High-'n'-dry? A comparison of cannabis and alcohol use in drivers presenting to hospital after a vehicular collision.

DESIGN: This was a prospective observational study. BACKGROUND AND AIMS: The characteristics of cannabis-involved motor vehicle collisions are poorly understood. This study of injured drivers identifies demographic and collision characteristics associated with high tetrahydrocannabinol (THC) concentrations. SETTING: The study was conducted in 15 Canadian trauma centres between January 2018 and December 2021. CASES: The cases (n = 6956) comprised injured drivers who required blood testing as part of routine trauma care. MEASUREMENTS: We quantified whole blood THC and blood alcohol concentration (BAC) and recorded driver sex, age and postal code, time of crash, crash type and injury severity. We defined three driver groups: high THC (THC ≥ 5 ng/ml and BAC = 0), high alcohol (BAC ≥ 0.08% and THC = 0) and THC/BAC-negative (THC = 0 = BAC). We used logistic regression techniques to identify factors associated with group membership. FINDINGS: Most injured drivers (70.2%) were THC/BAC-negative; 1274 (18.3%) had THC > 0, including 186 (2.7%) in the high THC group; 1161 (16.7%) had BAC > 0, including 606 (8.7%) in the high BAC group. Males and drivers aged less than 45 years had higher adjusted odds of being in the high THC group (versus the THC/BAC-negative group). Importantly, 4.6% of drivers aged less than 19 years had THC ≥ 5 ng/ml, and drivers aged less than 19 years had higher unadjusted odds of being in the high THC group than drivers aged 45-54 years. Males, drivers aged 19-44 years, rural drivers, seriously injured drivers and drivers injured in single-vehicle, night-time or weekend collisions had higher adjusted odds ratios (aORs) for being in the high alcohol group (versus THC/BAC-negative). Drivers aged less than 35 or more than 65 years and drivers involved in multi-vehicle, daytime or weekday collisions had higher adjusted odds for being in the high THC group (versus the high BAC group). CONCLUSIONS: In Canada, risk factors for cannabis-related motor vehicle collisions appear to differ from those for alcohol-related motor vehicle collisions. The collision factors associated with alcohol (single-vehicle, night-time, weekend, rural, serious injury) are not associated with cannabis-related collisions. Demographic factors (young drivers, male drivers) are associated with both alcohol and cannabis-related collisions, but are more strongly associated with cannabis-related collisions.

Exploring the impact of paediatric localized scleroderma on health-related quality of life: focus groups with youth and caregivers.

BACKGROUND: Paediatric localized scleroderma (LS) can negatively impact health-related quality of life (HRQoL) by causing skin fibrosis, abnormal limb development, disfigurement, and side-effects from immunosuppressive treatment. Studies to date have rarely included qualitative data gathered directly from paediatric patients with LS. OBJECTIVES: To assess the impact of LS on HRQoL among affected youth and their caregivers using qualitative description. METHODS: Youth with all subtypes of LS and their caregivers were purposively sampled to participate in age-appropriate focus groups (younger children, early adolescents, adolescents). Each group started with a drawing exercise followed by in-depth discussion of topics including skin symptoms (e.g. itch, pain, tightness), functional impairment, physical appearance, family and peer relationships, and treatment burden. Focus groups were transcribed verbatim and co-coded, with adjudication of differentially applied codes. The study findings were triangulated via comparison with adult reports and published literature. RESULTS: Eleven youth aged 9-16 years and 16 caregivers participated in three focus groups each. Major identified areas of impact included uncomfortable skin symptoms, physical functioning limitations, extracutaneous manifestations, body image, bullying and teasing, unwanted questioning from others, and treatment side-effects and burden. CONCLUSIONS: This is the first qualitative study of HRQoL in LS to include all major LS subtypes. We identified domains of HRQoL impacted by LS, some of which replicate earlier findings and some of which were novel. As impact also changed with developmental stage, our findings support the need for ongoing, formal evaluation of HRQoL in children and adolescents with LS. What is already known about this topic? Paediatric localized scleroderma (LS) negatively impacts health-related quality of life (HRQoL) via skin fibrosis, musculoskeletal and other extracutaneous manifestations from the disease process, and side-effects of systemic immunosuppression. The full impact of LS and its treatment on HRQoL is incompletely understood, with only one published qualitative study of youth with LS, which was limited to facial involvement. There are no qualitative studies of HRQoL in other LS subtypes to date. What does this study add? This is the first qualitative evaluation of HRQoL in youth with LS inclusive of all disease subtypes. Our study confirms that LS affects HRQoL across multiple distinct domains, including uncomfortable skin sensations, impacts on body image, bullying and teasing from peers, unwanted intrusive questioning, physical limitations, extracutaneous manifestations and high treatment burden. These results indicate the need for ongoing clinical assessment of paediatric patients in these domains. What are the clinical implications of the work? These results support the need to care for patients with LS holistically by synthesizing cutaneous, musculoskeletal and extracutaneous disease assessments with multidimensional evaluation of psychosocial impact and adverse effects of treatments. The development of an LS-specific HRQoL measure would advance such efforts.

