"God was with me": A qualitative study of Christian meaning-making among refugees.

In this consensual qualitative research study, we investigated the role of refugees' Christian faith in meaning-making coping. High percentages of religiosity in refugee populations support the need to understand the role of religion in their coping processes. Interviews with 20 Christian refugees from 10 African and Asian countries revealed that participants drew heavily from their faith resources to cope with their experiences. Specifically, refugees reported coping practices that included trust in God, prayer, intimacy with God, spiritual surrender, lament, worship, and social support. Although many participants described spiritual struggles, including doubting God, feeling distant from God, and questioning God, most found meaning amid refugee-related suffering and reported perspective shifts, a deepening of faith, seeing suffering as part of God's plan, experiencing a deepened sense of purpose, and growing in the likeness of Christ. Refugees also reported growth through suffering in the form of gratitude, altruism, testimony, and humility. Clinical implications include encouraging the use of religious resources for meaning-making and supporting the resolution of spiritual struggles.

Impact of an Institutional Clinical Pathway on Emergency Physicians' Stated Preferences in Treating Patients with Low-Risk Pulmonary Embolism.

BACKGROUND: Evidence continues to accumulate that select patients with acute low-risk pulmonary embolism (PE) can be safely discharged from the emergency department. Despite this, outpatient management continues to be uncommon. We report changes in emergency providers' stated preferences on low-risk acute PE management before and after the development and implementation of an institutional clinical pathway and decision tool. METHODS: We performed an observational analysis of attending emergency physicians' stated preferences towards the management of low-risk acute PE using survey results before and after the development and implementation of an electronic health record-embedded institutional low-risk acute PE pathway. RESULTS: Attending emergency medicine providers reported feeling more comfortable using PE risk stratification scores to identify dischargeable low-risk PE patients and also reported that they would be more likely to discharge a hypothetical patient with low-risk acute PE. CONCLUSION: Our results suggest that the implementation of an institutional clinical pathway with integration into the electronic health record was associated with a change in emergency physicians' stated preferences for managing patients with acute low-risk PE in the emergency department. Implementation of an evidence-based standard pathway was associated with increased comfort and familiarity with PE risk stratification, and an increased comfort with and preference for early outpatient management of low-risk PE.

Testimony and meaning: A qualitative study of Black women with cancer diagnoses.

OBJECTIVE: Research has established religion and spirituality as important resources for Black people in the U.S. coping with adversity. Most research has been from an etic perspective, examining religious variables that are valid across multiple religions. In the present study, we asked what emic aspects of the Black church's practices and theological emphases women with cancer drew on in constructing meaning-making narratives from their cancer experience. METHOD: In this consensual qualitative research study, we interviewed 30 Black women with cancer histories with an average age of 64.5. RESULTS: The religious practice of testimony emerged as the predominant theme. Testimony (a) provided a meaningful purpose to the cancer experience; (b) had a specific content of describing what God had done in their lives as well as some common theological emphases; (c) had dual desired outcomes of helping others and bringing glory to God; and (d) had an associated practice of giving testimony. CONCLUSION: We discuss testimony as a narrative structure and highlight its importance in informing culturally sensitive interventions aimed at supporting Black women with cancer. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Effect of exercise on pain processing and motor output in people with knee osteoarthritis: a systematic review and meta-analysis.

OBJECTIVE: Guidelines recommend exercise as a core treatment for knee osteoarthritis. However, it is unclear how exercise affects measures of pain processing and motor function. The aim was to evaluate the effect of exercise on measures of pain processing and motor function in people with knee osteoarthritis. METHODS: We searched five electronic databases (MEDLINE, EMBASE, CINAHL, SCOPUS and Cochrane Central Register of Controlled Trials) for studies on knee osteoarthritis, of any design, evaluating pain processing and motor function before and after exercise. Data were pooled with random-effects meta-analysis. Study quality was assessed using the Downs and Black and quality of evidence was assessed using the GRADE. RESULTS: Eighteen studies were eligible and 16 were included. Following acute exercise, pressure pain threshold increased local to the study limb (standardised mean difference [95% confidence interval (CI)] 0.26, [0.02, 0.51], n = 159 from 5 studies), but there was no statistically significant change remote from the study limb (0.09, [-0.11, 0.29], n = 90 from 4 studies). Following an exercise program (range 5-12 weeks) there were no statistically significant changes in pressure pain threshold (local 0.23, [-0.01, 0.47], n = 218 from 8 studies; remote 0.33 [-0.13, 0.79], n = 76 from 4 studies), temporal pain summation (0.38 [-0.08, 0.85], n = 122 from 3 studies) or voluntary quadriceps muscle activation (4.23% [-1.84 to 10.30], n = 139 from 4 studies). CONCLUSION: Very-low quality evidence suggests that pressure pain threshold increases following acute exercise. Very-low quality evidence suggests that pressure pain threshold, temporal pain summation or voluntary quadriceps activation do not change statistically significantly following exercise programs.

