Do food and stress biomarkers work for wastewater-based epidemiology? A critical evaluation.

Dietary characteristics and oxidative stress are closely linked to the wellbeing of individuals. In recent years, various urinary biomarkers of food and oxidative stress have been proposed for use in wastewater-based epidemiology (WBE), in efforts to objectively monitor the food consumed and the oxidative stress experienced by individuals in a wastewater catchment. However, it is not clear whether such biomarkers are suitable for wastewater-based epidemiology. This study presents a suite of 30 urinary food and oxidative stress biomarkers and evaluates their applicability for WBE studies. This includes 22 biomarkers which were not previously considered for WBE studies. Daily per capita loads of biomarkers were measured from 57 wastewater influent samples from nine Australian catchments. Stability of biomarkers were assessed using laboratory scale sewer reactors. Biomarkers of consumption of vitamin B2, vitamin B3 and fibre, as well as a component of citrus had per capita loads in line with reported literature values despite susceptibility of degradation in sewer reactors. Consumption biomarkers of red meat, fish, fruit, other vitamins and biomarkers of stress had per capita values inconsistent with literature findings, and/or degraded rapidly in sewer reactors, indicating that they are unsuitable for use as WBE biomarkers in the traditional quantitative sense. This study serves to communicate the suitability of food and oxidative stress biomarkers for future WBE research.

A Phase II trial of 8 weeks of degarelix for prostate volume reduction: Efficacy and hormonal recovery.

PURPOSE: The purpose of this study was to determine the efficacy of 8 weeks of degarelix for prostate downsizing before interstitial brachytherapy. We also report associated toxicity and the time course of endocrine recovery over the following 12 months. METHODS AND MATERIALS: Fifty patients were accrued to an open-label Phase II clinical trial (www.clinicaltrials.gov ID NCT01446991). Baseline prostate transrectal ultrasound (TRUS) was performed on all patients followed by degarelix administration and a repeat TRUS at Week 8. Brachytherapy was performed within 4 weeks of the 8-week TRUS for all patients who achieved suitable downsizing. RESULTS: The median prostate volume was reduced from 65.0 cc (interquartile range [IQR]: 55.2-80.0 cc) to 48.2 cc at 8 weeks (IQR: 41.2-59.3 cc), representing a median decrease of 26.2% (IQR: 21-31%). Functional recovery of testosterone within an age-adjusted normal range occurred at a median of 34.1 weeks (IQR: 28.2-44.5 weeks) from the date of the final injection. Despite this recovery, follicle-stimulating hormone and luteinizing hormone levels remained abnormally elevated throughout 12 months. Quality-of-life implications are discussed. CONCLUSIONS: Degarelix is effective for prostate downsizing before prostate brachytherapy with a median volume decrease of 26.2% by 8 weeks. Despite the short course of treatment and eventual testosterone recovery, follicle-stimulating hormone and luteinizing hormone remain elevated beyond 12 months. Further investigation with randomized comparisons to other hormonal agents is warranted.

Identification and quantitation of microparticles in solid materials.

Variation in the precise conditions of geological formation may produce variations in the exact composition of asbestos minerals of a particular class, and thus in their biological interactions. Examples are given of differences in O(18)/O(16) ratios, TiO(2) content, lattice substitutions, substitution of Al (III) for Si (IV) and attachments to spare hydrostatic charges.

Oculoplethysmography/carotid phonoangiography: its value as a screening test in patients with suspected carotid artery stenosis.

A review of 291 carotid arteries that were subjected to both oculoplethysmography/carotid phonoangiography (OPG/CPA) and arteriography showed that although 84% of the vessels that were narrowed less than 40% were properly categorized by the noninvasive test, there was poor grading ability for lesions 40% or greater, and an unacceptably high (40%) false-negative rate for marked carotid stenoses. This has been confirmed by others. Analysis of a 15-item questionnaire that was returned by 12 clinicians showed an unwarranted reliance on the OPG/CPA as a screening test in those patients without transient ischemic attacks. A large majority of responding physicians favored endarterectomy in asymptomatic patients with lesions greater than 70%, and the use of OPG/CPA prevented a substantial number of affected individuals from undergoing angiography and subsequent corrective surgery.

Comparison of reactive hyperemia and treadmill tests in the evaluation of peripheral vascular disease.