British Dietetic Association evidence-based guidelines for the protein requirements of adults undergoing maintenance haemodialysis or peritoneal dialysis.

BACKGROUND: Existing nutritional guidelines suggest that protein requirements of adults with stage five chronic kidney disease undergoing haemodialysis (HD) or peritoneal dialysis (PD) are increased as a result of protein losses during dialysis. The present review aimed to update previous guidance and develop evidence-based practice guidelines on the protein requirements of adults undergoing maintenance dialysis. METHODS: Following a PICO approach (Participants or Population, Intervention or Exposure, Comparison and Outcome), four research questions were formulated to investigate the total protein requirement and protein quality required by adults undergoing HD and PD. A comprehensive, systematic review was undertaken using the databases Medline, EMBASE and the Cochrane Library from 2005 to September 2009 for HD studies and from 1997 to September 2009 for PD studies. RESULTS: The literature search yielded 2931 studies, which were assessed for inclusion. Following appraisal, 19 studies in HD and 18 studies in PD met the inclusion criteria and were systematically reviewed. Limited good quality evidence supports the recommendations that: (i) adults undergoing maintenance HD require a minimum protein intake of 1.1 g kg(-1) ideal body weight (IBW) per day; and (ii) adults undergoing maintenance PD require a minimum protein intake of 1.0-1.2 kg(-1) IBW per day, in conjunction with an adequate energy intake. There were no studies that addressed the quality of protein for either HD or PD. CONCLUSIONS: Evidence suggests that nutritional status may be maintained with lower protein intakes than previously recommended. However, the evidence base is limited and further randomised controlled trials are required to establish the optimal protein intake for dialysis patients.

Urea metabolism in beef steers fed tall fescue, orchardgrass, or gamagrass hays.

Two experiments were conducted to assess effects of endophyte treatments (Exp. 1), forage species (Exp. 2), and supplementation (Exp. 2) on urea production, excretion, and recycling in beef steers. Infusion of (15,15)N-urea and enrichment of urea in urine samples were used to calculate urea-N entry and recycling to the gut. Acceptably stable enrichment of (15)N-urea in urine was obtained after 50 h of intrajugular infusion of (15,15)N-urea, indicating that valid data on urea metabolism can be obtained from steers fed forages twice daily. After adjustment by covariance for differences in N intake among treatments in Exp. 1, steers fed endophyte-infected tall fescue had less (P<0.10) urea-N entry, recycling to the gut, and return of recycled urea-N to the ornithine cycle than those fed endophyte-free or novel endophyte-infected tall fescue. However, urea-N urinary excretion or return to the gut was similar among endophyte treatments when expressed as a proportion of urea-N entry. Urea-N entry and return to the gut in Exp. 2 was similar in steers fed gamagrass or orchardgrass hay after adjustment by covariance for differences in N intake. Less (P<0.01) urinary excretion, expressed as grams per day or as a proportion of urea-N entry, with gamagrass than with orchardgrass was associated with faster in vitro NDF-N digestion with gamagrass. Supplementation of gamagrass or orchardgrass with 1.76 kg/d of readily fermentable fiber and starch decreased urea entry (P<0.06) and urinary excretion of urea (P<0.01). Interactions between hay source and supplement reflected a greater response to supplementation for steers fed orchardgrass than for those fed gamagrass. After adjustment for differences among treatments in N supply, results of both experiments support the concept of improved N use in response to increased carbohydrate fermentability in the rumen, due either to inherent differences in forage fiber or to supplementation with readily fermentable carbohydrate (starch or fiber). Closer coordination of ruminal fermentation of carbohydrate and N sources provided greater and more efficient capture of dietary N as tissue protein in forage-fed steers.