Postpartum supplementation of fermented ammoniated condensed whey improved feed efficiency and plasma metabolite profile.

Postpartum dietary supplementation of gluconeogenic precursors may improve the plasma metabolite profile of dairy cows, reducing metabolic disorders and improving lactation performance. The objective of this trial was to examine the effects of supplementation with fermented ammoniated condensed whey (FACW) postpartum on lactation performance and on profile of plasma metabolites and hormones in transition dairy cows. Individually fed multiparous Holstein cows were blocked by calving date and randomly assigned to control (2.9% dry matter of diet as soybean meal; n = 20) or FACW (2.9% dry matter of diet as liquid GlucoBoost, Fermented Nutrition, Luxemburg, WI; n = 19) dietary treatments. Treatments were offered from 1 to 45 d in milk (DIM). Cows were milked twice a day. Dry matter intake and milk yield were recorded daily and averaged weekly. Individual milk samples from 2 consecutive milkings were obtained once a week for component analysis. Rumen fluid was collected (n = 3 cows/treatment) at 4 time points per day at 7 and 21 DIM. Blood samples were collected within 1 h before feeding time for metabolite analysis and hyperketonemia diagnosis. Supplementation of FACW improved feed efficiency relative to control; this effect may be partially explained by a marginally significant reduction in dry matter intake from wk 3 to 7 for FACW-supplemented cows with no detected FACW-driven changes in milk yield, milk protein yield, and milk energy output compared with control. Also, there was no evidence for differences in intake of net energy for lactation, efficiency of energy use, energy balance, or body weight or body condition score change from calving to 45 DIM between treatments. Supplementation of FACW shifted rumen measures toward greater molar proportions of propionate and butyrate, and lesser molar proportions of acetate and valerate. Cows supplemented with FACW had greater plasma glucose concentrations in the period from 3 to 7 DIM and greater plasma insulin concentrations compared with control. Plasma nonesterified fatty acid and ß-hydroxybutyrate concentrations were decreased in cows supplemented with FACW compared with control cows in the period from 3 to 7 DIM. These findings indicate that FACW may have improved the plasma metabolite profile immediately postpartum in dairy cows. Additionally, supplementation of FACW resulted in improved feed efficiency as accessed by measures of milk output relative to feed intake.

Dynamics of colistin and tobramycin resistance among Enterobacter cloacae during prolonged use of selective decontamination of the digestive tract.

Background: A high prevalence of colistin resistance among E. cloacae isolates in two intensive care units (ICU) (of 16 and 6 beds) using selective digestive decontamination (SDD) since 1990 instigated a retrospective and prospective investigation to quantify the role of clonal transmission. SDD is topical application of colistin and tobramycin and systemic use of cefotaxime during the first days of ICU-admission. Methods: Multi-resistant E. cloacae (MREb) was defined as ESBL production and/or tobramycin non-susceptibility and/or colistin non-susceptibility. Incidence of acquisition and prevalence of carriage with MREb was determined from microbiological culture results. Results: Colistin-resistant E. cloacae was first detected in November 2009 and carriage was demonstrated in 141 patients until October 2014. Mean incidence of MREb acquisition was 4.61 and 1.86 per 1000 days at risk in ICUs 1 and 2, respectively, and the mean monthly prevalence of MREb in both ICUs was 7.0 and 3.1%, respectively, without a discernible trend in time. Conversion rates from carriage of colistin-susceptible to resistant E. cloacae were 0.20 and 0.13 per 1000 patient days, respectively. Whole genome sequencing of 149 isolates revealed eight clusters, with the number of SNPs of the largest two clusters ranging between 0 and 116 for cluster 1 (n = 49 isolates), and 0 and 27 for cluster 2 (n = 36 isolates), among isolates derived between 2009 and 2014. Conclusions: This study demonstrates a stable low-level endemicity of MREb in two Dutch ICUs with prolonged use of SDD, which was characterized by the persistent presence of two clusters, suggesting incidental clonal transmission.