The systolic ankle pressure response to thigh cuff occlusion (reactive hyperemia test) was compared with a similar measurement after treadmill exercise in 48 limbs of 24 normal volunteers. The reactive hyperemia test was then performed on 26 legs in 16 patients with clinical evidence of arterial disease of the leg and abnormal treadmill tests (mean decrease 39 +/- 24 percent). No decrease in pressure occurred in normal subjects after exercise. All control subjects demonstrated a decrease in pressure after thigh cuff occlusion (34 +/- 7.9 percent). The percent pressure decrease during reactive hyperemia in the abnormal group was significantly lower (49.7 +/- 19 percent; p less than 0.001). There was a high correlation between the percent decrease in pressure during reactive hyperemia and the decrease after exercise in the claudicants (r = 0.69; p less than 0.001). However, the percent pressure decrease in 13 of the 26 abnormal patients fell within 2 standard deviations of the reactive hyperemia control group mean. The range of the pressure decreases in these 13 patients, 16 to 48 percent, was shared by 47 of the 48 normal subjects. The findings in this study are inconsistent with those in previously published reports and suggest that reactive hyperemia testing cannot be used interchangeably with the treadmill exercise test.

A quantitative method for the evaluation of spectral analysis patterns in carotid artery stenosis.

Duplex scanning in conjunction with Fast Fourier Transform Spectral Analysis offers a means of identifying stenotic internal carotid arteries, but few quantitative algorithms for interpretation of the spectral analysis patterns have been described. We first developed two objective parameters for analyzing carotid artery spectral analysis patterns which included a total of three peak frequencies in diastole and a ratio of spectral pattern areas between the internal and common carotid vessels. We then devised a formula for interpretation of the test results based on a computerized, best-fit, step-wise, discriminate analysis performed on 196 angiographically studied carotid vessels. This formula was then prospectively applied to 154 other carotid arteries with independently interpreted angiograms. 103/109 (94%) of the carotid arteries with less than 50% angiographic stenosis were correctly identified as were 40/50 (89%) of the vessels with 50% or more narrowing. Combining these groups with 16/17 (94%) properly classified total occlusions resulted in an overall accuracy rate of 93%. Application of the formula to smaller subgroups also showed significant differences in the formula means as they related to the degree of angiographic stenosis. Duplex scanning in conjunction with spectral analysis offers a reliable screening test for the evaluation of patients with suspected carotid artery stenosis.

A review of morbidity and mortality in elderly patients undergoing pulmonary resection.

The morbidity and 30-day operative mortality were reviewed in the 43 patients 70 years of age or older who underwent pulmonary resection between June 1976 and May 1981. In addition to their surgical illness, many of these patients had pre-existing medical conditions including: coronary artery disease (8), hypertension (14), diabetes (4), and congestive heart failure (5). The mean preoperative 1 second forced expiratory volume (FEV1) was 1.7 liters and 17 patients had an FEV1 of less than 1.5 liters. The operative mortality was 2.3% (one patient), the average duration of postoperative hospital confinement was 9 days, and 39 of 42 (93%) of the patients were discharged within 2 weeks of their operation. There were 38 postoperative complications in 25 of the 42 survivors, most of which were minor and all of which were resolved. Problems included: air leak (13), atrial fibrillation or flutter (3), myocardial infarction (1), respiratory difficulties (9), hemorrhage (2), mental confusion (3), hyperpyrexia (3), difficult-to-manage diabetes (1), and social problems (3). Only two patients required prolonged mechanical ventilation. The low operative mortality, the short postoperative stay, and the minimal number of serious complications is contrasted with other published reports describing a high-operative mortality in elderly patients. The improvement may be related to recent advances in postoperative management and anesthetic techniques. These data suggest that advanced age is not a contraindication to curative pulmonary resection.

Unusual presentations of abdominal aortic aneurysms.

A review of the records of 100 consecutive patients undergoing surgical repair of abdominal aortic aneurysms disclosed two individuals who presented in a fashion sufficiently rare as to warrant detailed discussion. The first had concomitant rupture and thrombosis manifested by lower extremity paraplegia and anesthesia, and the second had documented DIC in conjunction with a stable aneurysm. The latter completely resolved with heparin and subsequent surgical repair. Each of these presentations has had documentation in the surgical literature in less than five instances, and both case histories are given, followed by a review of the literature and theories as to the underlying pathophysiology.

An algorithm for the surgical management of chronic abdominal aortic occlusion and occluded aortofemoral grafts.

