Political priorities and public health services in English local authorities: the case of tobacco control and smoking cessation services.

Background: Since 2013, local authorities in England have been responsible for public health including smoking cessation services. Methods: Online surveys of tobacco control leads in English local authorities were conducted in 2014 (76% response rate, n = 116), 2015 (82% response rate, n = 124) and 2016 (85% response rate, n = 129). Results: A high priority for tobacco control was reported in 17% of local authorities in 2014, rising to 27% in 2016. A low priority for tobacco control was reported in 4% of local authorities in 2014, rising to 11% in 2016. Budgets for smoking cessation services were cut in 16% of local authorities in 2014, 39% in 2015 and 59% in 2016. In 2016, budgets were cut in all local authorities where the priority given to tobacco control was perceived to be low and in 40% of the local authorities where it was perceived to be high. Cuts in smoking cessation budgets were principally due to cuts to the public health grant and wider cuts to local authority budgets. Conclusions: At a time of significant cost pressure, political support for tobacco control in English local authorities mitigates but does not remove the risk of cuts to budgets for smoking cessation services.

Primary synovial chondromatosis: a reassessment of malignant potential in 155 cases.

OBJECTIVE: Primary synovial chondromatosis (PSC) is a rare disorder characterised by cartilage formation in synovium-lined joints, tendon sheaths and bursae. It is thought that PSC cartilage arises from the proliferation of mesenchymal cells, which exhibit cartilaginous metaplasia in subintimal connective tissue. There are reports of transformation of PSC to chondrosarcoma, although the precise incidence and nature of this complication is uncertain. In this study we carried out a retrospective review PSC to determine the incidence of sarcomatous change in this condition, in addition to the clinical, radiological and pathological features that characterise this complication MATERIALS AND METHODS: We reviewed 155 cases of PSC and identified 4 cases (3 in the hip joint; 1 in the elbow joint) of aggressive behaviour and chondrosarcoma-like histology. RESULTS: Radiologically, these cases were all reported as showing features consistent with PSC and aggressive extra-articular soft tissue/bone involvement. Histologically, in addition to typical features of PSC, there was morphological evidence of peri-articular soft tissue and, in 2 cases, bone involvement by an infiltrating cartilaginous tumour. These tumours all behaved as locally aggressive neoplasms and did not give rise to metastasis. CONCLUSION: Our findings show that chondrosarcoma arises infrequently in PSC (approximately 2.5 %), and that this complication occurs most commonly in the hip joint (approximately 11 % of cases of hip PSC). These tumours behaved mainly as low-grade, locally aggressive tumours analogous to atypical cartilaginous tumour of bone/grade 1 chondrosarcoma of bone.

Effects of low-level x-irradiation on cat cerebella at different postnatal intervals. I. Quantitative evaluation of morphological changes.

Whole head fractionated doses of 200 r and 150 r were initiated postnatally in five experimental age groups (birth, 1-week, 2-week, 3-week and 4-week) and continued over a period of 14 or 20 days to prevent reconstitution of the external granular layer. Animals irradiated at birth displayed minor deficits in behavior, which included ataxia, tremor, hypertonus and dysmetria, while animals irradiated at 1-week showed only mild symptoms of hypermetria. All other animals displayed no motor deficits. Animals irradiated at birth had smaller eyes and ears, a reduction in the size of the entire head and were susceptible to seizures. All animals were sacrified at 70 days of age. The cerebellum was found to be reduced in size and weight, the greatest deficit being seen in animals x-irradiated at the very early ages. Newborn condition animals were found to have large compliments of interneurons in the molecular layer, an established internal granular layer, and Purkinje cells were found to have a normal orientation, position, and to be unreduced in number or size. Total granule cell deficits were found to range from 83% at birth to 29% at four weeks. Quantitative changes for the molecular layer, internal granular layer, medullary layer, Purkinje cell to granule cell ratio, and granule cell density, all depicted the greatest changes in the newborn, 1-week and 2-week conditions. This experiment confirmed that the critical period in the development at which damage would result in behavioral abnormalities was from birth to five days, while for neuroanatomical abnormalities, this critical period was from birth to 18 days.