Synovial changes detected by ultrasound in people with knee osteoarthritis - a meta-analysis of observational studies.

OBJECTIVES: To examine the prevalence of synovial effusion, synovial hypertrophy and positive Doppler signal (DS) detected by ultrasound (US) in people with knee osteoarthritis (OA) and/or knee pain compared to that in the general population. METHOD: A systematic literature search was undertaken in Medline, EMBASE, Allied and Complementary Medicine, PubMed Web of Science, and SCOPUS databases in May 2015. Frequencies of US abnormalities in people with knee OA/pain, in the general population or asymptomatic controls were pooled using the random effects model. Publication bias and heterogeneity between studies were examined. RESULTS: Twenty four studies in people with knee pain/OA and five studies of the general population or asymptomatic controls met the inclusion criteria. The pooled prevalence of US effusion, synovial hypertrophy and positive DS in people with knee OA/pain were 51.5% (95% CI 40.2 to 62.8), 41.5% (26.3-57.5) and 32.7% (8.34-63.24), respectively, which were higher than those in the general population or asymptomatic controls (19.9% (95%CI 7.8-35.3%), 14.5% (0-58.81), and 15.8 (3.08-35.36), respectively). People with knee OA (ACR criteria or radiographic OA) had greater prevalence of US abnormalities than people with knee pain (P = 0.037, P = 0.010 and P = 0.009, respectively). CONCLUSIONS: US detected effusion, synovial hypertrophy and DS are more common in people with knee OA/pain, compared to the general population. These abnormalities relate more to presence of OA structural changes than to pain.

Osteoarthritis year in review 2015: rehabilitation and outcomes.

OBJECTIVE: The purpose of this narrative review was to highlight recent research in the rehabilitation of people with osteoarthritis (OA) by summarizing findings from selected key systematic reviews and randomized controlled trials (RCTs). METHODS: A systematic search was conducted using the PubMed, Physiotherapy Evidence Database (PEDro) and Cochrane databases from April 1st 2014 to March 31st 2015. A selection of these is discussed based on study quality, relevance, contribution to new knowledge or controversial findings. Methodological quality of RCTs was assessed using guidelines from PEDro. RESULTS: From 274 articles, 74 were deemed to meet the eligibility criteria including 24 systematic reviews and 50 studies reporting on findings from RCTs. Overall the methodological quality of the RCTs was moderate. The studies were grouped into several themes covering; evidence of rehabilitation outcomes in less studied joints including the hand and hip; new insights into exercise in knee OA; effects of biomechanical treatments on symptoms and structure in knee OA; and effects of acupuncture. CONCLUSIONS: Exercise was the most common treatment evaluated. Although little evidence supported benefit of exercise for hand OA, exercise has positive effects for hip and knee OA symptoms and these benefits may depend upon patient phenotypes. The first evidence that a brace can influence knee joint structure emerged. The latest evidence suggests that acupuncture has, at best, small treatment effects on knee OA pain of unlikely clinical relevance.

Effect of variable water intake as mediated by dietary potassium carbonate supplementation on rumen dynamics in lactating dairy cows.

