Measuring public knowledge, attitudes, and behaviors related to radon to inform cancer control activities and practices.

Radon exposure is the second leading risk factor for lung cancer among smokers and the leading risk factor among non-smokers. Radon concentrated in lower levels of homes/buildings can be reduced if found, thus lowering lung cancer risk. The objective of this study was to measure radon knowledge in diverse populations, with varying radon-related laws, to inform radon-related cancer control practices and activities. A survey was mailed to 3000 homebuyers who purchased single-family homes; 995 responses (33%) were received. Overall, 86% of respondents heard of radon-related health issues. Real estate agents (69%) or home inspectors (65%) were the most common sources of information. Respondents were more likely to test their home for radon if they reported previously hearing of radon-related health issues or understanding of how radon-related health issues affect the home-buying process. Respondents in states with notification policies were twice as likely as those without policies to have heard about radon-related health issues (OR 2.01, 95% CI: 1.27-3.17). This study provides useful information for cancer control activities including that education is positively associated with home testing for radon. It also suggests partnering with real estate agents to further radon education and testing efforts to reduce radon exposure and lung cancer risk.

A feasibility study of magnetic resonance pelvimetry in women of short stature to identify the risk of cephalo-pelvic disproportion.

OBJECTIVE: To conduct a feasibility study to assess if MR Pelvimetry can be undertaken in short stature primigravidae, with a view to a main study to answer the question 'can MR pelvimetry be used to predict cephalo-pelvic disproportion (CPD) in women of short stature?'. STUDY DESIGN: This was a prospective single arm feasibility study. In the first phase, patient and public involvement was undertaken to assess acceptability of the study. In the second phase, primiparous women of ≤ 160 cm in height were selected from antenatal clinics. Obstetricians and midwives were asked to inform all eligible women about the study. Patients were approached in the third trimester and written information about the study provided. If the patient agreed to participate, they were invited for consent. MR scans were performed from 36 weeks gestation. Patients and their obstetricians were not informed of the results of the MR until after delivery (in view of NICE and WHO recommendations on pelvimetry). RESULTS: MR scans were performed on 21/35 (60%) participants who consented. The study was conducted without adverse events and was acceptable to all participants. Data were available from 19 patients; 7 (37%) of whom had caesarean section (CS) due to CPD, 7 (37%) had assisted vaginal birth (AVB), while 5 (26%) had spontaneous vaginal births (SVD). Two patients who had an elective CS were not included in the analysis. The pelvic measurements especially anatomical conjugate (inlet), transverse diameter (mid cavity) and anteroposterior diameter at the outlet were larger in the SVD group in comparison to in-labour CS /AVB. Interobserver MR scan measurements were comparable between radiologists: intraclass correlation coefficient (ICC) range 0.68 to 0.95. CONCLUSION: This feasibility study suggests that conducting a full study to answer the research question 'can MR pelvimetry predict CPD in women of short stature?'would be feasible and acceptable to patients. The recruitment, MR scan protocol, reporting, reliability of measures were all assessed and found acceptable for a trial. A trend was observed for smaller pelvic measurements in women who needed intervention compared with those who had a natural birth/SVD. With evidence from a full trial, this could have major implications for the management of short stature women, in terms of clinical practice and safety. KEY MESSAGES: A large trial would be feasible and acceptable to assess whether MR pelvimetry can predict CPD in women of short stature. Despite the small number of patients, a trend was observed for smaller pelvic measurements in women who needed intervention compared to those who had spontaneous vaginal birth. Evidence from a large trial could help inform clinical practice, and provide information and choice for women at risk of CPD.

The impact of myosteatosis on outcomes following surgery for gastrointestinal malignancy: a meta-analysis.