Heparin versus placebo for acute coronary syndromes.

BACKGROUND: Acute coronary syndromes (ACS) represent a spectrum of disease including unstable angina (UA) and non-ST segment myocardial infarction (NSTEMI). Despite treatment with aspirin, beta-blockers and nitroglycerin, UA/NSTEMI is still associated with significant morbidity and mortality. Although emerging evidence suggests that low molecular weight heparin (LMWH) is more efficacious compared to unfractionated heparin (UFH), there is limited data to support the role of heparins as a drug class in the treatment of ACS. OBJECTIVES: To determine the effect of heparins (UFH and LMWH) compared with placebo for the treatment of patients with ACS. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials on The Cochrane Library (issue 4, 2002), MEDLINE (1966 to May 2002), EMBASE (1980 to May 2002) and CINAHL (1982 to May 2002). Authors of included studies and pharmaceutical industry representatives were contacted to determine if unpublished studies which met the inclusion criteria were available. SELECTION CRITERIA: Randomized controlled trials of parenteral UFH or LMWH versus placebo in people with ACS (UA or NSTEMI). DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed quality of studies. Data were extracted independently by two reviewers. Study authors were contacted to verify and clarify missing data. MAIN RESULTS: Eight studies (3118 participants) were included in this review. We found no evidence for difference in overall mortality between the groups treated with heparin and placebo (RR = 0.84, 95% CI 0.36 to 1.98). Heparins reduced the occurrence of MI (RR = 0.40, 95% CI 0.25 to 0.63, NNT = 33). An increase in the incidence of minor bleeds (RR = 6.80, 95% CI 1.23 to 37.49, NNH = 17). AUTHORS' CONCLUSIONS: Compared to placebo, patients treated with heparins had similar risk of mortality, revascularization, recurrent angina, major bleeding and thrombocytopenia. However, those treated with heparins had decreased risk of MI and a higher incidence of minor bleeding.

Basic fibroblast growth factor has rapid bone anabolic effects in ovariectomized rats.