Water is a critical nutrient for dairy cows, with intake varying with environment, production, and diet. However, little work has evaluated the effects of water intake on rumen parameters. Using dietary potassium carbonate (K2CO3) as a K supplement to increase water intake, the objective of this study was to evaluate the effect of K2CO3 supplementation on water intake and on rumen parameters of lactating dairy cows. Nine ruminally cannulated, late-lactation Holstein cows (207±12d in milk) were randomly assigned to 1 of 3 treatments in a replicated 3×3 Latin square design with 18-d periods. Dietary treatments (on a dry matter basis) were no added K2CO3 (baseline dietary K levels of 1.67% dietary K), 0.75% added dietary K, and 1.5% added dietary K. Cows were offered treatment diets for a 14-d adaption period followed by a 4-d collection period. Ruminal total, liquid, and dry matter digesta weights were determined by total rumen evacuations conducted 2h after feeding on d 4 of the collection period. Rumen fluid samples were collected to determine pH, volatile fatty acids, and NH3 concentrations, and Co-EDTA was used to determine fractional liquid passage rate. Milk samples were collected twice daily during the collection period. Milk, milk fat, and protein yields showed quadratic responses with greatest yields for the 0.75% added dietary K treatment. Dry matter intake showed a quadratic response with 21.8kg/d for the 0.75% added dietary K treatment and 20.4 and 20.5kg/d for control and the 1.5% added dietary K treatment, respectively. Water intake increased linearly with increasing K2CO3 supplementation (102.4, 118.4, and 129.3L/d) as did ruminal fractional liquid passage rate in the earlier hours after feeding (0.118, 0.135, and 0.141 per hour). Total and wet weights of rumen contents declined linearly and dry weight tended to decline linearly as dietary K2CO3 increased, suggesting that the increasing water intake and fractional liquid passage rate with increasing K2CO3 increased the overall ruminal turnover rate. Ruminal ammonia concentrations declined linearly and pH increased linearly as K supplementation increased. As a molar percentage of total volatile fatty acids, acetate increased linearly as dietary K increased, though propionate declined. Increasing dietary K2CO3 and total K in the diets of lactating dairy cows increased water consumption and modified ruminal measures in ways suggesting that both liquid and total ruminal turnover were increased as both water and K intake increased.

Responses of late-lactation cows to forage substitutes in low-forage diets supplemented with by-products.

In response to drought-induced forage shortages along with increased corn and soy prices, this study was conducted to evaluate lactation responses of dairy cows to lower-forage diets supplemented with forage substitutes. By-product feeds were used to completely replace corn grain and soybean feeds. Forty-eight late-lactation cows were assigned to 1 of 4 diets using a randomized complete block design with a 2-wk covariate period followed by a 4-wk experimental period. The covariate diet contained corn grain, soybean meal, and 61% forage. Experimental diets contained chopped wheat straw (WS)/sugar beet pulp at 0/12, 3/9, 6/6, or 9/3 percentages of diet dry matter (DM). Corn silage (20%), alfalfa silage (20%), pelleted corn gluten feed (25.5%), distillers grains (8%), whole cottonseed (5%), cane molasses/whey blend (7%), and vitamin and mineral mix with monensin (2.5%) comprised the rest of diet DM. The WS/sugar beet pulp diets averaged 16.5% crude protein, 35% neutral detergent fiber, and 11% starch (DM basis). Cows consuming the experimental diets maintained a 3.5% fat- and protein-corrected milk production (35.2 kg; standard deviation=5.6 kg) that was numerically similar to that measured in the covariate period (35.3 kg; standard deviation=5.0 kg). Intakes of DM and crude protein declined linearly as WS increased, whereas neutral detergent fiber intake increased linearly. Linear increases in time spent ruminating (from 409 to 502 min/d) and eating (from 156 to 223 min/d) were noted as WS inclusion increased. Yields of milk fat and 3.5% fat-and protein-corrected milk did not change as WS increased, but those of protein and lactose declined linearly. Phosphorous intakes were in excess of recommended levels and decreased linearly with increasing WS inclusion. Nutritional model predictions for multiparous cows were closest to actual performance for the National Research Council 2001 model when a metabolizable protein basis was used; primiparous cow performance was better predicted by energy-based predictions made with the National Research Council or Cornell Net Carbohydrate and Protein System models. Model predictions of performance showed a quadratic diet effect with increasing WS. Lactating dairy cows maintained production on low-forage diets that included forage substitutes, and in which by-product feeds fully replaced corn grain and soybean. However, longer-term studies are needed to evaluate animal performance and to improve model predictions of performance on these nontraditional diets.

Isotrichid protozoa influence conversion of glucose to glycogen and other microbial products.

