Timing of adjuvant chemotherapy after laparotomy for Wilms tumor and neuroblastoma.

PURPOSE: To describe the timing of chemotherapy initiation after surgery for Wilms tumor (WT) and neuroblastoma within a dedicated children's cancer center. METHODS: A single-institution retrospective cohort study identified patients that underwent resection of unilateral WT or high-risk neuroblastoma and received adjuvant chemotherapy treatment. Adjuvant chemotherapy initiation and postoperative complications were recorded. RESULTS: Among 47 WT patients, the median time to chemotherapy initiation was 11 days [interquartile range IQR 7-14]. 3 WT patients had post-operative complications, but all preceded chemotherapy. Among 83 patients treated for high-risk neuroblastoma, the median time to chemotherapy was 11 days [IQR 9-14]. High-risk neuroblastoma patients with 30-day postoperative complications had a significantly longer time to initiation of adjuvant chemotherapy (odds ratio 1.13; p = 0.008). Many of these complications preceded and delayed the initiation of post-operative chemotherapy. No complications occurred in the group of 12 (25%) WT patients or 16 (19.3%) neuroblastoma patients who started chemotherapy ≤ 7 days after surgery. CONCLUSION: There is no association between early initiation of adjuvant chemotherapy and post-operative complications including wound healing. Early initiation of chemotherapy (≤ 7 days) is feasible in unilateral WT or high-risk neuroblastoma patients who are otherwise doing well without resulting in a preponderance of wound healing complications.

You'll feel better in the morning: slow wave activity and overnight mood regulation in interepisode bipolar disorder.

BACKGROUND: Sleep disturbances are prominent correlates of acute mood episodes and inadequate recovery in bipolar disorder (BD), yet the mechanistic relationship between sleep physiology and mood remains poorly understood. Using a series of pre-sleep mood inductions and overnight sleep recording, this study examined the relationship between overnight mood regulation and a marker of sleep intensity (non-rapid eye movement sleep slow wave activity; NREM SWA) during the interepisode phase of BD. METHODS: Adults with interepisode BD type 1 (BD; n = 20) and healthy adult controls (CTL; n = 23) slept in the laboratory for a screening night, a neutral mood induction night (baseline), a happy mood induction night, and a sad mood induction night. NREM SWA (0.75-4.75 Hz) was derived from overnight sleep EEG recordings. Overnight mood regulation was evaluated using an affect grid pleasantness rating post-mood induction (pre-sleep) and the next morning. RESULTS: Overnight mood regulation did not differ between groups following the sad or happy inductions. SWA did not significantly change for either group on the sad induction night compared with baseline. In BD only, SWA on the sad night was related to impaired overnight negative mood regulation. On the happy induction night, SWA increased relative to baseline in both groups, though SWA was not related to overnight mood regulation for either group. CONCLUSIONS: These findings indicate that SWA disruption may play a role in sustaining negative mood state from the previous night in interepisode BD. However, positive mood state could enhance SWA in bipolar patients and healthy adults.

Hypersomnia subtypes, sleep and relapse in bipolar disorder.

BACKGROUND: Though poorly defined, hypersomnia is associated with negative health outcomes and new-onset and recurrence of psychiatric illness. Lack of definition impedes generalizability across studies. The present research clarifies hypersomnia diagnoses in bipolar disorder by exploring possible subgroups and their relationship to prospective sleep data and relapse into mood episodes. METHOD: A community sample of 159 adults (aged 18-70 years) with bipolar spectrum diagnoses, euthymic at study entry, was included. Self-report inventories and clinician-administered interviews determined features of hypersomnia. Participants completed sleep diaries and wore wrist actigraphs at home to obtain prospective sleep data. Approximately 7 months later, psychiatric status was reassessed. Factor analysis and latent profile analysis explored empirical groupings within hypersomnia diagnoses. RESULTS: Factor analyses confirmed two separate subtypes of hypersomnia ('long sleep' and 'excessive sleepiness') that were uncorrelated. Latent profile analyses suggested a four-class solution, with 'long sleep' and 'excessive sleepiness' again representing two separate classes. Prospective sleep data suggested that the sleep of 'long sleepers' is characterized by a long time in bed, not long sleep duration. Longitudinal assessment suggested that 'excessive sleepiness' at baseline predicted mania/hypomania relapse. CONCLUSIONS: This study is the largest of hypersomnia to include objective sleep measurement, and refines our understanding of classification, characterization and associated morbidity. Hypersomnia appears to be comprised of two separate subgroups: long sleep and excessive sleepiness. Long sleep is characterized primarily by long bedrest duration. Excessive sleepiness is not associated with longer sleep or bedrest, but predicts relapse to mania/hypomania. Understanding these entities has important research and treatment implications.