Effects of low-level x-irradiation on cat cerebella at different postnatal intervals. II. Changes in Purkinje cell morphology.

The whole-head of infant kittens was irradiated with fractionated doses of 150 R and 200 R at different postnatal intervals. Experimental age conditions consisted of an irradiated newborn, 1-week, 2-week, 3-week, and a 4-week age condition while the age of sacrifice remained constant at 70 days. The molecular layer thickness was reduced by 47% in the newborn, 40% in the 1-week group, 17% in the 2-week group, 19% in the 3-week group and by 9% in the 4-week group. An evaluation of Golgi impregnated material revealed that the dendritic arborizations of purkinje cells were consistently reduced the earlier the age at which radiation was begun. A reduction in spiny branchlets was seen in all of the experimental conditions. All experimental age conditions displayed the phenomenon of dendritic "damming" at the pial surface, which consisted of an excessive crowding of spiny branches at this level. An increased growth of the primary dendrite before branching tood place was seen in the newborn and 1-week group. This became less but was still significant in the 2-week group. A correlation of this phenomenon with the presence or lack of stellate cells is disclssed. Purkinje cells with two or more dendrites emerging from their soma were classified and analyzed separately. It was found that the primary dendritic branching in these cells often followed separate morphological patterns and appeared to be independent of each other. Climbing fibers were found to conform to the abnormal dendritic arborizations of the Purkinje cells, and were reduced in complexity in the early radiation treatment groups. This suggested that climbing fibers had no influence upon the dendritic growth pattern, but instead were under the influence of the Purkinje cell dendritic growth.

Effects of low-level x-irradiation on cat cerebella at different postnatal intervals. III. Changes in the morphology of interneurons in the molecular layer.

The whole head of infant kittens was irradiated with fractionated doses of 150 R and 200 R at different postnatal intervals. Experimental age conditions consisted of a newborn, 1-week, 2-week, 3-week, and a 4-week age condition while the age of sacrifice remained constant at 70 days. Going analysis revealed that the interneurons found in the molecular layer of the newborn, 1-week and 2-week condition were basket cells. Stellate cells were found in increasing numbers in the 3-week and 4-week conditions. Basket calls were found to occupy the entire molecular layer in the newborn and 1-week conditions resulting in an abnormal axonal plexus. The position of the basket cell soma was found to be in the same plane as its axonal projection. The branching point of the primary dendrite of Purkinje cells was found to correlate with the amount of molecular layer occupied by the abnormal basket cell plexus. Interneurons in the molecular layer were found to show different dendritic growth patterns dependent upon where their soma was located. Interneurons in the deep molecular layer showed only a decreased dendritic field, whereas interneurons in the middle and superficial moledular layer had an abnormal growth of dendrites into the deep molecular layer. A hypothesis is presented to account for the decreased dendritic arborization and the increased length of the primary dendrite before branching, the ectopic basket cell and their abnormally directed dendritic growth, and the difference in behavioral deficits between the newborn and the 1-week conditions.

Clinical toxicity of peripheral nerve to intraoperative radiotherapy in a canine model.

PURPOSE: The clinical late effects of intraoperative radiotherapy (IORT) on peripheral nerve were investigated in a foxhound model. METHODS AND MATERIALS: Between 1982 and 1987, 40 animals underwent laparotomy with intraoperative radiotherapy of doses from 0-75 Gy administered to the right lumbosacral plexus. Subsequently, all animals were monitored closely and sacrificed to assess clinical effects to peripheral nerve. This analysis reports final clinical results of all animals, with follow-up to 5 years. RESULTS: All animals treated with > or = 25 Gy developed ipsilateral neuropathy. An inverse relationship was noted between intraoperative radiotherapy dose and time to neuropathy, with an effective dose for 50% paralysis (ED50) of 17.2 Gy. One of the animals treated with 15 Gy IORT developed paralysis, after a much longer latency than the other animals. CONCLUSIONS: Doses of 15 Gy delivered intraoperatively may be accompanied by peripheral neuropathy with long-term follow-up. This threshold is less than that reported with shorter follow-up. The value of ED50 determined here is in keeping with data from other animal trials, and from clinical trials in humans.

