Validation and reproducibility of an Australian caffeine food frequency questionnaire.

The aim of this study was to measure validity and reproducibility of a caffeine food frequency questionnaire (C-FFQ) developed for the Australian population. The C-FFQ was designed to assess average daily caffeine consumption using four categories of food and beverages including; energy drinks; soft drinks/soda; coffee and tea and chocolate (food and drink). Participants completed a seven-day food diary immediately followed by the C-FFQ on two consecutive days. The questionnaire was first piloted in 20 adults, and then, a validity/reproducibility study was conducted (n = 90 adults). The C-FFQ showed moderate correlations (r = .60), fair agreement (mean difference 63 mg) and reasonable quintile rankings indicating fair to moderate agreement with the seven-day food diary. To test reproducibility, the C-FFQ was compared to itself and showed strong correlations (r = .90), good quintile rankings and strong kappa values (κ = 0.65), indicating strong reproducibility. The C-FFQ shows adequate validity and reproducibility and will aid researchers in Australia to quantify caffeine consumption.

Distribution and presentation of Lyme borreliosis in Scotland - analysis of data from a national testing laboratory.

This study examines the distribution of laboratory-confirmed cases of Lyme borreliosis in Scotland and the clinical spectrum of presentations within NHS Highland. Methods General demographic data (age/sex/referring Health Board) from all cases of Lyme borreliosis serologically confirmed by the National Lyme Borreliosis Testing Laboratory from 1 January 2008 to 31 December 2013 were analysed. Clinical features of confirmed cases were ascertained from questionnaires sent to referring clinicians within NHS Highland during the study period. Results The number of laboratory-confirmed cases of Lyme borreliosis in Scotland peaked at 440 in 2010. From 2008 to 2013 the estimated average annual incidence was 6.8 per 100,000 (44.1 per 100,000 in NHS Highland). Of 594 questionnaires from NHS Highland patients: 76% had clinically confirmed Lyme borreliosis; 48% erythema migrans; 17% rash, 25% joint, 15% neurological and 1% cardiac symptoms. Only 61% could recall a tick bite. Conclusion The incidence of Lyme borreliosis may be stabilising in Scotland but NHS Highland remains an area of high incidence. Lyme borreliosis should be considered in symptomatic patients that have had exposure to ticks and not just those with a definite tick bite.

Laboratory diagnosis of Lyme borreliosis in Scottish patients: a novel approach.

Traditional two-tier (enzyme immunoassay [EIA] screening and Western blot confirmation) testing for the laboratory diagnosis of Lyme borreliosis (LB) is expensive, lacks sensitivity in the diagnosis of early LB, cannot distinguish between current and past infection and cannot be used as a marker for treatment response. The aims of the present study is to investigate the role of the C6 EIA as a screening assay, as part of two-tier EIA test strategy, and its use as a marker of treatment response or resolving infection in a routine diagnostic laboratory. The C6 EIA was significantly less sensitive than the Enzygnost Lyme link VlsE/IgG EIA (169/249 vs. 190/249 reactive sera, respectively; P = 0.0455, Fishers exact two-tailed test). The two-EIA strategy, utilising C6 EIA confirmation, was slightly more sensitive than traditional two-tier testing (82/151 vs. 67/151 positive sera). Twenty-seven patients were positive by the two-EIA strategy but negative by Western blot, raising questions of specificity, but 12 samples positive with the traditional two-tier testing were negative with the two-EIA strategy. There was no evidence to support the use of the C6 EIA for monitoring treatment response or resolving infection. The authors have devised a novel approach to detect LB in Scottish patients. For cases with a high clinical suspicion of disease, the C6 EIA could be incorporated into a two-EIA strategy, replacing the need for Western blot confirmation with a simpler, more cost-effective two-EIA strategy. Western blot confirmation would be reserved for those patients with discordant EIA results and whose clinical picture is more complex.

The impact of bilateral salpingo-oophorectomy on breast MRI background parenchymal enhancement and fibroglandular tissue.

