Management of Continuous Glucose Monitors in Radiation Oncology Patients.

Continuous glucose monitors (CGMs) are an increasingly prevalent electronic medical device utilized by patients with diabetes, offering several advantages over "finger sticks". There is a resulting rise in patients with CGMs seen in radiation oncology clinics. Manufacturers specify that CGMs should not be exposed to radiation (both diagnostic and therapeutic), due to risk of device damage, creating challenges for patients and providers. We present a workflow for management of CGMs in radiation oncology patients, beginning with systematic screening by providers and staff. We propose options for CGM management together with the device prescriber, including removal of the CGM or keeping it in place with periodic finger sticks to confirm accuracy, and offer guidance to radiation oncology providers and staff.

Body fat distribution with long-term dietary restriction in adult male rhesus macaques.

Dietary restriction (DR) is the only intervention that has been shown to increase average and median life span in laboratory rodents. The effect of long-term, moderate DR on body composition and fat distribution was evaluated in male rhesus monkeys. Thirty animals (8-14 years of age)fed either 30% less than baseline intake (R, n = 15) or allowed to eat to satiety (C, n = 15), have been assessed semiannually using somatometrics and dual-energy alpha-ray absorptiometry (DXA)for 7.5 years. R subjects have reduced body weight (p <.0001), total body fat (p < .0001), and percentage body fat located in the abdominal region (p < .05). In addition, there has been a sustained reduction in plasma leptin concentrations (p <.001). These findings suggest reduced risk for common morbidities, such as insulin resistance, dyslipidemia, and type 2 diabetes mellitus, that are associated with advancing age and increased levels of bodyfat, especially in the visceral depot.

Can general surgeons perform colonoscopy safely?

The purpose of the current study was to review the safety of colonoscopy performed by nonfellowship-trained general surgeons. To address this issue, we reviewed more than 1,000 consecutive diagnostic and therapeutic colonoscopies and recorded the complications. This was a multi-institutional study involving seven general surgeons, none of whom had had formal fellowship endoscopic training. Perforation was confirmed by laparotomy, bleeding was defined as that requiring hospitalization and/or transfusion, and cardiopulmonary arrest was self-explanatory. There was one perforation in the diagnostic group and none in the therapeutic group, for a rate of 0.10% overall and 0.12% in diagnostic colonoscopy. There were no instances of bleeding or cardiac arrest. This complication rate of 1 per 1,025 colonoscopic procedures by general surgeons compares favorably with that previously reported by other specialties (p less than 0.001). We conclude that postgraduate endoscopy fellowship is not necessary for general surgeons to become safe colonoscopists.

Quantitative measures of disease in broiler breeder chicks of different major histocompatibility complex genotypes after challenge with infectious bursal disease virus.

Criteria for evaluating genetic differences in resistance and susceptibility to infectious bursal disease (IBD) within a commercial broiler breeder line of chickens were compared. Line A broiler breeder chickens were challenged with graded doses of Animal and Plant Health Inspection Service (APHIS) strain IBD virus (IBDV) and evaluated at 2 time points, 3 days postinoculation (PI) and 10 days PI. Measures obtained at both time points included bursa to body weight, bursa histology, bursa lymphocyte count, and percentage of T cells in the bursa. Furthermore, viral load in the bursa was determined 3 days PI and anti-IBDV antibody titers, 10 days PI. A dose of 50 50% embryo infective dose caused IBD in about half the line A birds at the 10-day time point, and this dose was chosen for further studies. The data were analyzed for correlation among the various measures. Comparison of the 3-day- and 10-day-PI bursa lymphocyte counts indicated that birds challenged with low doses of virus suffered lymphocyte depletion at the 3-day time point, but many or all (depending on the dose) recovered by the 10-day time point. With a viral dose that caused bursal atrophy in about half the birds by 10 days PI, families segregating for 2 major histocompatibility complex (MHC) haplotypes were compared in terms of resistance to IBD. Results indicated that there was no difference among the 3 MHC genotypes in incidence of IBD by any of the disease measures.

[Biloma]. / Biloma.

The Term "Biloma" describes an extraductular collection of bile within a defined capsular space secondary to traumatic, iatrogenic or spontaneous injury of the biliary tree, of medical, surgical or mixed treatment.

Hispanic preferences for health care providers and health care information.

In a 1994 telephone survey, only 13% of 522 adult Hispanic respondents in the Southwest used media as the main source of information for physicians, while 19% used media for information regarding health services. Family and friends were main sources. About 75% of the respondents had a family physician with the mother (68%) making health care decisions for the family. A large majority of respondents said that neither the physician's sex, nor race were factors in choosing physicians.

Flow cytometric immunofluorescence and DNA analysis: using a 1.5 mW helium-neon laser (544 nm).

