The dynamic change of circulating tumour cells in patients with operable breast cancer before and after chemotherapy based on a multimarker QPCR platform.

BACKGROUND: The possible presence of early tumour dissemination is the rationale behind the use of systemic adjuvant chemotherapy in patients with operable breast cancer. Circulating tumour cells (CTC) in peripheral blood may represent the possible presence of early tumour dissemination. However, relatively few studies were designed to investigate the relationship between the change of CTC status and the efficacy of adjuvant chemotherapy in operable breast cancer patients. METHODS: In a prospective study, we established a multimarker real-time quantitative PCR platform to detect CTC in peripheral blood of breast cancer patients. By using this platform, we detected CTC in peripheral blood of 94 operable breast cancer patients. Control group consisted of 20 patients with benign breast disease and 20 healthy volunteers. For 72 patients who underwent systemic adjuvant chemotherapy, the dynamic CTC status at three different time points (1 day before initiation of chemotherapy, 1 week after three cycles of chemotherapy and 1 week after all cycles of chemotherapy) was observed. RESULTS: Circulating tumour cells were detected in 56% (53 out of 94) of patients with operable breast cancer. The specificity was 95%. Seventy-two patients who received systemic adjuvant chemotherapy were followed up. After three cycles of chemotherapy, 47% (18 out of 38) of patients who were CTC-positive before chemotherapy changed into negative status. In addition, another 5% (2 out of 38) of patients had changed into negative status after all cycles of chemotherapy. CONCLUSION: Systemic adjuvant chemotherapy had a significant impact on CTC status, and this effect could be observed after three cycles of chemotherapy. Circulating tumour cells detection had the potential to be used to evaluate the efficacy of systemic adjuvant chemotherapy immediately after the chemotherapy was finished in operable breast cancer patients.

Membrane changes in a single photoreceptor cause associative learning in Hermissenda.

Single type B photoreceptors in intact, restrained Hermissenda were impaled with a microelectrode and exposed to either paired or unpaired presentations of light and depolarizing current to simulate natural stimulus effects during conditioning with light and rotation. Paired, but not unpaired, stimulus presentations produced cumulative depolarization and increased input resistance in type B cells. These membrane changes are similar to those observed after pairings of light and rotation are administered to either intact animals or isolated nervous systems or when light is paired with electrical stimulation of the vestibular system in isolated nervous systems. One and two days after treatment, pairing- and light-specific suppression of phototactic behavior was observed in recovered animals. These findings indicate that the membrane changes of type B cells produced by pairing light with current injections cause acquisition of the learned behavior.

Pseudomonas aeruginosa transmission is infrequent in New Zealand cystic fibrosis clinics.

Pseudomonas aeruginosa is an important pathogen in cystic fibrosis (CF). Although most patients harbour unique P. aeruginosa isolates, some clinics report patients sharing common strains. The overall importance of person-to-person transmission in P. aeruginosa acquisition and whether routine patient segregation is necessary remains uncertain. The present authors therefore investigated the extent of P. aeruginosa transmission in New Zealand CF clinics. New Zealand's seven major CF centres were assessed, combining epidemiological data with computer-assisted SalI DNA fingerprinting of 496 isolates from 102 patients. One cluster of related isolates was significantly more prevalent in the largest clinic than expected by chance. The seven patients with isolates belonging to this cluster had more contact with each other than the remaining patients attending this centre. No other convincing evidence of transmission was found in any of the other smaller clinics. Three P. aeruginosa strains believed to be transmissible between patients in Australian and British CF clinics are present in New Zealand, but there was no definite evidence they had spread. Pseudomonas aeruginosa transmission is currently infrequent in New Zealand cystic fibrosis clinics. This situation could change rapidly and ongoing surveillance is required. The current results confirm that computer-assisted SalI DNA fingerprinting is ideally suited for such surveillance.

Comparison of single-dose meperidine, butorphanol, and dihydroergotamine in the treatment of vascular headache.

We treated 64 emergency room patients with a primary vascular headache with dihydroergotamine (DHE), meperidine, or butorphanol. Post-treatment pain scores were lowest in the DHE group (p less than 0.01). Eight of 21 patients receiving DHE had greater than 90% reduction in pain compared with three of 19 patients receiving butorphanol and none of 22 receiving meperidine.

Emergency center categorization standards.