The goal of this in vitro study was to determine the influence of isotrichid protozoa (IP) on the conversion of glucose (Glc) to glycogen (Glyc) and transformation of Glc into fermentation products. Treatments were ruminal inoculum mechanically processed (blended) to destroy IP (B+, verified microscopically) or not mechanically processed (B-). Accumulated microbial Glyc was measured at 3h of fermentation with (L+; protozoa+bacteria) or without (L- predominantly protozoa) lysis of bacterial cells in the fermentation solids with 0.2 N NaOH. Two 3-h in vitro fermentations were performed using Goering-Van Soest medium in batch culture vessels supplemented with 78.75 mg of Glc/vessel in a 26.5-mL liquid volume. Rumen inoculum from 2 cannulated cows was filtered through cheesecloth, combined, and maintained under CO(2) for all procedures. At 3h, 0.63 and 0.38 mg of Glc remained in B- and B+. Net microbial Glyc accumulation (and Glc in Glyc as % of added Glc) detected at 3h of fermentation were 3.32 (4.69%), -1.42 (-2.01%), 6.45 (9.10%), and 3.65 (5.15%) mg for B-L-, B+L-, B-L+ and B+L+, respectively. Treatments B+ and L+ gave lower Glyc values than B- and L-, respectively. Treatment B+L- demonstrated net utilization of α-glucan contributed by inoculum with no net Glyc production. With destruction of IP, total Glyc accumulation declined by 44%, but estimated bacterial Glyc increased. Microbial accumulation of N increased 17.7% and calculated CH(4) production decreased 24.7% in B+ compared with B-, but accumulation of C in microbes, production of organic acids or C in organic acids, calculated CO(2), and carbohydrates in cell-free medium did not differ between B+ and B-. Given the short 3-h timeframe, increased N accumulation in B+ was attributed to decreased Glyc sequestration by IP rather than decreased predation on bacteria. After correction for estimates of C from AA and peptides utilized by microbes, 15% of substrate Glc C could not be accounted for in measured products in B+ or B-. Approximately 30% of substrate Glc was consumed by energetic costs associated with Glc transport and Glyc synthesis. The substantial accumulation of Glyc and changes in microbial N and Glyc accumulation related to presence of IP suggest that these factors should be considered in predicting profiles and amounts of microbial products and yield of nutrients to the cow as related to utilization of glucose. Determination of applicability of these findings to other soluble carbohydrates could be useful.

The importance of listening: juvenile allocation shifts in response to acoustic cues of the social environment.

The social environment has a strong effect on the strength and direction of sexual selection. Juveniles, however, often have social cues that signal the current competitive environment which may provide cues of future competitive challenges. Here we demonstrate that juvenile crickets (Teleogryllus commodus) use the calls of surrounding adult males as a cue of the quality and density of rivals/mates they are likely to encounter. We reared hatchling crickets in six acoustic environments that varied in the density and quality of calls and demonstrate that individuals modified their development rate, phenotype and behaviour at maturity. Males matured more rapidly at a smaller size and called more when reared in a low competition environment. In contrast, males delayed maturity to grow larger when faced with an increased density of high-quality males. Females matured more rapidly when reared in a high density of high-quality males and allocated proportionately more resources towards egg production. A second experiment limiting nutrient availability demonstrates sex-specific allocation shifts in the last stadium when cues are most reliable. Our results demonstrate that the social environment significantly affects allocation strategies and phenotypes, highlighting the importance of juvenile experience and competitive context when examining fitness and selection.

Distal luxation of the patella in a horse.

A 19-year-old Thoroughbred gelding presented with sudden onset, non-weight bearing lameness in the right hindlimb. Radiography confirmed distal luxation of the patella, which was replaced into its normal anatomical location under general anaesthesia. There were no pathological sequelae noted on follow-up examination 9 months after the initial injury. To our knowledge, this is a rare manifestation of patellar luxation, only reported once previously in the equine literature.

Are auditory P300 and duration MMN heritable and putative endophenotypes of psychotic bipolar disorder? A Maudsley Bipolar Twin and Family Study.