An algorithm for the surgical management of chronic abdominal aortic occlusion is presented based upon experience of treating 60 consecutive patients. Of 33 patients with juxtarenal aortic occlusion, 17 underwent aortofemoral bypass (AFB), 10 descending thoracic aortofemoral (DTAF), 5 axillofemoral (AxF) bypass, and 1 ascending thoracic aortofemoral bypass. Of 11 patients with mid or distal aortic occlusion, 8 underwent AFB, 2 DTAF and 1 AxF. Of 16 patients with aortic graft occlusion, 1 underwent AFB, 10 DTAF and 5 AxF. Acceptable risk patients were selected for AFB (26). DTAF (22) was frequently preferred for patients with occluded aortic grafts or other hazardous intraabdominal pathology. AxF (11) was used for patients with severe cardiopulmonary risk, limited life expectancy from malignancy, or when emergency procedures were required for salvage of severely ischemic limbs in debilitated patients with chronic aortic occlusion. In the AFB, DTAF and AxF groups the perioperative mortality was 8%, 5% and 36% respectively, the late mortality was 15%, 36% and 45%, and the 5-year primary cumulative graft patency was 92%, 89% and 15%.

Long term follow-up of descending thoracic aorto-iliac/femoral bypass.

A prospective study of 26 patients undergoing descending thoracic aorto-iliac/femoral (DTAI/F) bypass was conducted over a 13-year period with an average follow up of 53 months. Reasons for selecting the procedure were occluded aortic bifurcation grafts (9 patients), hostile abdomen (6), infected aortic graft (1), microaorta (10, and surgeons preference in 8 patients who had juxtarenal aortic occlusion. The operative mortality was 3.8% (1 patient). A late mortality of 36% was due to myocardial infarction (1), lung carcinoma (2), renal failure (4), stroke (1) and pulmonary insufficiency (1). Graft failure occurred in 4 patients at 23, 26, 54 and 109 months respectively. Primary cumulative patency was 86% statistically valid at 42 months. DTAI/F bypass is recommended in selected patients when conventional approaches to the aorta are considered unduly hazardous.

Descending thoracic aortobifemoral bypass for occluded abdominal aorta: retroperitoneal route without an abdominal incision.

Severe juxtarenal aortic disease and occluded aortic bifurcation grafts have prompted surgeons to seek alternative routes when reoperating. We have modified the descending thoracic aortobifemoral bypass procedure by drawing the graft through a retroperitoneal tunnel to the left groin, thereby eliminating the need for an abdominal incision. The lower thoracic area is exposed through a left anterolateral thoracotomy incision and each common femoral artery is exposed by vertical incisions in the groins. The right limb is drawn through a retrorectus tunnel to the right groin for the final anastomosis. Experience with this technique in 12 patients has demonstrated less risk of atheroemboli, less blood loss, shorter operating time, and a more rapid postoperative recovery, than is the case in reentering the abdomen for a secondary aortic procedure.

Objective criteria for the interpretation of carotid artery spectral analysis patterns.

The duplex scanner (imager + pulsed Doppler) in combination with a fast Fourier transform spectrum analyzer has been used to identify areas of arterial narrowing. To evaluate its effectiveness in the detection of clinically significant carotid stenosis, 1 previously described and 2 original objective parameters were applied to the real time sound frequency tracings from 157 carotid arteries that also had angiograms available to determine the presence and degree of stenotic involvement. There was a statistically significant difference between the means of the test scores of the group of vessels with high grade narrowing (greater than or equal to 60%) and those with less than 40% stenosis for all 3 criteria. Of major clinical interest were our 2 parameters, the 3-point diastolic internal carotid frequency total and the internal-to-common carotid spectral area ratio, both of which showed considerable promise as predictors of stenotic disease. For each test, 40/46 (87%) of the test scores of the arteries with 50% or greater narrowing fell outside 2 standard deviations (95% confidence level) of the means of the vessels with less than 50% stenosis. A previously reported parameter, the internal-to-common carotid peak systolic frequency ratio, was notably less discriminant in this regard.

Applying the Sports Medicine Australia pre-exercise screening procedures: who will be excluded?