Fat embolism syndrome after femur fracture with intramedullary nailing: case report.

Fat embolism syndrome is a life-threatening condition that can develop after orthopedic injury and surgery. This syndrome developed in a 19-year-old man after a traumatic femoral fracture that was surgically repaired with intramedullary nailing. The complications experienced by the patient highlight the importance of prevention and early detection of fat embolism syndrome. Although minimization of the syndrome focuses primarily on prehospital care and early stabilization of a patient's condition, prevention of the potential consequences requires early detection by bedside nurses who care for trauma and orthopedic patients. Detailed nursing assessment and rapid recognition and reporting of the signs and symptoms associated with fat embolism syndrome are key to improving the outcomes of these patients.

Electromyographic patterns suggest changes in motor unit physiology associated with early osteoarthritis of the knee.

OBJECTIVE: To assess characteristics of active motor units (MUs) during volitional vastus medialis (VM) activation in adults with symptomatic knee osteoarthritis (OA) across the spectrum of radiographic severity and age-comparable healthy control volunteers. METHODS: We evaluated 39 participants (age 65+/-3 years) in whom weight-bearing knee X-rays were assigned a Kellgren & Lawrence (KL) grade (18 with KL grade=0; four each with KL grades=1, 2 and 4; nine with grade 3). Electromyography (EMG) signals were simultaneously acquired using surface [surface EMG (S-EMG)] and intramuscular needle electrodes, and analyzed by decomposition-enhanced spike-triggered averaging to obtain estimates of size [surface-represented MU action potentials (S-MUAP) area], number [MU recruitment index (MURI)] and firing rates [MU firing rates (mFR)] of active MUs at 10%, 20%, 30% and 50% effort relative to maximum voluntary force [maximal voluntary isometric contraction (MVIC)] during isometric knee extension. RESULTS: Knee extensor MVIC was lower in OA participants, especially at higher KL grades (P=0.05). Taking the observed force differences into account, OA was also associated with activation of larger MUs (S-MUAP area/MVICx%effort; P<0.0001). In contrast, the estimated number of active units (MURI/MVICx%effort) changed differently as effort increased from 10% to 50% and was higher with advanced OA (KL=3, 4) than controls (P=0.0002). CONCLUSION: VM activation changes at the level of the MU with symptomatic knee OA, and this change is influenced by radiographic severity. Poor muscle quality may explain the pattern observed with higher KL grades, but alternative factors (e.g., nerve or joint injury, physical inactivity or muscle composition changes) should be examined in early OA.

A role for workforce competencies in evidence-based health promotion education

Education programs should be based on research about the knowledge and skills required for practice, rather than on intuition or tradition, but there is limited published curriculum research on health promotion education. This paper describes a case study of how workforce competencies have been used to assist evidence-based health promotion education in the areas of curriculum design, selection of assessment tasks and continuous quality assurance processes in an undergraduate program at an Australian university. A curriculum-competency mapping process successfully identified gaps and areas of overlap in an existing program. Previously published health promotion workforce competencies were effectively used in the process of selecting assessment items, providing clear guidelines for curriculum revision and a useful method to objectively assess competency content in an evidence informed framework. These health promotion workforce competencies constituted an additional tool to assess course quality. We recommend other tertiary institutions consider curriculum-competency mapping and curriculum based assessment selection as quality and evidence based curriculum review strategies. (AU)

Trampling resistance of tropical rainforest soils and vegetation in the wet tropics of north east Australia.

Controlled trampling was conducted to investigate the trampling resistance of contrasting high fertility basaltic and low fertility rhyolitic soils and their associated highland tropical rainforest vegetation in north east Australia's Wet Tropics. Although this approach has been taken in numerous studies of trampling in a variety of ecosystem types (temperate and subtropical forest, alpine shrubland, coral reef and seagrass beds), the experimental method does not appear to have been previously applied in a tropical rainforest context. Ground vegetation cover and soil penetration resistance demonstrated variable responses to trampling. Trampling, most noticeably after 200 and 500 passes reduced organic litter cover. Bulk density increased with trampling intensity, particularly on basalt soils as rhyolite soils appeared somewhat resistant to the impacts of trampling. The permeability of the basalt and rhyolite soils decreased markedly with increased trampling intensity, even after only 75 passes. These findings suggest physical and hydrological changes may occur rapidly in tropical rainforest soils following low levels of trampling, particularly on basalt soils.