Late effects of intraoperative radiation therapy on retroperitoneal tissues, intestine, and bile duct in a large animal model.

PURPOSE: The late histopathological effects of intraoperative radiotherapy (IORT) on retroperitoneal tissues, intestine, and bile duct were investigated in dogs. METHODS AND MATERIALS: Fourteen adult foxhounds were subjected to laparotomy and varying doses (0-45 Gy) of IORT (11 MeV electrons) delivered to retroperitoneal tissues including the great vessels and ureters, to a loop of defunctionalized small bowel, or to the extrahepatic bile duct. One control animal received an aortic transection and reanastomosis at the time of laparotomy; another control received laparotomy alone. This paper describes the late effects of single-fraction IORT occurring 3-5 years following treatment. RESULTS AND CONCLUSION: Dogs receiving IORT to the retroperitoneum through a 4 x 15 cm portal showed few gross or histologic abnormalities at 20 Gy. At doses ranging from 30-45 Gy, radiation changes in normal tissues were consistently observed. Retroperitoneal fibrosis with encasement of the ureters and great vessels developed at doses > or = 30 Gy. Radiation changes were present in the aorta and vena cava at doses > or = 40 Gy. A 30 Gy dog developed an in-field malignant osteosarcoma at 3 years which invaded the vertebral column and compressed the spinal cord. A 40 Gy animal developed obstruction of the right ureter with fatal septic hydronephrosis at 4 years. Animals receiving IORT through a 5 cm IORT portal to an upper abdominal field which included a defunctionalized loop of small bowel, showed a few gross or histologic abnormalities at a dose of 20 Gy. At 30 Gy, hyaline degeneration of the intestinal muscularis layer of the bowel occurred. At a dose of 45 Gy, internal intestinal fistulae developed. One 30 Gy animal developed right ureteral obstruction and hydronephrosis at 5 years. A dog receiving 30 Gy IORT through a 5 cm portal to the extrahepatic bile duct showed diffuse fibrosis through the gastroduodenal ligament. These canine studies contribute to the area of late tissue tolerance to IORT.

Intracellular accumulation of beta-amyloid(1-42) in neurons is facilitated by the alpha 7 nicotinic acetylcholine receptor in Alzheimer's disease.

Amyloid beta(1-42), a major component of amyloid plaques, binds with exceptionally high affinity to the alpha 7 nicotinic acetylcholine receptor and accumulates intracellularly in neurons of Alzheimer's disease brains. In this study, we investigated the possibility that this binding plays a key role in facilitating intraneuronal accumulation of amyloid beta(1-42). Consecutive section immunohistochemistry and digital imaging were used to reveal the spatial relationship between amyloid beta(1-42) and the alpha 7 receptor in affected neurons of Alzheimer's disease brains. Results showed that neurons containing substantial intracellular accumulations of amyloid beta(1-42) invariably express relatively high levels of the alpha 7 receptor. Furthermore, this receptor is highly co-localized with amyloid beta(1-42) within neurons of Alzheimer's disease brains. To experimentally test the possibility that the binding interaction between exogenous amyloid beta(1-42) and the alpha 7 receptor facilitates internalization and intracellular accumulation of amyloid beta(1-42) in Alzheimer's disease brains, we studied the fate of exogenous amyloid beta(1-42) and its interaction with the alpha 7 receptor in vitro using cultured, transfected neuroblastoma cells that express elevated levels of this receptor. Transfected cells exhibited rapid binding, internalization and accumulation of exogenous amyloid beta(1-42), but not amyloid beta(1-40). Furthermore, the rate and extent of amyloid beta(1-42) internalization was related directly to the alpha 7 receptor protein level, since (1) the rate of amyloid beta(1-42) accumulation was much lower in untransfected cells that express much lower levels of this receptor and (2) internalization was effectively blocked by alpha-bungarotoxin, an alpha 7 receptor antagonist. As in neurons of Alzheimer's disease brains, the alpha 7 receptor in transfected cells was precisely co-localized with amyloid beta(1-42) in prominent intracellular aggregates. Internalization of amyloid beta(1-42) in transfected cells was blocked by phenylarsine oxide, an inhibitor of endocytosis. We suggest that the intraneuronal accumulation of amyloid beta(1-42) in Alzheimer's disease brains occurs predominantly in neurons that express the alpha 7 receptor. In addition, internalization of amyloid beta(1-42) may be facilitated by the high-affinity binding of amyloid beta(1-42) to the alpha 7 receptor on neuronal cell surfaces, followed by endocytosis of the resulting complex. This provides a plausible explanation for the selective vulnerability of neurons expressing the alpha 7 receptor in Alzheimer's disease brains and for the fact that amyloid beta(1-42) is the dominant amyloid beta peptide species in intracellular accumulations and amyloid plaques.