Recently Sports Medicine Australia (SMA) and the Australian Association for Exercise and Sport Science (AAESS) developed guidelines for pre-exercise screening and supervision of fitness testing, based on the American College of Sports Medicine (ACSM) system. The procedure involves classifying individuals into one of three risk groups (apparently healthy, at higher risk, with known disease). Using data collected in a 1992 survey of 2298 Australian adults aged 18-78 years conducted by the Department of the Arts, Sport, the Environment and Territories (DASET), we calculated the percentage of the general population falling within each risk group and therefore exclusion rates (ie the proportion of subjects who, it is recommended, would require medical clearance prior to exercise or exercise testing). The analysis of data found that between 43-73% of males and 44-61% of females would require clearance. A cost analysis suggests that a rigorous application of the SMA-AAESS guidelines would cost between $250 million and $1.2 billion each year. On the basis of the results, suggestions for reviewing the guidelines have been proposed.

The doctor as patient: an encounter with Guillain-Bárré syndrome.

The author describes the course and treatment of a severe acute illness that began with cranial nerve palsies and ataxia and progressed rapidly to generalized weakness with respiratory embarrassment. There was no sensory loss or elevation of the protein level in the cerebrospinal fluid. The Miller Fisher variant of Guillain-Barré syndrome was diagnosed. At the height of the illness, a period lasting about 2 weeks, the author was almost completely paralysed, retaining only a little motion in some fingers and one foot; she was able to breathe on her own but required suctioning through a tracheostomy, and her eyes had to be taped shut because of her facial paralysis. She remained mentally alert throughout. Proper care of such a helpless patient demands not only excellent technical performance of many nursing procedures but a sensitivity to the patient as a person. The author describes the many shortcomings of the care she received and the value of physiotherapy in her rehabilitation and makes a number of specific recommendations for the care of critically ill conscious patients.

Report on seniors' dental care. Past experience and future challenges.

After attending the CDHA North American Research Conference held in Niagara Falls last October, Ms. Bowes says she found a significant amount of interest in the area of geriatric care being expressed by those in attendance. Consequently, when she returned home, she decided to offer CDHA members an opportunity to gain some insight on this topic from her own experiences. Although no 'formal' report summarizing the findings noted here was ever forwarded to the facilities involved, Ms. Bowes says that "some of the information gathered has been used in documents and reports that were forwarded to the Ministry of Health and the local Board of Health for Simcoe County." The purpose of this report is to alert dental professionals to the future dental needs of our rapidly aging population and to perhaps assist those who are considering the provision of the elderly by outlining my personal experience.

Ultrastructural immunocytochemical localisation of lysozyme in human bronchial glands.

An immunocytochemical unlabelled antibody method using rabbit antihuman lysozyme, antirabbit immunoglobulin, and soluble rabbit antihorseradish peroxidase/horseradish peroxidase complexes was used to study the fine structural distribution of lysozyme in human bronchial glands. None was identified in mucous cells but there was heavy staining of the serous cell granules. The serous cell granules were not stained uniformly, suggesting the presence of other secretory products but lysozyme secretion appears to be a major function of these cells. The pathological implications of this are discussed.

Tibial condylar fractures. Evaluation of treatment and outcome.

One hundred ten tibial condylar fractures incurred during the period from 1972 to 1978 were reviewed retrospectively. Fifty-two knees were reviewed more than one year after initial injury and were subjected to critical evaluation using a point rating system. Overall, the results were acceptable in 84% of patients. The use of a cast of traction generally produced very good results. Case bracing was used in 31% of the series. Open reduction was reserved for 17 severe and challenging fractures; six of the 17 had unsatisfactory functional results.

Major and trace element compositions of the UICC standard asbestos samples.

Major and trace element compositions for chrysotile (2 samples), amosite, crocidolite, and anthophyllite UICC standard asbestos samples have been determined using UV-visible spectrophotometry, atomic absorption spectometry, flame photometry, volumetric analysis, and gravimetric analysis for major elements and x-ray and optical spectrometry for trace elements. The trace element data are for Li, S, Cl, Sc, V, Cr, Co, Ni, Cu, Zn, Ga, Rb, Sr, Zr, Nb, Ba, La, Ce, Pb, and Th and distribution in the various mineral phases is discussed.

A simple vacuum cassette for microradiography.

Microradiography has been found to be a useful research tool for the investigation of bone formation, resorption and mineralization. Since relatively thin (60-125 mum) embedded hard tissue sections are used for this procedure, great care must be taken to ensure that the specimen is placed firmly and flatly without buckling against the photographic emulsion during the period of x-ray exposure in order to avoid distortion in the final microradiograph. The construction and use of a simple and inexpensive vacuum cassette for this purpose is described. With the use of a portable vacuum reservoir, specimen mounting can be done in a darkroom some distance from the x-ray source, often permitting the use of already existing x-ray facilities in other laboratories.