The SAEM EC Categorization Task Force was developed in response to the 1994 Macy Foundation's recommendation that emergency medicine (EM) organizations "should revise the classification of emergency departments ... to reflect the level of care available in emergency departments, and indicate whether or not facilities are adequate and whether appropriately qualified and credentialed emergency physicians are available 24 hours a day." By holding Level 1 emergency centers (ECs) to objective standards based on the quality of care delivered as well as administrative, research, and educational efforts, SAEM hopes to improve patient care. The SAEM EC Categorization Task Force is now beginning the process of reviewing ECs that provide comprehensive emergency care and serve as regional resources for education, research, and administration in EM. This standards document describes relative and critical criteria to be met in order to receive designation as a Level 1 emergency center. Such centers must meet all critical criteria, and be in sufficient compliance with most or all relative criteria, in order to achieve this designation. This process is entirely voluntary. Any EC is eligible for review. Any institution can initiate the review process by applying. Application materials and further information, including the policies and procedures of the SAEM EC Categorization Task Force, are available from SAEM.

Response of regenerative tissues to plaque: a histological study in monkeys.

This study was designed to determine the histologic response of regenerated tissue to plaque, using an adult Taiwan monkey model with chronically-inflamed, surgically-created, periodontal defects. Standardized 2-walled periodontal defects were surgically created at the mesial of the mandibular lateral incisor on one side. Sutures, 3-0 braided silk, were placed for 8 weeks and tissues positioned so that denuded root surfaces were exposed to plaque, with the subsequent development of the chronically-inflamed periodontal tissues. At 8 weeks the defects were subjected to guided tissue regeneration procedures using expanded polytetrafluoroethylene membrane and allowed to heal for 6 months. Contralateral clinically healthy sites, without surgical procedures, were used as controls. In both experimental (membrane) and control sites, silk ligatures were placed to allow plaque accumulation for 2 or 10 weeks. Four monkeys were sacrificed at each time point and specimens processed for histologic and histometric study. The results indicated that plaque-induced inflammation was less at sites treated by guided tissue regenerative procedures when compared to originally clinically-healthy sites exposed to plaque for the same duration. However, histologically the newly formed osseous tissue was compromised under these conditions.

Diltiazem overdose: case report and review.

We present a case of diltiazem overdose in which the patient ingested 4.2 grams in an apparent suicide attempt. He arrived in the emergency department two hours postingestion with a blood pressure of 60/40 torr and a heart rate of 62 beats/min in a junctional rhythm. Intervention included activated charcoal, gastric lavage, intravenous fluids, calcium (both chloride and gluconate), dopamine, and atropine with improvement in vital signs. Diltiazem levels were obtained and half-life calculated. This ingestion is one of the largest reported in the literature and is remarkable in that the patient recovered without pacing or other extraordinary measures. All eight previously published cases of diltiazem overdose, including all unpublished reports to the manufacturer, are reviewed and their management strategies examined. Successful treatment in which recovery has occurred in less than 48 hours, includes pressors, calcium, glucagon, pacing, and charcoal hemoperfusion. A strategy for emergency physicians to use when approaching this problem is suggested from the review.

How serious is the radon problem?

In the last year or two, a vast array of radon-detection kits has appeared in stores and catalogs. The authors explain what radon is and why it has captured the interest of the American public. They also examine the extent and significance of the radon problem and suggest solutions for homes that are found to have a high concentration.

The effect of a teflon membrane to augment the healing of extraction sockets in monkeys.

The present study was undertaken in 9 monkeys to test the effect of a teflon membrane to augment the healing of extraction sockets. The 4 lateral incisors of each animal were extracted using a surgical flap approach. Two of the sockets on one side were covered with teflon membrane (experimental sites), while the same procedure was repeated with the exception of the applications of the teflon membrane on the remaining two sockets of the contralateral side (controls). The distal surfaces of the central incisors were notched at the level of the crest of the alveolar bone as the reference points for measurements of alveolar bone response. Re-entries were performed on three monkeys at 50, 90 and 150 days after tooth extraction and the bone fill of the sockets was evaluated. It was concluded from the results that there was a tendency for the teflon membrane placement to result in a greater amount of clinical alveolar bone fill and lesser extent of bone resorption after tooth extraction.

Current concept of guided tissue regeneration with non-absorbable membrane.

Guided tissue regeneration has been well established as a treatment modality for periodontal disease. Proper case selection and delicate surgical skills can lead to the predictable success. Additionally, the GTR may also be used to treat marginal tissue recession, peri-implantitis, and palato-gingival grooves. Furthermore, osteopromotion with membrane techniques can be used as a means to provide ridge augmentation in ridge defects, or as an adjunct to implant placements. It does play a very important role in implant dentistry and aesthetic dentistry.

Attaining academic department status for emergency medicine within medical schools.

The specialty of emergency medicine has emerged as a separate academic department within medical schools. These academic departments were contacted and asked to submit information on the process they undertook to attain department status. The path taken by each department was unique and dependent on many factors. Information about these departments is summarized, and ten broad recommendations for academic emergency physicians to consider when seeking department status are given.