A dose response randomised controlled trial of docosahexaenoic acid (DHA) in preterm infants.

Thirty one infants born less than 30 weeks׳ gestational age were randomised to receive either 40 (n=11), 80 (n=9) or 120 (n=11) mg/kg/day of docosahexaenoic acid (DHA) respectively as an emulsion, via the feeding tube, commenced within 4 days of the first enteral feed. Twenty three infants were enroled in non-randomised reference groups; n=11 who had no supplementary DHA and n=12 who had maternal DHA supplementation. All levels of DHA in the emulsion were well tolerated with no effect on number of days of interrupted feeds or days to full enteral feeds. DHA levels in diets were directly related to blood DHA levels but were unrelated to arachidonic acid (AA) levels. All randomised groups and the maternal supplementation reference group prevented the drop in DHA levels at study end that was evident in infants not receiving supplementation. Australian New Zealand Clinical Trials Registry: ACTRN12610000382077.

[The natural orifice surgery concept. Vision and rationale for a paradigm shift]. / "Natural-Orifice-Surgery- (NOS-)Konzept". Vision und Rationale für einen Paradigmenwechsel.

BACKGROUND: During the 20th Century, laparoscopic surgery achieved high standards and significantly reduced morbidity. In order to make surgery simpler and safer, a new concept, natural orifice surgery (NOS), has recently been introduced. The approach to the abdominal cavity may be transoral-transgastric, transvaginal-transdouglas or transanal-transrectal. This article describes the logic behind this approach and the expected challenges. METHODS: In order to realize this goal, we founded the first European based working group on NOS. This group concentrates on the development of transdouglas procedures in women by using the transdouglas endoscopic device (TED). This is a wide, multi-channel instrument, which will enable surgery to be performed via a single entry. RESULTS: Simulation of various intra-abdominal operations, such as staging, cholecystectomy, appendectomy, myomectomy und ovarectomy, using TED has already been carried out. Practical studies are planned in the near future. CONCLUSION: The feasibility of NOS has been demonstrated in various experimental studies. We believe that this technique will create a spectrum of innovative and high quality operations and will improve patient safety.

Nature as a complementary therapy for women.

Evaluating the safety and effectiveness of complementary therapies is a challenge for nurses. Many people enjoy spending time in nature. The purpose of this article is to examine the theoretical and empirical evidence for using nature as a complementary therapy to rest and restore one's ability to concentrate. As women become active participants in their health care, a complementary therapy to restore and maintain concentration may help promote self-care.

Mutations in SPC110, encoding the yeast spindle pole body calmodulin-binding protein, cause defects in cell integrity as well as spindle formation.

The 110 kDa spindle pole body component, Spc110p, is an essential target of calmodulin in budding yeast. Cells with mutations which reduce calmodulin binding to Spc110p are unable to form a mitotic spindle and die. Here we show that these effects can be overcome either directly by increasing extracellular calcium or calmodulin expression, which reverse the primary spindle defect, or indirectly through increased extracellular osmolarity or high dosage of MID2 or SLG1/HCS77/WSC1 which preserve viability. We propose that overcoming a cell integrity defect associated with the mitotic arrest enables the defective spindle pole bodies to provide sufficient function for proliferation of a large proportion of mutant cells. Our findings demonstrate a role for calcium in the Spc110p-calmodulin interaction in vivo and have important general implications for the interpretation of genetic interactions involving cell integrity genes.

Pretreatment of lacerations with lidocaine, epinephrine, and tetracaine at triage: a randomized double-blind trial.