RhoA-dependent switch between alpha2beta1 and alpha3beta1 integrins is induced by laminin-5 during early stage of HT-29 cell differentiation.

Integrin-mediated interactions between the basement membrane and epithelial cells control the differentiation of epithelia. We characterized the modulation of adhesive behaviors to basement membrane proteins and of integrin function in the human colon adenocarcinoma HT-29 cell line, which differentiates into enterocytes after the substitution of galactose for glucose in the medium. We demonstrate an increased capability of these cells to adhere to collagen type IV during the early stage of differentiation. This effect occurs without any changes in integrin cell surface expression but rather results from an alpha2beta1/alpha3beta1 integrin switch, alpha3beta1 integrin becoming the major collagen receptor. The increase in laminin-5 secretion and deposit on the matrix is a key factor in the mechanism regulating cell adhesion, because it is responsible for the activation of alpha3beta1 integrin. Furthermore, down-regulation of RhoA GTPase activity occurs during HT-29 cell differentiation and correlates with the activation of the integrin alpha3beta1. Indeed, C3 transferase, a RhoA GTPase inhibitor, induces a similar alpha2beta1/alpha3beta1 switch in undifferentiated HT-29 cells. These results indicate that the decrease in RhoA activation is the biochemical mechanism underlying this integrin switch observed during cell differentiation. The physiological relevance of such modulation of integrin activity in the functioning of the crypt-villus axis is discussed.

Hormone replacement therapy and longitudinal changes in blood pressure in postmenopausal women.

BACKGROUND: The incidence of hypertension in postmenopausal women exceeds that in age-matched men. Longitudinal studies relating hormone replacement therapy (HRT) to blood pressure changes are sparse. OBJECTIVE: To investigate the association between HRT and longitudinal changes in blood pressure in postmenopausal women. DESIGN: Longitudinal observational study. SETTING: Community-dwelling volunteers. PATIENTS: 226 healthy, normotensive postmenopausal women from the Baltimore Longitudinal Study of Aging with a mean (+/-SD) age of 64 +/- 10 years were followed for 5.7 +/- 5.3 years. Seventy-seven women used both estrogen and progestin, and 149 used neither. MEASUREMENTS: Lifestyle variables, blood pressure, and traditional cardiovascular risk factors were measured at baseline and approximately every 2 years thereafter. RESULTS: Systolic blood pressure at baseline was similar in HRT users and nonusers (133.9 +/- 16.0 mm Hg vs. 132.4 +/- 14.8 mm Hg). Over time, average systolic blood pressure increased less in HRT users than nonusers, independent of other cardiovascular risk factors, physical activity, and alcohol use. For example, HRT users who were 55 years of age at their first Baltimore Longitudinal Study of Aging visit experienced a 7.6-mm Hg average increase in systolic blood pressure over 10 years; in contrast, the average increase in nonusers was 18.7 mm Hg. The lesser increase in systolic blood pressure in HRT users was more evident at older age. Diastolic blood pressure, which did not change statistically over time in either group, was not associated with HRT. CONCLUSION: Postmenopausal women taking HRT have a smaller increase in systolic blood pressure over time than those not taking HRT. This difference is intensified at older ages.

Relationship between muscle strength and the time taken to complete a standardized walk-turn-walk test.

We examined the effects of age and gender on the relationship between knee strength and walking time during a walk-turn-walk test in 176 male and 168 female generally healthy participants of the Baltimore Longitudinal Study of Aging who were aged 21-89 years. Subjects were timed as they walked 50 ft (15.24 m), turned around, and walked back to the starting point, both at a comfortable pace and as fast as possible. Isokinetic concentric knee extensor strength was measured at 30 degrees /s by using a Kin-Com dynamometer. Both comfortable and fast gait times increased with increasing age for both women and men, starting in middle age. An interaction was found between gender and age showing that older women are slower than older men at both paces. Gait time decreased linearly with increasing knee extensor strength, plateauing at higher strength levels (>130 N m for comfortable gait, and 190 N m for fast gait). Most women occupied the linear part of the curve below the plateau. Adjustment for body size, age, physical activity, and particularly number of steps to complete the task removed the relationship between strength and gait time for the comfortable gait. Women took longer to complete the walk-turn-walk test than men at older ages, were on the linear part of the strength-gait time relationship, and used more steps to complete the task, all of which may contribute to their greater likelihood of frailty in later years.