BACKGROUND: Impaired P300 auditory response has been reported in patients with psychotic bipolar disorder (BPD) and unaffected relatives of psychotic bipolar patients. Deficits in mismatch negativity (MMN), however, have not been observed in bipolar patients. To our knowledge, no family study of MMN in BPD has been reported. The current study combined the Maudsley twin and bipolar family samples using genetic model fitting analyses to: (1) assess the relationship between BPD and MMN, (2) substantiate the association between psychotic BPD and P300 variables, (3) verify the genetic overlap of BPD with P300 amplitude previously reported in the twin sample, and (4) examine the shared genetic influences between BPD and bilateral temporal scalp locations of P300 components. METHOD: A total of 301 subjects were included in this study, including 94 twin pairs, 31 bipolar families, and 39 unrelated healthy controls. Statistical analyses were based on structural equation modelling. RESULTS: Both P300 and MMN are heritable, with heritability estimates of 0.58 for MMN, 0.68-0.80 for P300 amplitude, and 0.21-0.56 for P300 latency. The bipolar patients and their relatives showed normal MMN. No significant association, either genetic or environmental, was found with BPD. BPD was significantly associated with reduced P300 amplitude and prolonged latency on midline and bilateral temporal-posterior scalp areas. Shared genetic factors were the main source of these associations. CONCLUSIONS: The results confirm that MMN is not an endophenotype for psychotic BPD whereas P300 amplitude and latency components are valid endophenotypes for psychotic BPD.

Microwave ablation of renal parenchymal tumors before nephrectomy: phase I study.

OBJECTIVE: The purpose of this study was to determine, in renal neoplasms, the size of ablation zones induced in vivo with percutaneous microwave probes and whether skip areas remain within the ablation zones. CONCLUSION: For a single 10-minute ablation, ablated volumes averaged 27 cm3 and 105 cm3 with a single-probe and a three-probe ablation array, respectively. There were no skip areas within the ablated zone. Microwave ablation can safely and quickly generate large ablation lesions and renal neoplasms.

Phase I-II prospective dose-escalating trial of lycopene in patients with biochemical relapse of prostate cancer after definitive local therapy.

OBJECTIVES: To report a prospective trial of lycopene supplementation in biochemically relapsed prostate cancer. METHODS: A total of 36 men with biochemically relapsed prostate cancer were enrolled in a dose-escalating, Phase I-II trial of lycopene supplementation. Six consecutive cohorts of 6 patients each received daily supplementation with 15, 30, 45, 60, 90, and 120 mg/day for 1 year. The serum levels of prostate-specific antigen (PSA) and plasma levels of lycopene were measured at baseline and every 3 months. The primary endpoints were PSA response (defined as a 50% decrease in serum PSA from baseline), pharmacokinetics, and the toxicity/tolerability of this regimen. RESULTS: A total of 36 patients were enrolled. The median age was 74 years (range 56 to 83), with a median serum PSA at entry of 4.4 ng/mL (range 0.8 to 24.9). No serum PSA responses were observed, and 37% of patients had PSA progression. The median time to progression was not reached. Toxicity was mild, with 1 patient discontinuing therapy because of diarrhea. Significant elevations of plasma lycopene were noted at 3 months and then appeared to plateau for all six dose levels. The plasma levels for doses between 15 and 90 mg/day were similar, with additional elevation only at 120 mg/day. CONCLUSIONS: Lycopene supplementation in men with biochemically relapsed prostate cancer is safe and well tolerated. The plasma levels of lycopene were similar for a wide dose range (15 to 90 mg/day) and plateaued by 3 months. Lycopene supplementation at the doses used in this study did not result in any discernible response in serum PSA.

Complementary and alternative medicine for advanced prostate cancer.

Complimentary and alternative medicines (CAM) have increased drastically in popularity in the past decade. These are largely in the form of nutritional supplements. Despite a wealth of information sources on the subject, the fundamental problem with CAM therapies is a dearth of evidence-based medicine. Advanced prostate cancer has significant long-term morbidity, and there is a growing interest in alternative and complimentary forms of therapy that will improve the outcomes of patients who have recurrent or advanced prostate cancer while obviating the need for more toxic forms of therapy. In this article we summarize the use of some of the more common CAM nutritional supplements and review the scientific data that are available to support their use.