INTRODUCTION: The aim of this review was to evaluate the impact of preoperative myosteatosis on long-term outcomes following surgery for gastrointestinal malignancy. METHODS: We conducted a systematic search of the electronic information sources, including PubMed MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL and AMED. Studies were included if they reported the impact of preoperatively defined myosteatosis, or a similar term, on long-term survival outcomes following surgery for gastrointestinal malignancy. A subgroup analysis was performed for those studies reporting outcomes for colorectal cancer patients only. FINDINGS: Thirty-nine full-text articles were reviewed for inclusion, with 19 being retained after the inclusion criteria were applied. The total number of included patients across all studies was 14,481. Patients with myosteatosis had significantly poorer overall survival, according to univariate (hazard ratio (HR) 1.82, 95% confidence interval (CI) 1.67-1.99) and multivariable (HR 1.66, 95% CI 1.49-1.86) analysis. This was also demonstrated for cancer-specific survival (univariate HR 1.62, 95% CI 1.18-2.22; multivariable HR 1.73, 95% CI 1.48-2.03) and recurrence-free survival (univariate HR 1.28, 95% CI 1.10-1.48; multivariable HR 1.38, 95% CI 1.07-1.77). CONCLUSIONS: This meta-analysis demonstrates that patients with preoperative myosteatosis have poorer long-term survival outcomes following surgery for gastrointestinal malignancy. Therefore, myosteatosis should be used for preoperative optimisation and as a prognostic tool before surgery. More standardised definitions of myosteatosis and further cohort studies of patients with non-colorectal malignancies are required.

Efficacy and complications of Angioseal in antegrade puncture.

AIM: Although arterial closure devices are in use for over a decade, there have been no specific study to assess the use of the same in antegrade puncture. MATERIAL AND METHOD: Consecutive patients undergoing antegrade puncture for peripheral vascular disease in a single centre performed by a single operator were included in this study. The notes and the angiograms were reviewed retrospectively for possible complications and the severity of disease. RESULT: Over a 25-month period, 21 patients with antegrade puncture had Angioseal deployed for haemostasis. Post-procedure complications recorded from the case notes showed one episode of haematoma formation and one case of worsening ischaemia. The severity of the disease at the puncture site did not influence the outcome. CONCLUSION: Use of Angioseal is safe and effective in antegrade punctures for peripheral vascular disease. The result is independent of the severity of disease at the puncture site.

Yield of imaging and scintigraphy assessing biochemical failure in prostate cancer patients.

A retrospective study was undertaken to determine the diagnostic yield of computed tomography (CT) and bone scan in patients with biochemical failure after definitive therapy for prostate cancer. The records of the Radiation Oncology Division were screened for patients presenting with prostate cancer between January 1, 1993, and December 31, 1996. Of 198 patients, 44 developed biochemical failure postoperatively (n = 24) or postradiotherapy (n = 20), and were not treated with hormones prior to restaging. Review was made of restaging studies performed at the time of biochemical failure. Postoperatively, 5% (1 of 20) of bone scans and 11% (2 of 18) of CT scans were positive. Postradiotherapy, 30% (6 of 20) of bone scans and 30% (3 of 10) of CT scans were positive. Our study showed that imaging studies are of low utility in the evaluation of patients with biochemical failure after definitive therapy of prostate cancer given that most patients begin hormonal therapy irrespective of the results of restaging studies. If salvage therapy is considered, imaging results may have a role in the decision-making process.

Gastrojejunostomy for management of acute proximal enteritis in a horse.

A 5-year-old Arabian stallion was treated medically 6 days for proximal enteritis. On the sixth day, exploratory celiotomy verified the diagnosis and ruled out other intraluminal and extraluminal gastrointestinal tract obstructions. A gastrojejunostomy was performed. The horse had trouble maintaining and gaining weight in the first year after surgery, but 8 years after surgery, the owner reported that the horse was doing well.

Sundown syndrome: etiology and management.

1. Although no clear definition of "sundowning" or "sundown syndrome" exists in the literature, most health care professionals affix either of these terms to the behavior observed in patients with dementia associated with increased agitation and confusion that occurs in the late afternoon. 2. Specific etiologic hypotheses that relate to sundowning behavior include disturbance in Rapid Eye Movement (REM) sleep, episodes of sleep apnea, and a deterioration of the suprachiasmatic nucleus of the hypothalamus. 3. Management of sundowning behavior includes the identification and treatment of any physiologic factors, low doses of specific neuroleptics, and nonpharmacological interventions such as restriction of daytime sleep, exposure to bright lights during the day, and mild activity schedules.

The role of the allied health professional in improving patient adherence.