We evaluate a 1.5 mW HeNe laser (544 nm) for use on an EPICS Elite with a 76 microns Sortsense flow cell. The two applications chosen were immunofluorescence and DNA analysis. We measured the fluorescence threshhold of phycoerytherin calibration beads to be approximately 336 MESF. Cell analysis with a HeNe laser and Argon laser correlated well for the CD4PE, CD56PE, CD19PE conjugates, with correlation coefficients of 0.98, 0.99, 0.94, respectively. The % positive and mean channel fluorescence were comparable to the results obtained with a 15 mW Argon laser. In addition, a three-color configuration yielded excellent results. Cell analysis of CD4PE, CD3ECD and CD19Cy-Chrome with the HeNe laser and Argon laser correlated well with correlation coefficients of 0.96, 0.95, and 0.92, respectively. The histograms showed good separation between the negative cells, the dimly staining cells and the brightly staining cells. Propidium Iodide was chosen for DNA analysis. Full CV values for whole blood DNA fluorescence using the green laser were good at 2.6%. These data indicate the low power 544 nm laser is sufficient to do immunophenotyping and DNA analysis. Results may be explained by higher quantum efficiency and lower background fluorescence. The wavelength of the 544 nm laser is much closer to the excitation peaks of PI, PE, and the tandem dyes ECD and Cy-Chrome. Also, the Raman scattering of water for the 544 nm laser has a longer wavelength maximum than the emission peaks of PI, PE, and ECD. The major advantages of this laser for the research laboratory are small size, no cooling fan, low power requirements and low cost.

Low recall of local television health care news segment topics, sponsors and program names.

In an effort to examine the effectiveness of hospitals' sponsoring of local broadcast news health care segments, viewer recall of information presented in news reports, the program name of the reports, and the names of the hospital sponsors of those reports were analyzed. Despite the fact that telephone survey respondents said they place a higher value on televised health care information than they do for other mass media, recall was found to be generally poor. A majority of respondents could not name the topic of the televised health news report they had viewed, the program name or the program sponsor.

A comparison of dual-energy X-ray absorptiometry and somatometrics for determining body fat in rhesus macaques.

OBJECTIVE: Various approaches have been used to assess fat and fat distribution in nonhuman primates, including measurements of body weight, body dimensions, and estimates derived from these, such as body mass index. Methods such as tritiated water dilution and dual-energy X-ray absorptiometry (DXA) have also been used. The aim of the present study was to evaluate and compare DXA measurements and somatometrics. RESEARCH METHODS AND PROCEDURES: Body composition of 15 adult male rhesus macaques was measured by DXA and somatometrics at four time-points over a 4-year period. Additionally, DXA precision and somatometric variability were analyzed by repeated measurements of the same subjects. RESULTS: DXA estimates of body fat were positively correlated with body weight, body mass index, body circumferences, and abdominal skinfold thicknesses. DXA assessments of soft tissue composition were precise, with coefficients of variation below 3.3% for all compartments analyzed. The majority of the observed variability in somatometrics was explained by subject variance, rather than by inter- or intraobserver variability, or by observer experience level. DISCUSSION: We conclude that noninvasive DXA technology provides precise estimates of nonhuman primate body composition that correlate well with the traditional somatometric measures used in primate studies.

Age and sex differences in body size and composition during rhesus monkey adulthood.

Body size and composition were measured in forty-one adult Rhesus monkeys (Macaca mulatta) in order to characterize changes that occur during later life for both genders. Data were obtained by traditional somatometric techniques and by dual-energy X-ray absorptiometry. Representative monkeys were chosen within six categories defined by age (Young Adult, 6-9 year-old; Middle Aged, 15-19 year-old; Older Adult, 26-30 year-old), and sex. Body weight and most external measures of body size were greater during middle age and later life than in young adulthood, as were body fat content and lean body mass. Females tended to have a higher percentage body fat than males in all age categories. Lean tissue mass was markedly greater in the two younger groups for both sexes, compared to older adults. Bone mineral content and density were higher in the males than the females, but differences in bone mineralization among age groups did not achieve statistical significance. Such data derived from adult nonhuman primates are useful for defining fundamental biological changes with age in these species, and have value as a comparative model for studies of human aging and age-related morbidity.

A whole blood alternative to traditional methods for CD4+ T lymphocyte determination.

Flow cytometry, the method of choice for determining subset cell populations, requires sophisticated instrumentation and highly trained operators. An alternative method for subpopulation determinations is presented that is fast, simple, and readily interpreted for absolute subset counts. This method uses antibody labeled microspheres added to whole blood and after lysing, read on a hemocytometer using an ordinary light microscope. The total time of testing is less than 10 min with results comparable to that obtained using a flow cytometer and a hematology analyzer to calculate absolute subpopulation values. This method is demonstrated for CD4+ lymphocytes which have considerable value in following HIV-infected individuals.

Lymphocyte subset determination using a hematology analyzer.