Primary tuberculous enterocolitis. Report of three cases and review of the literature.

Three patients had primary enteric tuberculosis. Therapy included antituberculous chemotherapy and resection of the involved segment of bowel with primary anastomosis in each case. The symptomatology, roentgenographic findings, histopathology, and treatment of enteric tuberculosis are reviewed. The surgeon must be aware of the fact that primary enteric tuberculosis continues to exist in the United States. Though no pathognomonic symptoms or syndrome occur in enteric tuberculosis, this disease should be included in the differential diagnosis of patients with vague abdominal complaints, weight loss, and anorexia.

Neoadjuvant therapy of squamous cell carcinoma of the esophagus: role of resection and benefit in partial responders.

Twenty-eight patients were treated between 1981 and 1987 with a combination of radiation therapy and two courses of 5-fluorouracil and cisplatin followed by esophageal resection. Sixteen patients (57%) underwent resection. Operative mortality was 6% (1 of 16), and the 15 operative survivors have been followed for more than 23 months. Complete pathological response was achieved in 8 of the 15 patients, and 10 patients (66%) are alive with no evidence of disease; 4 patients (27%) have survived with no evidence of disease for more than 5 years. Four partial responders are alive, and 3 are alive with no evidence of disease for more than 5 years. An aggressive approach with a low mortality has demonstrated survival benefit to complete responders and, contrary to findings of previous reports, has established a role for surgical resection and survival benefit in patients with partial response, with 3 of 7 (47%) patients surviving more than 5 years.

Postnatal development of cell columns and their associated dendritic bundles in the lumbosacral spinal cord of the rat. I. The ventrolateral cell column.

The postnatal development of the ventrolateral dendrite bundle (LDB) in the rat lumbosacral cord was studied quantitatively with Golgi-Cox impregnation. At birth, motoneuronal perikarya and their dendrites were not fully developed, and had not begun to form bundles; varicose dendritic shafts radiated symmetrically from motoneurons. Dendrites contained numerous spines and growth cones. At 5 days, dendritic shafts began to arrange themselves longitudinally, and by 10 days of age, dendrite bundling was apparent. Dendritic growth and bundling appeared complete by two months of age. LDB formation was a dynamic process; rapid dendritic growth occurred in discrete phases with brief intervals of slower dendritic development between them. The mean number of secondary and tertiary dendrites, and the mean branch length of all orders progressively increased. Motoneurons of the LDB primarily innervate the pelvic musculature. Selective horizontal orientation of dendrites into discrete compact bundles suggests that the LDB may serve as a specialized receiving and integrating system for autonomic control over excretory and reproductive functions. It is interesting to note that in patients suffering from amyotrophic lateral sclerosis, motoneurons in the LDB are resistant to destruction. This finding suggests that motoneurons in the LDB may express unique features that protect them from certain disease processes. A better understanding of the developmental anatomical, physiological and biochemical properties of the LDB may provide insight into the treatment of patients with disease processes involving spinal cord and brainstem lower motoneurons.

Postnatal development of cell columns and their associated dendritic bundles in the lumbosacral spinal cord of the rat. II. The ventromedial cell column.