Patient nonadherence to a prescribed treatment has received recent recognition as a significant problem in medical care and rehabilitation. Increasingly, many allied health professionals are being asked to function in the role of patient counselor to help patients initiate and maintain medication regimens, and make health-related lifestyle changes. A review of the literature indicates five major factors that significantly affect patient adherence: (1) patient education, (2) patient-health care provider rapport, (3) patient assertiveness, (4) the degree to which treatment regimen fits the patient's lifestyle and (5) the use of specific behavior change strategy. The allied health professional can work with all of these factors to improve patient adherence.

Dual engagement of 14-3-3 proteins controls signal relay from ASK2 to the ASK1 signalosome.

Faithful and efficient transmission of biological signals through mitogen-activated protein kinase (MAPK) pathways requires engagement of highly regulated cellular machinery in response to diverse environmental cues. Here, we report a novel mechanism controlling signal relay between two MAP3Ks, apoptosis signal-regulating kinase (ASK) 1 and ASK2. We show that ASK2 specifically interacts with 14-3-3 proteins through phosphorylated S964. Although a 14-3-3-binding defective mutant of ASK1 (S967A) has no effect on the ASK2/14-3-3 interaction, both overexpression of the analogous ASK2 (S964A) mutant and knockdown of ASK2 dramatically reduced the amount of ASK1 complexed with 14-3-3. These data suggest a dominant role of ASK2 in 14-3-3 control of ASK1 function. Indeed, ASK2 S964A-induced dissociation of 14-3-3 from ASK1 correlated with enhanced phosphorylation of ASK1 at T838 and increased c-Jun N-terminal kinase phosphorylation, the two biological readouts of ASK1 activation. Our results suggest a model in which upstream signals couple ASK2 S964 phosphorylation to the ASK1 signalosome through dual engagement of 14-3-3.

A comparison of a 'J' wire and a straight wire in successful antegrade cannulation of the superficial femoral artery.

AIMS: To evaluate the success of two different types of wire in common use in their ability to successfully cannulate the superficial femoral artery (SFA) using antegrade puncture. METHODS: 50 consecutive patients in whom antegrade infra-inguinal intervention was planned, underwent common femoral arterial puncture and then cannulation with either a standard 3mm 'J' wire or a floppy tipped straight wire (William Cook-Europe). The frequency with which each type of wire entered the SFA or profunda femoris artery without image guidance was recorded. Further analysis was also made of the success of manipulation of the wire into the SFA following profunda cannulation and the use of alternative guide wires. RESULTS: In 19 out of 25 (76%) patients the 'J' wire correctly entered the SFA without image guidance. Only 5 out of 25 (25%) of straight wires entered the SFA with the initial pass (p < 0.0001). Following further manipulation with the same wire all except 1 'J' wire was successfully negotiated into the SFA. The same was true for only 9 of the remaining straight wires with 11 patients requiring an alternative guide wire. CONCLUSIONS: When performing antegrade cannulation of the SFA a 'J' wire is more likely to be successful than a straight guide wire.

Ischemic myocardial injury in cultured heart cells: preliminary observations on morphology and beating activity.

An in vitro model of myocardial ischemia has been established with primary monolayer cultures of neonatal rat heart cells. Ischemic conditions were simulated in vitro by subjecting the heart cell cultures to various levels of oxygen and glucose deprivation. After the ischemic treatments, cultures of beating muscle (M) cells were evaluated for functional and morphological changes. The experimental protocol consisted of treatment with 20% or 0% O2 and 1000, 500 or 0 mg glucose per 1 of medium for 4, 12 or 24 hr. Control cultures were treated with 20% O2 and 1000 mg glucose. The morphological alterations induced by the deficiency of O2 and glucose in the medium were the formation of pseudopodia and cytoplasmic vacuoles; increased cytoplasmic granulation; and the formation of abnormal cell shapes, such as long, spindly shaped M cells. There was a time-dependent decrease in beating activity as the M cells were exposed to longer durations of ischemic conditions. However, if the cultures were replenished with complete medium (1000 mg glucose) and 20% O2, the cells regained their ability to beat.

Ischemic myocardial injury in cultured heart cells: leakage of cytoplasmic enzymes from injured cells.