Preliminary studies to develop a personal dosemeter for use by aircraft crew.

This paper describes preliminary work to develop a cosmic-radiation dosemeter for use by military aircraft crew. The dosemeter is based on a combination of CR-39 etched-track detectors and TLD-700 thermoluminescent detectors. It is intended that the CR-39 be used to assess the neutron dose, while the TLD-700 is used to assess the photon and charged particle dose. The sensitivity of CR-39 to the neutron component of cosmic radiation was estimated by irradiating samples of the plastic at the CERN-CEC High Energy Reference Field Facility. This facility produced a radiation field with a neutron spectrum resembling that of the neutron component of cosmic radiation at typical airflight altitudes. The response of the CR-39 was linear over the range of doses studied (0.2-6.0 mSv) and there was no significant fading in the 6-month period after irradiation. The TLD-700 component of the dosemeter was calibrated using 137Cs gamma rays. The response of the TLD-700 was linear over the range of doses studied (0.01-5.0 mSv) with no significant fading in the 6-month period after irradiation. It was concluded that a combination of CR-39 and TLD-700 detectors would provide an effective cosmic-radiation dosemeter for use by military aircraft crew.

Leisure-time physical activities and their relationship to cardiorespiratory fitness in healthy men and women 18-95 years old.

PURPOSE: We examined leisure-time physical activities (LTPA) and their contribution to peak oxygen consumption (VO2) in healthy men (N = 619) and women (N = 497) aged 18-95 yr (mean 51 +/- 17) who were participants of the Baltimore Longitudinal study of Aging. METHODS: Calculations of LTPA were based on the average self-reported time spent performing 97 activities and converted into MET-min x 24 h(-1). The activities were divided into three levels of LTPA based on absolute intensity. Peak VO2 was determined from a maximal treadmill exercise test. RESULTS: Total LTPA was inversely related to age in both sexes (r = -0.26, P < 0.0001 in men and r = -0.23, P < 0.0001 in women), mediated primarily by less high-intensity activities in older subjects, with only minor differences in moderate- and low-intensity activities across age. Peak VO2 correlated positively with LTPA; the correlations were strongest for high-intensity LTPA (r = 0.33 in men and 0.27 in women, each P < 0.0001), intermediate for moderate-intensity activity (r = 0.12, P < 0.004 in men and r = 0.17, P < 0.0001 in women) and minimal for low-intensity activity (r = 0.08, P = 0.05 in men and r = 0.06, P = 0.20 in women). On univariate analysis, total LTPA accounted for 12.9% of peak VO2 variance for men and 10.6% for women. By multivariate analysis, LTPA independently accounted for 1.6% of the peak VO2 variance in men and 1.8% in women after controlling for age and body mass index. CONCLUSIONS: In healthy adults across a broad age range, LTPA is a relatively minor independent contributor to aerobic capacity.

Defining and measuring balance in adults.

The ability to maintain balance is often taken for granted, yet it is the foundation for mobility and overall functional independence throughout the life span. The purpose of this article is to define balance, review the components of balance, and describe common instruments used to measure balance. Clinical screening instruments, functional performance tests, and technological measures of balance are reviewed addressing their uses, strengths, and limitations.

Isokinetic strength testing in research and practice.

Age-related losses in lower extremity strength result in functional disabilities that diminish the quality of life for many older adults. Multiple factors, including type of muscle fiber, size of the muscle, length and speed of the muscle at contraction, age, and gender, affect the magnitude of strength generated. Assessment in clinical practice, in order to be cost and time effective, screens older adults for loss in strength. Further evaluation of strength loss requires the use of sophisticated procedures and equipment. Research into the causes of loss of strength and interventions to lessen or prevent loss of strength requires valid and reliable assessment tools. This article examines components of isokinetic muscle strength, the measurement of strength in clinical practice, methods to measure isokinetic strength, and validity and reliability of these measures.

Postcomatose unawareness in a brain-injured population.

Different states of unawareness are present following a coma in the brain-injured population. An attempt to answer three questions is made based on a review of the literature and multiple case studies: Which type of sensory and motor stimulation can be suggested? Which instruments can be used to measure behaviors and what are their benefits and limitation? Does learning theory help explain the postcomatose unawareness experience? The theoretical paradigm strongly suggests employing learning theory to target a precise behavior to unmask learning potential and to use known remediation mechanisms such as errorless learning or implicit learning. Speculations in the area of unmasking potential are available; these require intervention to target specific function that could be lost with nonuse.