Anti-CD4 antibody (T4)-coated microspheres were used to label CD4 cells in whole blood. The mixture was lysed and analyzed by a modified Coulter VCS hematology analyzer, which differentiated microsphere-labeled cells by a change in Coulter volume, conductance, and light scatter. %CD3+/CD4+ fluorescent values from a profile were compared to %CD4 values using the VCS-microsphere method. CD3 gating was used to exclude CD4+ monocytes from the 90LS-FALS lymphocyte gate. The results correlated well (R = 0.996). The percentage of CD4+ lymphocytes from profile scatterplots and VCS scatterplots showed a line of regression close to the equivalence line (n = 76, slope = 0.96) when CD3 gating was used for the profile. These results suggest that CD3 gating, though necessary for 90LS-FALS scatterplots, may not be necessary for volume-conductance-light scatterplots.

Discriminant value of thyroid function tests.

Different thyroid function tests permitted a final classification of 204 consecutive patients with suspected thyroid disorders into three populations (thyrotoxic, euthyroid, and hypothyroid). Linear discriminant analysis was applied to all test results (10 variates) on adjacent population pairs. Two invitro tests (serum protein bound iodine (P.B.I.) and tri-iodothyronine (T-3) uptake values) gave good separation of thyrotoxic from euthyroid patients and fairly good distinction of hypothyroid patients. If a (131)I uptake figure was then added to the in-vitro results most patients (95.5%), including thse initially classified as equivocal, were correctly diagnosed. Other tests, including clinical questionnaires, were poor discriminants.Two new techniques of utilizing the test data were devised. Firstly, the data from the two in-vitro tests were also displayed graphically, and oblique boundary lines derived from the discriminant functions gave better separation of patients than previously used limits or mathematical expressions of "free thyroxine." Secondly, a nomogram incorporating the best four discriminants was designed as a diagnostic aid and proved to be the best means of interpreting the tests.Discriminant analysis of this kind can be used in the interpretation of diagnostic tests in any branch of medicine, and it allows the best use to be made of the available data.

Hemodynamics and prostacyclin release in the early phases of aortic surgery: comparison of transabdominal and retroperitoneal approaches.

Although the retroperitoneal aortic approach (RP) is advocated to reduce myocardial ischemia and cardiac-related death, inadequate physiologic data exist to support this contention. As the aorta is exposed via the transabdominal approach (TA) we noted some patients have manifested reduced systemic vascular resistance (SVR) associated with tachycardia, reduced blood pressure, and facial flushing. To determine whether RP offered physiologic advantages over TA we compared cardiac dynamics and blood levels of 6-keto-prostaglandin F1 alpha (6-keto-PGF1 alpha), the stable metabolite of prostacyclin, during exposure of the aorta in 52 patients (33 with TA and 19 with RP), comparable in age, cardiac history, medications, and body surface area. Serial measurements of mean arterial pressure, heart rate, wedge pressure, pulmonary artery pressure, cardiac index, and 6-keto-PGF1 alpha were obtained. Results revealed decreased mean arterial pressure and systemic vascular resistance, increased cardiac index and heart rate, and facial flush occurring 10 minutes after the bowel was explored in TA. This was not observed in RP. These hemodynamic alterations correlated in time and magnitude with a fourteen fold increase in 6-keto-PGF1 alpha. These changes in cardiac indexes can produce increased myocardial oxygen consumption with the risk for myocardial ischemia, particularly in patients with coronary artery disease. The absence of this response to bowel exploration in RP may account for some of the observed advantages in "high-risk" aortic reconstruction.

Ibuprofen pretreatment inhibits prostacyclin release during abdominal exploration in aortic surgery.

Mesenteric traction during aortic surgery produces facial flushing, reduced mean arterial pressure (MAP), and systemic vascular resistance (SVR) with increased heart rate (HR) and cardiac index (CI). Elevated 6-keto-prostaglandin-F1 alpha (6-keto-PGF1 alpha) suggests prostacyclin is the mediator. To test this hypothesis, the cyclooxygenase inhibitor, ibuprofen (n = 14), or placebo (n = 13) was administered to patients electively scheduled for aortic reconstruction. The hemodynamic measurements and plasma concentrations of prostanoids between groups were compared immediately before (0), and 5, 10, 15, 30, and 45 min following mesenteric traction. Following mesenteric traction significant differences (P less than 0.05) were observed between the ibuprofen pretreatment and placebo group over time in SVR, MAP, HR, CI, 6-keto-PGF1 alpha, and thromboxane B2 (TXB2). Significant differences between groups at individual times were found in SVR, HR, CI, 6-keto-PGF1 alpha, and TXB2. In the placebo group flushing was accompanied by reduced SVR and MAP and increased HR and CI. The greatest effect was seen at 10 min and resolved over 30 min. Plasma concentration of 6-keto-PGF1 alpha increased from 159 +/- 103 (mean +/- SEM) pg/ml to a peak value of 3,765 +/- 803 at 10 min. A late increase in TXB2 occurred with a peak value of 1,970 +/- 891 (mean +/- SEM) pg/ml at 30 min. In the ibuprofen pretreated group no significant changes occurred in hemodynamic measurements or concentrations of prostanoids. The inhibition of 6-keto-PGF1 alpha and its associated hemodynamic changes in the treatment group, but not in the placebo group, confirms the hypothesis that prostacyclin is the mediator of the mesenteric traction response in abdominal aortic surgery.