Basic fibroblast growth factor (bFGF) has a strong bone anabolic effect in intact and ovariectomized (OVX) rats treated for 7-14 days. Other growth factors such as IGF-I and TGF-beta have been implicated as potential mediators for this effect. The purpose of this study was to examine the early effects of bFGF therapy, in vivo, on bone formation and gene expression in OVX rats in order to determine whether upregulation of gene expression for IGF-I and/or TGF-beta precedes or coincides with the stimulatory effects of bFGF on bone formation. At 3 months of age, Sprague Dawley rats were OVX or sham-operated (SHAM), then maintained untreated for 3 months. One group of baseline OVX rats (BSL OVX) and BSL SHAM rats were then killed. Additional OVX groups were treated IV with bFGF at a daily dose of 200 microg/kg and killed at 1-7 and 10 days. Another group of OVX rats was treated IV with vehicle daily for 10 days, then killed. Lumbar vertebrae were processed for cancellous bone histomorphometry or RNA isolation. Ovariectomy induced increased cancellous bone turnover and a significant decrease in vertebral bone mass. Treatment of OVX rats with bFGF resulted in a significant increase in bone formation. As early as 24 h after bFGF treatment of OVX rats, osteoblast surface, osteoid surface, and osteoid volume were more than double those in BSL OVX rats and continued to increase with time. These variables were also significantly higher in bFGF-treated OVX rats at 10 days compared with vehicle-treated OVX rats. Gene expression for IGF-I was not different between BSL OVX rats and bFGF-treated OVX rats at 1 day, but was significantly higher by approximately 50% in OVX rats treated with bFGF for 2 and 7 days, and was also significantly higher by nearly 75% in OVX rats treated for 10 days compared with OVX rats treated with vehicle. Gene expression for TGF-beta1 was unchanged at early times and only significantly upregulated by a relatively modest 30% in OVX rats treated with bFGF for 10 days. The results indicate that the bone anabolic effects of bFGF in OVX rats begin as early as 24 h following the initial treatment, and increase with time. These early stages of the strong stimulatory effect of bFGF on bone formation were not associated with a large upregulation of gene expression for IGF-I and TGF-beta. The rapid increase in osteoblast surface in bFGF-treated OVX rats suggests that the growth factor induces conversion of bone lining cells to osteoblasts.

Bone anabolic effects of subcutaneous treatment with basic fibroblast growth factor alone and in combination with estrogen in osteopenic ovariectomized rats.

Although basic fibroblast growth factor (bFGF) is a potent stimulator of bone formation when administered intravenously, less is known regarding the effects of this peptide on bone following subcutaneous (s.c.) administration. In addition, it is unknown whether coadministration of estrogen enhances the bone response to treatment with bFGF. Therefore, the purpose of this study was (1) to characterize the skeletal response to s.c. injection of a high dose of bFGF, and (2) to determine whether concurrent administration of estrogen affects the skeletal response to bFGF treatment. Female Sprague-Dawley rats were ovariectomized (ovx) or sham-operated (sham) at 3 months of age and left untreated for 2 months to establish cancellous osteopenia in the ovx group. The sham rats (n=10) and one group of ovx rats (n=9) were then injected s.c. with vehicle alone for 3 weeks. Two additional groups of ovx rats were injected s.c. with bFGF (n=10) or with bFGF + estrogen (n=10) for 3 weeks. bFGF was administered s.c. at a daily dose of 1 mg/kg/day and estrogen was administered s.c. 4 days per week at a dose of 10 microg/kg for the 3-week duration of treatment. Lumbar vertebrae were collected and processed undecalcified for quantitative bone histomorphometry. Cancellous bone volume was lower and cancellous bone turnover was higher in vehicle-treated ovx rats than in vehicle-treated sham rats. Subcutaneous treatment of ovx rats with bFGF for 3 weeks resulted in a 4-fold increase in osteoblast surface and an 8-fold increase in osteoid surface in comparison to vehicle treatment of ovx rats. Osteoid volume was also markedly increased in the bFGF-treated ovx rats (7 +/- 4%) in comparison to vehicle-treated ovx rats (<0.1%). Osteoblast surface, osteoid surface, and osteoid volume were nearly identical in ovx rats treated with bFGF alone and with bFGF + estrogen. Although the majority of the osteoid in bFGF- and bFGF + estrogen-treated animals was deposited along mineralized bone surfaces, osteoid spicules without any connections to preexisting bone surfaces were also detected, providing definitive proof for bone formation within bone marrow in response to bFGF administration. Osteoclast surface, an index of bone resorption, was not affected by bFGF treatment. However, cotreatment of ovx rats with bFGF + estrogen resulted in lower osteoclast surface in comparison to treatment of ovx rats with either vehicle or bFGF alone. In summary, these findings indicate that administration of a high dose of bFGF via s.c. injection markedly increases bone formation and may be a useful treatment for cancellous osteopenia in the estrogen-deplete skeleton. The anabolic effects of bFGF on bone are not enhanced by concurrent treatment with estrogen at the replacement dose used in this study.