Postnatal formation of the ventromedial dendrite bundle (MDB) in the rat lumboscral cord was examined quantitatively with Golgi-Cox impregnation. At birth, dendrites of motoneurons in the MDB had not achieved their total length, and had not begun to form bundles. Dendrites projected from the soma in a radially symmetric fashion. At 5 days, dendritic shafts reoriented into the longitudinal plane, and by 10 days of age dendrite bundling was apparent. Between day 1 and 60, primary, secondary and tertiary dendrites from motoneurons in the MDB increased both in number and in length, and the MDB became more compact and intertwined. Dendritic growth and bundling was complete by two months of age. The dendritic spatial arrangement of the MDB, as well as the LDB, may provide an important anatomical substrate for receiving appropriate developing axonal inputs. In turn, it is likely that specific incoming axonal inputs that arrive in this cell column early in development may signal the redirection of dendrites of ventromedial motoneurons into the longitudinal plane.

Morphological characteristics of dendrite bundles in the lumbar spinal cord of the rat.

The finding of motoneuron dendrites organized into small compact bundles in cats, monkeys and pigs suggested that a study of this phenomenon in rats should be undertaken. An analysis was performed with electron microscopy, light microscopy and Golgi methods. An extensive dendrite bundle organization was found in the sixth lumbar segment of the spinal cord. Two discrete bundles were localized bilaterally: a lateral bundle in the ventrolateral gray substance, and a medial bundle in the ventral funiculus. The lateral bundle was found to consist of longitudinally oriented dendrites, neurocytons, glial cells and capillaries. As many as 1678 closely packed dendrites were observed in the lateral bundle. The medial bundle contained dendrites directed across the midline and also longitudinally oriented dendrites. Neurocytons in the medial dendrite bundle were found singly or in clusters, and many radiating bundles of dendrites were observed projecting toward the lateral bundle. Golgi analysis confirmed that neurons in the lateral bundle had most of their dendrites oriented longitudinally. It was possible to trace several dendrites into the lateral bundle from dorsally and medially lying neurons. Electron microscopy substantiated the fact that the bundles were composed of dendrites. It also revealed numerous dendrodendritic and dendrosomatic contacts which were desmosomal in type as well as an abundance of small unidentified processes. Various functions which have been attributed to the dendrite bundles are discussed.

Catecholamine innervation of cervical dendrite bundles: possible phrenic nucleus innervation.

The catecholaminergic innervation of three recently described dendrite bundles (midline, central and lateral) in the cervical spinal cord of the adult Long-Evans hooded rat [41] was examined using Golgi impregnation, fluorescence histochemistry for catecholamines, and cholinesterase histochemistry. The midline and lateral bundles were similar in appearance to those described by the Scheibel and Scheibel [50,51], while the central bundle, present in the region of the phrenic nucleus, has not been described previously. Analysis of Golgi-Cox impregnated horizontal sections demonstrated the presence of fine varicose fibers within all three bundles. These profiles entered the bundles at right angles, either singly or within small transverse dendritic subunits, then turned in a rostral or caudal direction, and coursed adjacent to dendrites of motoneurons in the bundles. Catecholamine histofluorescence in horizontal sections revealed abundant varicosities within all three bundles, similar in size and appearance to the varicose fibers seen in Golgi-Cox impregnated sections. Catecholamine fibers entered the dendrite bundles at right angles then turned rostrally or caudally and coursed horizontally within the bundles. Varicose fluorescent profiles formed pericellular rings around the motoneurons and linear profiles adjacent to the dendrites, sometimes outlining the entire proximal portion of primary dendrites. Catecholamine fibers entered the dendrite bundles at right angles then turned rostrally or caudally to course adjacent to the dendrites within the bundles. Cholinesterase histochemistry in alternate sections revealed staining of motoneurons and their dendrites, and confirmed the location of the catecholamine varicosities within the motoneuron dendrite bundles.(ABSTRACT TRUNCATED AT 250 WORDS)

The needs of people with HIV in the UK: findings from a national survey.