OBJECTIVE: The objective of this study was to evaluate the effect of bilateral salpingo-oophorectomy (BSO) on background parenchymal enhancement (BPE) and the amount of fibroglandular tissue (FGT) seen on breast MRI. METHODS: Retrospective review identified 21 BRCA mutation carriers who underwent breast MRI before and after elective BSO. After exclusion of patients placed on postoperative hormone replacement therapy, there were 18 eligible patients. Blinded to surgical status, three independent readers used categorical scales to rate BPE (minimal, mild, moderate, marked) and the amount of FGT (fatty, scattered, heterogeneously dense, dense) on pre- and post-BSO MRI examinations. The sign test was used to assess for changes in the categorical ratings of BPE and FGT. RESULTS: Significant proportions of women demonstrated decreases in BPE and in the amount of FGT following oophorectomy (P = 0.004 and 0.02, respectively.) BPE decreases were larger and seen earlier than FGT changes. There was no significant relationship between age/body mass index and changes in BPE and FGT. CONCLUSIONS: BPE and the amount of FGT seen on breast MRI are significantly decreased by oophorectomy; BPE decreases to a greater extent and earlier than FGT. KEY POINTS: • Background parenchymal enhancement significantly decreases at breast MRI following oophorectomy. • Fibroglandular tissue significantly decreases on breast MRI following oophorectomy. • Decrease in background parenchymal enhancement is greater than in fibroglandular tissue. • Decrease in background parenchymal enhancement occurs earlier than in fibroglandular tissue.

Insect succession and decomposition of wildlife carcasses during fall and winter in Louisiana.

Fourteen fresh animal carcasses were monitored throughout decomposition in a mixed flatwood forest in East Baton Rouge Parish, LA, from 5 October to 7 December 1999 (fall) and from 18 January to 30 March 2000 (winter). Species composition and residency patterns of necrophilous insects were documented for four animal species per seasonal experiment: one Louisiana black bear (threatened species), two white-tailed deer, two alligators, and two swine (experimental reference). Results suggested variation in species composition associated with temperature (fall versus winter conditions) and carcass type. In total, 89 species from 39 families and three classes were manually collected from the seven fall carcasses. Ninety-five species from 38 families and three classes were collected at the seven winter carcasses. Overall arthropod diversity was greatest for fall deer and winter swine carrion. Fall alligator carcasses were associated with fewer taxa than the three mammal species during both seasons. The hairy maggot blow fly, Chrysomya rufifacies (Macquart), was the dominant species of the fall study, impacting developmental rates and overall carrion community structure. The winter study was characterized by prolonged carcass decomposition and reduced insect activity due to fluctuating ambient temperatures.

Spring succession of necrophilous insects on wildlife carcasses in Louisiana.

Seven fresh animal carcasses were monitored throughout decomposition in a mixed flatwood forest in East Baton Rouge Parish, LA from 1 April to 1 July 1999. Succession patterns of necrophilous insects were documented for the following: one Louisiana black bear (threatened species), two white-tailed deer, two alligators, and two swine as the experimental reference. Our results suggest variation in the species composition of necrophilous insects among animal carcass types. A total of 93 arthropod species, from 46 families and three classes, were manually collected from the seven carcasses. Only 19 insect species were collected on all four animal types and were represented by eight families: Coleoptera: Histeridae, Nitidulidae, Silphidae, Staphylinidae; Diptera: Calliphoridae, Muscidae, Piophilidae, Sepsidae. Eleven of the 46 families were not collected at either alligator site but were observed at bear, deer, and swine carrion: Coleoptera: Cleridae, Dermestidae, Geotrupidae, Scarabaeidae; Diptera: Micropezidae, Sarcophagidae, Syrphidae; Hymenoptera: Apidae; Lepidoptera: Nymphalidae; and Odonata: Libellulidae. Residency and succession patterns of necrophilous insects are presented for each animal type with particular emphasis on selected fly (Calliphoridae, Muscidae, Piophilidae, Stratiomyidae) and beetle species (Cleridae, Dermestidae, Histeridae, Nitidulidae, Silphidae, Staphylinidae).

The Harris-Galante Porous acetabular component at intermediate follow-up.