Phase I/II study of 19-nor-1alpha-25-dihydroxyvitamin D2 (paricalcitol) in advanced, androgen-insensitive prostate cancer.

PURPOSE: We assessed the safety and efficacy of the vitamin D analogue, 19-nor-1alpha-25-dihydroxyvitamin D2 (paricalcitol), in patients with androgen-independent prostate cancer. EXPERIMENTAL DESIGN: Patients received paricalcitol i.v. three times per week on an escalating dose of 5 to 25 microg (3-15 microg/m2). The primary end point was prostate-specific antigen (PSA) response. Secondary end points were characterization of toxicity in this population, changes in serum parathyroid hormone (PTH), and survival. RESULTS: A total of 18 patients were enrolled. No patient showed a sustained 50% drop in serum PSA, despite several large declines in PSA (e.g., 1,300 ng/mL). Paricalcitol was well tolerated. One instance of significant hypercalcemia, a serum calcium of 14.3 mg/dL, was observed at the highest dose (25 microg). At entry into the study, seven (41%) of the patients had elevated serum levels of PTH, which were significantly reduced by paricalcitol. Higher levels of serum PTH at study entry were significantly and negatively associated with survival (P<0.01). CONCLUSION: No objective responses were seen in the primary end point. However, elevated serum levels of PTH, a common feature of advanced prostate cancer, were reduced by paricalcitol. Because elevated PTH is associated with increased cardiovascular and skeletal morbidity, including an increased risk for pathologic fracture, further evaluation of paricalcitol in the reduction of skeletal morbidity in advanced prostate cancer is warranted.

Randomized prospective trial of a novel local anesthetic technique for extensive prostate biopsy.

OBJECTIVES: To determine the effectiveness of a novel technique of administering local anesthesia for extensive prostate biopsy. Little reported experience with local anesthesia for extensive prostate biopsy methods is available. METHODS: A prospective, randomized study was performed on 50 men undergoing transrectal ultrasound-guided prostate biopsy using the five-region technique. Patients were randomized into one of two groups. One group received 22 mL of a 1% lidocaine solution injected into the neurovascular bundles, the genitourinary diaphragm, and between the rectal wall and prostate. The second group received 10 mL of 2% intrarectal lidocaine jelly. A median of 12 biopsy cores was obtained from each patient. The patients were then asked by a urology nurse unaware of the anesthesia method to grade the discomfort using a 10-point linear visual analog pain scale. RESULTS: Twenty-three men received anesthesia with lidocaine jelly, and 27 received anesthesia with lidocaine infiltration. The mean pain scores were significantly different statistically between the lidocaine jelly and lidocaine infiltration groups with respect to overall pain (4.2 versus 0.5) and pain during the biopsy portion of the procedure (4.2 versus 0.5). CONCLUSIONS: Extensive biopsy techniques may be comfortably performed by the urologist in an office setting using local anesthesia. The administration of 22 mL of a 1% lidocaine solution, injected at the prostatic pedicles, the genitourinary diaphragm, and the space between the prostate and rectum, allows the patient to comfortably undergo an extensive biopsy protocol in an office setting.

Metabolic responses of transition Holstein cows fed anionic salts and supplemented at calving with calcium and energy.

The objective of this study was to determine the concentrations of plasma Ca, P, Mg, nonesterified fatty acids (NEFA), 3-hydroxybutyrate (BHBA), and glucose in transition cows fed anionic salts prepartum and provided with calcium and energy supplements at calving. The study was conducted on a Florida Holstein dairy farm from November to December 1997. Treatments consisted of no treatment (n = 30); 60 g of Ca as calcium chloride, orally (n = 30); 110 g of Ca as calcium propionate 510 g plus 400 g of propylene glycol, orally (n = 30); two doses of 60 g of Ca as calcium chloride, one at calving and the second 24 h later, orally (n = 30); and 10 g of Ca as borogluconate, intravenously (n = 30). Treatments were administered within 12 h after parturition. Blood samples were collected at d 1 (parturition), 2, 3, 6, 9, and 12 after calving. Plasma total Ca, P, Mg, NEFA, BHBA, and glucose were measured. There were no differences in the concentrations of the blood metabolites among treatments.