The aim of this study was to describe the needs of people living with HIV in the UK. A questionnaire addressing 17 areas of need was completed by 1821 people living with HIV in the UK. The core need indicator was a personal assessment of happiness with current state. A quarter of all respondents were happy with their current state across all needs. For each need, the following proportions were unhappy with their current state: sex, 40%; anxiety/depression, 33%; sleep, 32%; self-confidence, 32%; money, 28%; household chores and self-care, 18%; housing, 18%; appetite, eating and drinking, 17%; friendships, 17%; discrimination, 16%; mobility, 15%; dealing with health professionals, 15%; relationships, 14%; drugs and alcohol, 9%; taking treatments regularly, 5%; HIV treatment knowledge, 4%; looking after children, 2%. Although some people with HIV are coping well with minimal unmet need, the overall picture of need is dominated by personal, social and economic issues.

Radical radiotherapy for inoperable non-small cell lung cancer: what factors predict prognosis?

We set out to determine the factors that predict the outcome of conventional radical radiotherapy for inoperable non-small cell lung cancer. A retrospective casenote review was carried out of all 69 patients treated between 1986 and 1992 at the Northern Ireland Centre for Clinical Oncology, Belfast, with radical radiotherapy for inoperable non-small cell lung cancer. The tumour dose ranged from 45 Gy to 67.5 Gy, delivered in 15-30 fractions, 5 days per week over 3-6 weeks. All patients were followed up for 5 years. The disease was TNM Stage T1-T4N0-N2M0. The majority of tumours (51) were squamous. Overall survival was 63.8% (44-patients; 95% confidence interval (CT) 51.3-75.2) at one year; median survival was 16 months and 5-year survival was 13% (nine patients; 95% CI 6.1-23.3). Five-year survival for the 36 patients with stage T1 or T2 disease was 5.6% (2 patients). Five-year survival for the 33 patients with stage T3 or T4 disease, all with tumours at or near the carina, was 21.2% (seven patients). A WHO performance status of 0 or 1 (P = 0.03, Cox proportional hazards model) was associated with a better chance of survival.

Allograft bone for arthrodesis and repair of skeletal hand problems.

Banked freeze-dried allograft bone was used in 16 patients who underwent three types of wrist operation. Subjective, objective, roentgenographic and economic end-result evaluations were satisfactory. The mean time to union was 12.4 weeks, and the complication rate was low. Allograft bone compares favourably with autografts and avoids donor site morbidity, as well as the need for general anaesthesia.

Chondromyxoid fibroma of the proximal phalanx. A tumour that may be confused with chondrosarcoma.

Chondromyxoid fibroma is a rare benign tumour of chondral origin. The diagnosis is difficult, but as Jaffe emphasized, "its recognition is of some importance in that pathologically it may be mistaken for sarcoma and, as such, treated more radically than is necessary" (Jaffe, 1948). Salzer (1965) found only 136 cases in the world literature since 1948 when Jaffe defined the criteria for their histological diagnosis. Only six cases of chondromyxoid fibroma have been reported involving the hand (Frank, Rockwood, 1969; Zatyepin, Klimova, Lipkin, Perety, 1979).

Relationships between impulse oscillometry, spirometry and dyspnoea in COPD.

BACKGROUND: Severity of chronic obstructive pulmonary disease (COPD) is based either on symptoms/disability or lung function, which have no discernible correlation. We hypothesised that impulse oscillometry (IOS), a non-effort-dependent measure of central and peripheral airway mechanics, could correlate to dyspnoea in COPD. METHODS: We analysed screening data from 57 COPD patients who had spirometry, IOS and Medical Research Council dyspnoea score (MRC) measurements. We searched for predictors or correlations of MRC from IOS, spirometry and demographics. RESULTS: MRC had no significant predictors or correlations from IOS, spirometry or demographics (possibly excepting smoking history, p=0.05). IOS correlated significantly with spirometry: FEV1 and FEF25-75 vs. R5-R20 (peripheral airway resistance), r= -0.499, p > 0.001 and r= -0.397, p= 0.002 respectively. CONCLUSION: MRC is not related to IOS or spirometry in COPD. IOS correlates well with spirometry, particularly peripheral airway resistance (R5-R20). IOS is useful, but does not provide a link between symptoms and pulmonary function measurements.