long intervals. ICC values for inter-rater agreement and stability ranged from 0.90 to 0.99. The relation between scores on the FIM and IADL scale was also examined. The analysis produced an r value of 0.85, suggesting a positive statistical relationship among the items assessed. The high ICC values indicate that the Functional Independence Measure Instrument and IADL scale of the Multidimensional Functional Assessment of Older Adults provide consistent information across two experienced raters and over time when used with a sample of elderly persons residing in the community.

The need for information on assistive devices by older persons.

Analyzing the results of the first 110 interviews from the Rehabilitation Engineering Research Center on Aging's Consumer Assessments Project, this study examined subjects' responses to the question, "Can you think of a device you would like to have that you haven't been able to find--a device that may not have yet been developed?" Each response was compared to the results of a Hyper-ABLEDATA search for similar existing products. When asked to propose a new device, 43 subjects (39% of the sample) responded with suggestions. In all instances, however, the respondents suggested devices that are already available. These findings indicate that subjects did not have up-to-date or complete information on the assistive devices that could improve their quality of life.

Toxicological index of paraquat: a new strategy for assessment of severity of paraquat poisoning in 128 patients.

A new assessment of the severity of paraquat poisoning in 128 patients has been developed. It involves toxicological index of paraquat and discriminant function score. This system not only allows a more accurate assessment of severity of the poisoning, but also provides a more reliable prediction of the outcome in an early stage for the purpose of forensic and clinical toxicology.