OBJECTIVE: Pretreatment of lacerations with topical anesthetics reduces the pain of subsequent anesthetic injection yet requires time. This study was conducted to determine the ability of triage nurses to identify lacerations necessitating closure and pretreat them with a topical anesthetic and to compare the pain levels of lidocaine injection in lacerations pretreated with LET (lidocaine 2%, epinephrine 1:1,000, tetracaine 2%) vs a placebo. METHODS: This was a double-blind, randomized clinical trial that included consecutive emergency department patients aged > or = 1 year with clean, non-bite lacerations < or = 6 hours old. At triage the lacerations were randomized to LET solution or a placebo containing epinephrine 1:1,000. At examination an emergency practitioner assessed the laceration edges for the presence of blanching and adequacy of anesthesia to a 27-gauge needlestick. At the practitioner's discretion, supplemental lidocaine was infiltrated through the wound and the patient (or guardian) recorded the pain of infiltration on a 100-mm visual analog scale marked "most pain" at the high end. The mean levels of pain of lidocaine infiltration were compared between groups with a t-test and the proportions of adequately anesthetized wounds were compared with a chi2 test. A sample of 40 patients had 80% power to detect a 20-mm between-group difference in the pain of injection (alpha = 0.05). RESULTS: Of 43 patients enrolled (mostly children and males), 22 received LET and 21 placebo. The groups were similar for baseline characteristics. Lacerations in the LET group were more frequently adequately anesthetized (46% vs 14%, p = 0.03), and LET patients experienced less pain from injection than controls (22 mm vs 42 mm, p = 0.02). CONCLUSIONS: Application of LET by triage nurses is more effective than placebo in adequately anesthetizing simple lacerations in normal hosts and decreases the pain of local anesthetic infiltration.

Inhibition of pancreatic cancer growth by the dietary isoprenoids farnesol and geraniol.

Fruits and vegetables have protective effects against many human cancers, including pancreatic cancer. Isoprenoids are one class of phytochemicals which have antitumor activity, but little is known about their effects on cancer of the pancreas. We tested the hypothesis that isoprenoids would inhibit the growth of pancreatic tumor cells. Significant (60-90%) inhibition of the anchorage-independent growth of human MIA PaCa2 pancreatic tumor cells was attained with 25 microM farnesol, 25 microM geranylgeraniol, 100 microM perillyl amine, 100 microM geraniol, or 300 microM perillyl alcohol. We then tested the relative in vivo antitumor activities of dietary farnesol, geraniol, and perillyl alcohol against transplanted PC-1 hamster pancreatic adenocarcinomas. Syrian Golden hamsters fed geraniol or farnesol at 20 g/kg diet exhibited complete inhibition of PC-1 pancreatic tumor growth. Both farnesol and geraniol were more potent than perillyl alcohol, which inhibited tumor growth by 50% at 40 g/kg diet. Neither body weights nor plasma cholesterol levels of animals consuming isoprenoid diets were significantly different from those of pair-fed controls. Thus, farnesol, geraniol, and perillyl alcohol suppress pancreatic tumor growth without significantly affecting blood cholesterol levels. These dietary isoprenoids warrant further investigation for pancreatic cancer prevention and treatment.

Chemotherapy of pancreatic cancer with the monoterpene perillyl alcohol.

Perillyl alcohol has antitumor activity against rat mammary and liver cancer. Here, we report the chemotherapeutic effects of perillyl alcohol on pancreatic cancer. Perillyl alcohol reduced the growth of hamster pancreatic tumors to less than half that of controls (P < 0.025). Moreover, 16% of perillyl alcohol-treated pancreatic tumors completely regressed whereas no control tumors regressed (P < 0.05). Perillyl alcohol induced contact inhibition in cultured human pancreatic carcinoma cells and inhibited their anchorage-independent growth (P < 0.001). Thus, perillyl alcohol has antitumor activity against pancreatic carcinomas at non-toxic doses, and may be an effective chemotherapeutic agent for human pancreatic cancer.

Characterisation of the S-adenosylmethionine decarboxylase (SAMDC) gene of potato.