Outcome of the acetabular component in 90 consecutive primary noncemented total hip arthroplasties (THAs) was prospectively studied. The acetabular cup consisted of a hemispherical titanium alloy shell with a titanium fiber-mesh porous coating and a modular polyethylene liner (Harris-Galante Porous-1, Zimmer, Warsaw, Ind). The cup was implanted using line-to-line reaming with adjunctive dome screw fixation. The femoral component consisted of a titanium alloy stem with titanium fiber-mesh porous coating and a 28-mm cobalt-chrome modular head. Mean patient age was 53 years (range: 27-75 years); male:female ratio was 48:42; and mean follow-up was 6 years (range: 4.5-8 years). One acetabular component was revised for aseptic loosening. Of 81 unrevised hips available for follow-up, mean Harris hip score was 57 preoperatively and 96 at final follow-up (72% excellent, 15% good, 1 3% fair, and none poor). Of 61 unrevised hips with adequate radiographic follow-up, radiographic failure (complete periprosthetic radiolucency) was evident in 3 (4.9%) and periacetabular osteolysis in none. Radiographic failure did not correlate with poor clinical outcome. Linear polyethylene wear rate (mean: 0.13 mm/year) did not correlate with age, gender, weight, outcome, or cup abduction angle, but did correlate with the presence of femoral periprosthetic osteolysis (0.18 mm/year with femoral osteolysis versus 0.11 mm/year without; P= .01). This series of porous-coated hemispherical cups demonstrated excellent intermediate-term clinical and radiographic outcome, comparable with similarly favorable results reported by the prosthesis designers. A potentially adverse effect of polyethylene wear on the longevity of a THA was supported by a positive correlation between polyethylene wear rate and femoral osteolysis.

Indomethacin versus radiation therapy for heterotopic ossification after hip arthroplasty.

This study compared the efficacy and cost of radiation therapy with indomethacin in the prophylaxis of heterotopic ossification following total hip replacement. Twenty-two patients received a radiation dose of 10 Gy in five fractions, 28 patients 8 Gy in one fraction, and 27 patients 25 mg oral indomethacin three times a day for either 7 or 21 days. Patients at higher risk for heterotopic ossification were more likely to receive radiation therapy than indomethacin. At a mean follow-up of 2 years, there were no differences in failure rates between the high-risk patients treated with radiation and the low-risk patients treated with indomethacin. Currently, the patient-billed cost of radiation is $1400 whereas the cost for indomethacin is approximately $100. Indomethacin appears to be as effective as radiation therapy in patients at low to moderate risk for heterotopic ossification and offers significant cost savings.

Timely detection of colorectal cancer in the elderly. Implications of the aging process.

Increased age is a risk factor for colorectal cancer; however, there is a lack of literature that focuses on the early detection of colorectal cancer in the elderly. The nursing process provides the conceptual basis for this article, which discusses normal bowel function, aging changes in the bowel, and colorectal cancer. A nursing care plan for alterations in bowel elimination/constipation is presented as a model.

Partial hydatidiform moles: a review.

The current study was undertaken in an effort to identify the clinical characteristics and natural history of partial moles. Three cases recently managed at Tripler Army Medical Center and 52 cases collected from the medical literature were reviewed. The mean age of the women at diagnosis was 25.6 years. The mean gestational age at diagnosis was 23.8 weeks. The most common presenting symptom was vaginal bleeding in 69 per cent of women. Although triploidy was the most frequent karyotype (68 per cent), normal 46,XY or XX karyotypes were present, and phenotypically normal infants were delivered of mothers with a coexisting molar pregnancy. Malignant trophoblastic disease occurred in 14.5 per cent of the women. All of them achieved remission with adjuvant therapy. Partial moles are considered a less virulent form of molar pregnancy. The clinical characteristics and natural history are not entirely dissimilar from the complete mole. Malignant sequelae can occur after the evacuation of a partial mole. These women should be followed with serial serum beta-HCG.

Ouabain and low extracellular potassium inhibit PTH secretion from bovine parathyroid cells by a mechanism that does not involve increases in the cytosolic calcium concentration.

We have previously found that high extracellular calcium (Ca++) concentrations inhibit PTH release in association with a threefold to fourfold rise in cytosolic Ca++ concentration. Recent data have also shown that low extracellular potassium (K+) concentration or ouabain also inhibits PTH release to an extent comparable to that seen with high Ca++ and produce a marked rise in the intracellular sodium (Na+) content. These results suggested that low K+ and ouabain might modulate PTH release through increases in cytosolic Ca++ related to alterations in Na+-Ca++-exchange. In the present studies, we have examined further the mechanism(s) by which inhibition of the Na+-K+-ATPase regulates PTH release. Exposure of cells loaded with the Ca++-sensitive dye QUIN-2 to low K+ produced a 10% to 17% increase in cytosolic Ca++ at 0.5 to 1.0 mmol/L extracellular Ca++, which was statistically significant only at 0.75 mmol/L Ca++. In contrast, low K+ caused a statistically significant decrease in cytosolic Ca++ at 1.5 to 2 mmol/L Ca++, while ouabain lowered cytosolic Ca++ significantly by 23% to 46% at all Ca++ concentrations examined (0.5 to 2 mmol/L). Low K+ or ouabain had no effect on cellular levels of ATP or GTP or intracellular pH measured using the pH-sensitive dye BCECF [2', 7'-bis(carboxyethyl)-5,6-carboxyfluorescein]. The inhibition of secretion by low K+ or ouabain, unlike that due to high extracellular Ca++, was not reversed by TPA (12-O-tetradecanoyl phorbol 13-acetate), an activator of protein kinase C. Low K+ did produce a modest (30% to 40%) lowering of agonist-stimulated but not basal cAMP content.(ABSTRACT TRUNCATED AT 250 WORDS)