Low molecular weight heparins versus unfractionated heparin for acute coronary syndromes.

BACKGROUND: Acute coronary syndromes (ACS) are an important source of morbidity and mortality. Despite weak evidence for the use of unfractionated heparin (UFH) for acute coronary syndromes it is considered an accepted treatment for unstable angina and non-ST segment elevation myocardial infarction (MI). However, evidence suggests low molecular weight heparins (LMWH) are safer and more effective than UFH in the treatment and prevention of other thrombotic disorders. OBJECTIVES: To assess the effects of LMWH compared to UFH for acute coronary syndromes. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register (the Cochrane Library issue 4, 2000), MEDLINE (January 1966 to December 2000), EMBASE (1980 to December 2000) and CINAHL (1982 to December 2000) and reference lists of articles. Authors of all include studies and pharmaceutical industry representatives were contacted to determine if unpublished studies which met the inclusion criteria were available. SELECTION CRITERIA: Randomized controlled trials of subcutaneous LMWH versus intravenous UFH in people with acute coronary syndromes (unstable angina or non-ST segment elevation MI). DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed quality of studies. Data were extracted independently by two reviewers. Study authors were contacted to verify and clarify missing data. MAIN RESULTS: We identified 27 potentially relevant studies, 7 studies (11,092 participants) were included in this review. We found no evidence for difference in overall mortality between the groups treated with LMWH and UFH (RR = 1.0; 95% CI: 0.69, 1.44). Some pooled outcomes showed some evidence of heterogeneity, few of the pooled outcomes were statistically heterogeneous most were homogeneous. LMWH reduced the occurrence of MI (RR = 0.83; 95% CI: 0.70, 0.99) and the need for revascularization procedures (RR = 0.88; 95% CI: 0.82, 0.95). We found no evidence for difference in occurrence of recurrent angina (RR = 0.83; 95% CI: 0.68, 1.02), major bleeds (RR = 1.00; 95% CI: 0.80, 1.24) or minor bleeds (RR = 1.40; 95% CI: 0.66, 2.90). A decrease in the incidence of thrombocytopenia (RR = 0.64; 95% CI: 0.44, 0.94) was observed for patients given LMWH. From these results, 125 patients need to be treated with LMWH to prevent 1 additional MI and 50 patients need to be treated to prevent 1 revascularization procedure. Insufficient data exist to compare different types of LMWH. REVIEWER'S CONCLUSIONS: LMWH and UFH had similar risk of mortality, recurrent angina, and major or minor bleeding but LMWH had decreased risk of MI, revascularization and thrombocytopenia. New Trials with longer follow up are required.

Comparison of methods for erythroblast selection: application to selecting fetal erythroblasts from maternal blood.

BACKGROUND: Many methods have been employed to obtain fetal cells from maternal blood for prenatal diagnostics, but there has been little work done that compares the efficacy of different methods. This study presents a comparison of two commonly used methods for selecting erythroblasts with selection directly from whole blood. METHODS: Erythroblasts were isolated from maternal blood by either differential lysis or density separation, followed by selection with an antibody to the transferrin receptor. These methods were compared with antibody selection directly from whole blood. The total yield of erythroblasts was determined for each method. RESULTS: Red cell lysis is not recommended because the lysis step cannot be well controlled. Density separation followed by antibody selection works well. However, a faster and simpler method, antibody selection directly from whole blood using Immunicon Ferrofluid and magnetic separators, works as well and has the potential to yield even more cells. CONCLUSIONS: Considering the need for a simple and quick method for selecting fetal cells from maternal blood, we suggest selection directly from whole blood.

Infant mental health and variability of parental depression symptoms.

OBJECTIVE: To examine the course of mothers' depression symptoms in association with child and family functioning beyond that explained by diagnostic status. METHOD: A longitudinal high-risk design with 16 months of course-of-illness follow-up was used. Structured clinical and family interviews, direct observation of child social-emotional competence, and parent reports of child behavior problems were included. RESULTS: Parameters of maternal symptom patterns across time were associated with child and family functioning. Most of these effects remained when presence/absence of major depression diagnosis was covaried. CONCLUSIONS: The trajectory of symptoms over time is important to consider in studies of children at risk and may also help to inform how illness in infancy and early childhood is conceptualized.