S-adenosylmethionine decarboxylase (SAMDC) is involved in the biosynthesis of the polyamines, spermidine and spermine. Recently, we reported the isolation of a putative cDNA clone of the SAMDC clone of potato (Plant Mol Biol 20; 641-651). In order to confirm that the potato genes does encode SAMDC, a complementation experiment with a yeast strain that possesses a null mutation in the SAMDC gene was performed. The yeast strain contains a deletion-insertion mutation in the SAMDC gene and has an absolute requirement for the addition of exogenous spermidine for growth. When the full-length potato cDNA was expressed in the mutant yeast strain there was no longer a requirement for exogenous spermidine. Immunoblotting experiments suggest that the potato SAMDC gene product has an apparent molecular mass of 39 kDa. Expression of the SAMDC gene was high in the young and actively dividing tissues and low in the mature and non-dividing tissues of both vegetative and reproductive organs. Additionally, isolation and characterisation of the corresponding genomic clone is reported. The gene has one intron in its 5'-untranslated sequence but otherwise the transcribed portion is identical to the cDNA clone.

Drug use and cigarette smoking in applicants for drug abuse treatment.

Whereas smoking rates have declined in the last three decades from around 40% to under 30%, the rates for substance abuse clients remain at a plateau almost three times as high. In order to examine the relations between nicotine and drug use, applicants for drug abuse treatment were surveyed about their cigarette smoking. Results indicated that 85% of applicants were smokers. Also, it was found that for smokers, frequency and type of drug use were associated with amount of cigarette use. Among the five categories of primary drugs surveyed, heroin users had the highest levels of smoking. Additionally, frequency of primary drug use and frequency of overall drug use correlated with cigarette smoking. Within categories of primary drug, frequency of use was related to severity of nicotine dependence for marijuana only. Given the possible association between severity of illicit drug use and smoking found in this study, it behooves treatment organizations to help clients overcome their nicotine dependence.

Personality, drug use, and early attrition from substance abuse treatment.

This study examined the relationships among demographics, personality variables, drug use, and early attrition from substance abuse treatment. Attrition was considered at two time intervals; immediately (after one visit) and after 2 months. One hundred consecutive admissions to a community drug-abuse treatment center were given the MCMI and the SCL-90R following a standard intake interview. Subjects were classified according to their primary drug of abuse, yielding 16 opiate, 16 amphetamine, 34 cocaine, and 29 marijuana abusers. ANOVA's, ANCOVA's, and chi-squares were performed to compare characteristics of the different groups. Immediate Dropouts were less likely to be court mandated than Remainers, but were not different on any other demographic or drug use variable. Remainers had higher scores than Immediate Dropouts on 7 MCMI scales. A significant interaction between drug type, symptom severity, and early attrition was found for amphetamine abusers with high levels of subjective distress as measured by the SCL-90R. These clients dropped out earlier than amphetamine abusers without elevated SCL-90R scores. Analysis also indicated that Long-Term Remainers were less likely to be employed than Dropouts. All other comparisons between these groups failed to produce significant differences. This study confirms earlier research which found a high rate of early attrition from treatment with substance-abusing clients. Results also indicate that severity of psychopathology is not key in predicting attrition; it is more the nature of the disorder that influences client dropout. It is argued that continuation in community treatment is problematic for most substances abusers, and treatment facilities should routinely employ attrition prevention procedures.

Modern autotransfusion. Experience with a washed red cell processing technique.

The technique of intraoperative autotransfusion utilizing the Haemonetics Cell Saver is described. This device separates and washes red blood cells removed from the surgical field. Advantages of this unit over others are (1) no systemic anticoagulation is required, (2) circulatory fibrin debris is removed, (3) plasma hemoglobin is removed, and (4) any circulating anticoagulant is removed. Experience with 136 consecutive cases. 101 elective and 35 emergency, is reported. The only complication was coagulopathy, which occurred in 5.1 percent of the cases. It is easily treated with blood component therapy and occurs in those patients in whom greater then 3,500 cm3 of blood is autotransfused. The Cell Saver has proven an important adjunct in surgical patients in whom greater than 1,000 cm3 of blood will be lost, as well as in emergency patients. It provides an efficient, economical and safe method to autotransfuse blood.