An in vitro model of myocardial ischemia has been established with primary monolayer cultures of postnatal rat myocardial cells. Ischemic conditions were simulated in vitro by subjecting the myocardial cell cultures to various levels of oxygen and glucose deprivation. The experimental protocol consisted of treatment with 20% or 0% O2 and 1000, 500 or 0 mg glucose per 1 of medium for 4 or 24 hr. Control cultures were treated with 20% O2 and 1000 mg glucose. After the ischemic treatments, cultures of beating muscle (M) cells were evaluated for signs of injury, i.e. leakage of cytoplasmic enzymes into the culture medium. Differences were found in leakage of lactate dehydrogenase (LDH) and creatine phosphokinase (CPK) from the cultures that were exposed to partial ischemia of glucose deprivation and from those cultures that were exposed to total ischemia of oxygen and glucose deprivation. Glucose deprivation along resulted in a slight-to-moderate loss of LDH and CPK from the cells, whereas total ischemia resulted in a significant release of the two cytoplasmic enzymes. When the cultures were allowed to recover after ischemic treatment in complete medium (1000 mg glucose) and a normal atmosphere of 20% O2, they had levels of LDH leakage comparable to those of control cultures. Cell viability and total protein content of the ischemic cultures did not differ significantly from controls.

Marrow MR signal abnormality associated with bilateral avulsive cortical irregularities in a gymnast.

Abnormal marrow signal and marrow enhancement have not been described in association with benign avulsive cortical irregularity. We present the case of an 11-year-old gymnast with such findings that partially resolved over time. The marrow MR abnormalities are believed to represent an extension or spectrum of findings associated with avulsive cortical irregularity, and should not instantly suggest infection or malignancy, as has been previously indicated. Careful and close clinical and radiological follow-up is required to confirm its benign course.

Issues in information malpractice.

In today's information explosion environment, the health sciences librarian is increasingly placed in the role of interpreting, translating, and evaluating information for clientele. With this emerging role and the burgeoning of fee for service programs, the question of information malpractice liability becomes an increasingly important issue. This paper explores the basis for legal actions against librarians and offers some precautionary measures to help protect against such legal action.

Frequency of coexistent disease at CT in patients with prostate carcinoma selected for definitive radiation therapy: is limited treatment-planning CT adequate?

PURPOSE: To document the frequency of clinically important coexistent disease depicted at contrast material-enhanced abdominal and pelvic computed tomography (CT) in patients undergoing definitive radiation therapy for prostate carcinoma, as such lesions might be missed at limited nonenhanced treatment-planning CT. MATERIALS AND METHODS: Of 133 consecutive patients with prostate carcinoma who were referred to the radiation oncology division between January 1, 1994, and December 31, 1996, 77 underwent definitive radiation therapy that required either contrast-enhanced abdominal and pelvic CT (n = 67) or contrast-enhanced pelvic CT (n = 10). Results of these studies were reviewed and retrospectively categorized. RESULTS: Forty-eight (62%) of the 77 patients had either negative studies or minor abnormalities that did not require further follow-up. Only two patients (3%) had major abnormalities that required intervention. Five patients (6%) had new findings of clinically important coexistent disease, but no intervention was required. CONCLUSION: The incidence of clinically important coexistent disease in patients with prostate carcinoma who are referred for definitive radiation therapy is low. Therefore, contrast-enhanced abdominal and pelvic CT in addition to treatment-planning CT is of limited value.

Reduction of cell injury in hypoxic cultures of rat myocardial cells by methylprednisolone.

An in vitro model to study myocardial cell injury was developed with primary monolayer cultures of rat myocardial cells. Two important conditions associated with myocardial ischemia were simulated by depriving the cultures of oxygen and glucose for a specified period of time. Cellular injury caused by hypoxia and glucose deprivation resulted in significant leakage of lactate dehydrogenase (LDH) from the cells into the culture medium. The cells were not lethally injured by treatments as reflected by a lack of change in cell viability and protein content when compared to controls. Pretreatment of cultures with methylprednisolone for 24 hr provided protection to the cells when challenged by hypoxia and glucose deprivation. Methylprednisolone exhibited a dose-response effect in reducing LDH leakage in cultures, which were subsequently deprived of oxygen and glucose for 4 hr. Similar pretreatment with hydrocortisone had no effect in limiting cellular injury in hypoxic and glucose-deprived cultures.