Collection of process data after cardiac surgery: initial implementation with a Java-based intranet applet.

BACKGROUND: Using a Java-based intranet program (applet), we collected postoperative process data after coronary artery bypass grafting. METHODS: A Java-based applet was developed and deployed on a hospital intranet. Briefly, the nurse entered patient process data using a point and click interface. The applet generated a nursing note, and process data were saved in a Microsoft Access database. In 10 patients, this method was validated by comparison with a retrospective chart review. In 45 consecutive patients, weekly control charts were generated from the data. When aberrations from the pathway occurred, feedback was initiated to restore the goals of the critical pathway. RESULTS: The intranet process data collection method was verified by a manual chart review with 98% sensitivity. The control charts for time to extubation, intensive care unit stay, and hospital stay showed a deviation from critical pathway goals after the first 20 patients. Feedback modulation was associated with a return to critical pathway goals. CONCLUSIONS: Java-based applets are inexpensive and can collect accurate postoperative process data, identify critical pathway deviations, and allow timely feedback of process data.

Galileo at Io: results from high-resolution imaging.

During late 1999/early 2000, the solid state imaging experiment on the Galileo spacecraft returned more than 100 high-resolution (5 to 500 meters per pixel) images of volcanically active Io. We observed an active lava lake, an active curtain of lava, active lava flows, calderas, mountains, plateaus, and plains. Several of the sulfur dioxide-rich plumes are erupting from distal flows, rather than from the source of silicate lava (caldera or fissure, often with red pyroclastic deposits). Most of the active flows in equatorial regions are being emplaced slowly beneath insulated crust, but rapidly emplaced channelized flows are also found at all latitudes. There is no evidence for high-viscosity lava, but some bright flows may consist of sulfur rather than mafic silicates. The mountains, plateaus, and calderas are strongly influenced by tectonics and gravitational collapse. Sapping channels and scarps suggest that many portions of the upper approximately 1 kilometer are rich in volatiles.

High-density hapten labeling and HRP conjugation of oligonucleotides for use as in situ hybridization probes to detect mRNA targets in cells and tissues.

Oligonucleotides that carry a detectable label can be used to probe for mRNA targets in in situ hybridization experiments. Oligonucleotide probes (OPs) have several advantages over cDNA probes and riboprobes. These include the easy synthesis of large quantities of probe, superior penetration of probe into cells and tissues, and the ability to design gene- or allele-specific probes. One significant disadvantage of OPs is poor sensitivity, in part due to the constraints of adding and subsequently detecting multiple labels per oligonucleotide. In this study, we compared OPs labeled with multiple detectable haptens (such as biotin, digoxigenin, or fluorescein) to those directly conjugated with horseradish peroxidase (HRP). We used branching phosphoramidites to add from two to 64 haptens per OP and show that in cells, 16-32 haptens per OP give the best detection sensitivity for mRNA targets. OPs were also made by directly conjugating the same oligonucleotide sequences to HRP. In general, the HRP-conjugated OPs were more sensitive than the multihapten versions of the same sequence. Both probe designs work well both on cells and on formaldehyde-fixed, paraffin-embedded tissues. We also show that a cocktail of OPs further increases sensitivity and that OPs can be designed to detect specific members of a gene family. This work demonstrates that multihapten-labeled and HRP-conjugated OPs are sensitive and specific and can make superior in situ hybridization probes for both research and diagnostic applications.

Ex vivo human placental transfer and the vasoactive properties of hydralazine.