Extracellular calcium potentiates the inhibitory effects of magnesium on parathyroid function in dispersed bovine parathyroid cells.

We studied the relative potencies of extracellular calcium and magnesium in inhibiting PTH release and dopamine-stimulated cAMP accumulation in dispersed bovine parathyroid cells. At 1.0 mmol/L calcium, PTH release was half-maximally suppressed by 1.8 mmol/L magnesium. At calcium concentrations in the subphysiologic range (less than or equal to 100 mumol), on the other hand, magnesium was markedly less potent as an inhibitor of these parameters. With 1.0 mmol/L EGTA and no added calcium (free calcium less than 10(-8) mol/L), half-maximal inhibition of PTH release accumulation occurred at 10 to 15 mmol/L magnesium. Extracellular calcium also markedly potentiated the inhibitory effects of extracellular magnesium on dopamine-stimulated cyclic adenosine monophosphate (cAMP) accumulation. Low magnesium concentrations (less than 1 mmol/L), on the other hand, had little effect on the sensitivity of parathyroid cells to calcium. These results do not fit a model in which calcium and magnesium independently and additively inhibit PTH release in dispersed bovine parathyroid cells. Instead, they demonstrate that the inhibition of PTH release and agonist-stimulated cAMP accumulation by magnesium are critically dependent on the presence of extracellular calcium but not vice versa. These data suggest that extracellular calcium may play an important role in the mechanism(s) by which extracellular magnesium modulates parathyroid function, perhaps through a magnesium-induced uptake of extracellular calcium.

Extracellular calcium is not necessary for acute, low calcium- or dopamine-stimulated PTH secretion in dispersed bovine parathyroid cells.

Although elevated extracellular calcium concentrations inhibit PTH release, little is known about the necessity of extracellular calcium for the secretory process in this cell type. In the studies reported here, we examined the effects of low extracellular calcium concentrations on basal and agonist-stimulated immunoreactive PTH (iPTH) release in dispersed bovine parathyroid cells. There was a difference of 15% or less in the rate of iPTH release from cells exposed for 30-60 minutes to calcium concentrations varying from less than 10(-8) mol/L to 1 mmol/L. Low calcium concentrations likewise had no effect on dopamine-stimulated iPTH secretion. We employed high performance liquid chromatography (HPLC) to demonstrate directly that EGTA did not alter the degradation of PTH in the medium and that the release of intact PTH was stimulated slightly by very low extracellular calcium concentrations. Like iPTH release, both the basal and dopamine-stimulated cAMP content in parathyroid cells were unchanged by extracellular calcium concentrations as low as 10(-8) mol/L. Following exposure of cells to EGTA for two or more hours, there was a 50% to 60% inhibition of iPTH secretion. This reduction in secretory rate was not reversible, however, by the readdition of 0.1-1.0 mmol/L calcium for one hour. These results demonstrate that the secretion of PTH differs from that of many other exocytotic systems not only in that hormonal release is inhibited at high extracellular calcium concentrations but also in that extracellular calcium is not needed for acute hormonal release.

Synthesis of 4,5-dimethoxykynuramine and its in vivo conversion to 6,7-dimethoxy-4-quinolinol.

4,5-Dimethoxykynuramine was synthesized in a three-step sequence originating with veratrole. Indirect evidence indicates that the drug was converted in vivo to the hypotensive agent 6,7-dimethoxy-4-quinolinol by the action of monoamine oxidase.

A dicentric no. 15 chromosome with two satellite regions.

A case of an inherited chromosome no. 15 with two centromeres and two satellite regions is described and its origin postulated. The chromosome appears to have no clinical significance.