OBJECTIVE: The purpose of this study was to determine the placental transfer and fetal vascular effects of hydralazine in an ex vivo human placental system. STUDY DESIGN: Nine placentas from uncomplicated term vaginal or cesarean deliveries were studied by means of the ex vivo single-cotyledon perfusion system. Antipyrine was used for the reference compound in the determination of the clearance index of hydralazine. Fetal vascular effects of hydralazine were determined by the effects on the perfusion pressure of the fetal artery in a constant-flow open system. Variations in fetal pressure were analyzed with the 1-sample Student t test. RESULTS: The clearance index of hydralazine ranged from 0.61 +/- 0. 18 to 0.73 +/- 0.14. The accumulation of hydralazine in the recirculated fetal compartment was linear in relationship to the maternal concentration. Fetal pressure changes were noted in 6 of the 9 placentas, or 66.6%. The mean change in pressure was -4.1 +/- 4.4 mm Hg (P =.0231). CONCLUSIONS: Hydralazine readily crosses the ex vivo human placental perfusion system.

Pregnancy and renal tubular acidosis.

Renal tubular acidosis (RTA) is uncommonly encountered in pregnancy. The risk for these women to develop pregnancy-induced hypertension has not been previously described. The renal defect noted in these women, aggravated by the normal hypervolemia of pregnancy, may predispose to hypertension. Three pregnancies in two women with RTA type 1 developed persistent diastolic hypertension in the third trimester. Mild renal insufficiency was noted in each woman as defined by serum creatinine of 0.9-1.1 and 1.4-1.6 mg/dL, respectively. Vaginal delivery was achieved in each without complications. Blood pressures returned to normal following each pregnancy. Pregnancy-induced hypertension developed in each of three pregnancies in two patients with RTA type 1. The risk for these women to develop pregnancy-induced hypertension may be associated with the higher reported risk in women with underlying renal disease.

Angiogenesis correlates with metastasis in melanoma.

BACKGROUND: Angiogenesis has been correlated with melanoma progression, but its role in melanoma metastasis is unclear. METHODS: To determine whether angiogenesis correlates with the presence of melanoma metastases, we compared the number of microvessels in the primary melanomas of 12 patients presenting with metastases to those of 13 patients without metastases. Patient groups were matched for gender, age, tumor depth, and histological type and anatomical location of the primary melanoma. Microvessels were stained with factor VIII antibody and counted. RESULTS: Microvessel counts were significantly greater for the metastatic than the nonmetastatic melanomas (51.63+/-14.95 vs. 24.86+/-8.415; P < .0001). One hundred percent of the metastatic melanomas had a mean microvessel count of > or = 37, whereas only 8% of the nonmetastatic melanomas had a mean microvessel count of > or = 37 (sensitivity = 1.00, specificity = .92). Interestingly, patients with lymph node metastases had significantly lower microvessel counts than did patients with distant metastases (42.00+/-3.482 vs. 58.50+/-16.40; P < .05), and significantly higher microvessel counts than did patients without metastases (42.00+/-3.482 vs. 24.86+/-8.415; P < .001). CONCLUSIONS: An increased number of microvessels in the primary tumors of patients with melanoma correlates with the simultaneous presence of metastases. This suggests that angiogenesis may be important in the process of melanoma metastasis.

Comparison of upper limb muscle activity in four walking canes: a preliminary study.

It is hypothesized that the cane and forearm can be aligned to reduce muscular activity needed during ambulation. In this prospective study, 10 nonimpaired control subjects were tested both in stationary and dynamic weight-bearing states while using different cane prototypes and the platform cane (PC) as compared to the standard cane (SC). The outcome measures were: 1) root mean square (RMS) voltage (µV) of electromyographic (EMG) signal as a measure of muscle power and 2) distance of ambulation. Results of stationary cane use showed that Prototype 1 decreased RMS output by 19 percent (p=0.01), Prototype 2 with wrist splint decreased it by 23 percent (p=0.003), and the PC decreased it by 68 percent (p<0.0001) as compared to the SC (ANOVA, posthoc LSM). In conclusion, the two prototypes and the PC significantly decrease RMS voltage muscle output in the upper limb, compared to the SC.