Effect of interferon alpha,interferon beta,and interferon gamma on the in vitro growth of human renal adenocarcinoma cells

Interferon-, interferon-, and interferon- differ in their antiproliferative effects for several cell lines. Interferons were thus assessed for their activity in inhibiting proliferation of three renal cell carcinoma cell lines. The malignant epithelial phenotype of each of these cell lines was confirmed by electron microscopy, histology, karyotype and tumorigenicity. When compared on an anti-viral unit basis, naturally produced interferon- was more effective than natural interferon- for all cell lines and clones. Proliferation of each of the cell lines was inhibited by interferon-. In all cases, removal of interferons from culture media resulted in resumption of the rate of cell growth after a variable delay of 6–10 days. If the antiproliferative effects of interferons predominate in mediating tumor regression, clinical response may depend upon the type of interferon to which the tumor is exposed.     

The IHAT-GUT Iron Supplementation Trial in Rural Gambia: Barriers,Facilitators, and Benefits

Introduction: In most sub-Saharan African countries iron deficiency anaemia remains highly prevalent in children and this has not changed in the last 25 years. Supplementation with iron hydroxide adipate tartrate (IHAT) was being investigated in anaemic children in a phase two clinical trial (termed IHAT-GUT), conducted at the Medical Research Council Unit the Gambia at the London School of Hygiene and Tropical Medicine (LSHTM) (abbreviated as MRCG hereof). This qualitative study aimed to explore the personal perceptions of the trial staff in relation to conducting a clinical trial in such settings in order to highlight the health system specific needs and strengths in the rural, resource-poor setting of the Upper River Region in the Gambia. Methods: Individual interviews (n = 17) were conducted with local trial staff of the IHAT-GUT trial. Data were analysed using inductive thematic analysis. Results: Potential barriers and facilitators to conducting this clinical trial were identified at the patient, staff, and trial management levels. Several challenges, such as the rural location and cultural context, were identified but noted as not being long-term inhibitors. Participants believed the facilitators and benefits outnumbered the barriers, and included the impact on education and healthcare, the ambitious and knowledgeable locally recruited staff, and the local partnership. Conclusions: While facilitators and barriers were identified to conducting this clinical trial in a rural, resource-poor setting, the overall impact was perceived as beneficial, and this study is a useful example of community involvement and partnership for further health improvement programs. To effectively implement a nutrition intervention, the local health systems and context must be carefully considered through qualitative research beforehand.     

Problems for clinical judgement: 4. Surviving in the report card era

HEALTH CARE REPORT CARDS INVOLVE COMPARISONS of health care systems, hospitals or clinicians on performance measures. They are going to be an important feature of medical care in Canada in the new millennium as patients demand more information about their medical care. Although many clinicians are aware of this growing trend, they may not be prepared for all of its implications. In this article, we provide some historical background on health care report cards and describe a number of strategies to help clinicians survive and thrive in the report card era. We offer a number of tips ranging from knowing your outcomes first to proactively getting involved in developing report cards.     

Emergency Department Observation Versus Readmission Following total Joint Arthroplasty: Can We Avoid the Bundle Buster?

BackgroundAs the Center for Medicare and Medicaid (CMS) moves toward bundled payment plans for total joint arthroplasty (TJA), it becomes necessary to reduce factors that increase cost for an episode of care such as readmissions. The goal of this study is to evaluate the payment for observation stay versus readmission for patients who present to the emergency department.MethodsA retrospective review from 2014-2019 was conducted identifying all Medicare patients who had a primary, elective TJA and visited the ED within 90 days postoperatively. If a readmission was one midnight or less or had an equivalent diagnosis to an observation stay patient, it was characterized as a readmission that could have qualified as an observation stay. Using our institution’s average payment for Medicare readmissions and observations, actual and potential savings were calculated.ResultsSixty-nine out of 523 (13.2%) patients were placed under observation, while 454 (86.8%) patients were readmitted. Eighty-six out of 523 (18.9%) patients qualified for observation status. There was an actual savings of 11.8% by placing patients on observation status and readmission rate was decreased by 13.2%. Savings could have increased by a total of 27.7% and readmissions decreased by a total of 29.6% if all patients who qualified had been placed on observation status.ConclusionAt our institution, the implementation of observation stay has led to a savings of 11.8% and a potential total savings of 27.7%. The rate of readmissions was decreased by 13.2% and had the potential to decrease by a total of 29.6%.     

Association of hospital and surgeon operative volumes and surgeon pediatric subspecialization with pediatric laparoscopic cholecystectomy outcomes: A population-based cohort study

BackgroundMost pediatric cholecystectomies are performed by adult general surgeons, but it is unclear whether outcomes differ by surgeon pediatric subspecialization, hospital procedure volume, or surgeon procedure volume. We aimed to determine whether higher hospital or surgeon laparoscopic cholecystectomy (LC) volume or surgeon pediatric subspecialization is associated with better outcomes after LC in children.MethodsWe performed a retrospective cohort study using statewide hospital discharge databases from the states of Florida, Georgia, and Iowa. We included children aged 4–18 years who underwent inpatient or outpatient LC for acute or chronic gallbladder disease in January 2010–August 2015.Propensity score weighting was used to estimate relationships between operative volumes or surgeon pediatric subspecialization and rates of readmission or emergency department (ED) visit within 30 days.ResultsA total of 5391 children were included (mean age 15.9 years, 81.6% female). Children operated on by surgeons with high LC volumes in hospitals with high LC volumes were less likely to experience a readmission or ED visit within 30 days (10.8% vs. 13.7%, p = 0.04). Additionally, children operated on by adult general surgeons in hospitals with high LC volumes were less likely to experience a readmission or ED visit within 30 days (10.9% vs. 13.8%, p = 0.03).ConclusionsChildren are less likely to be readmitted to the hospital or present to the ED after laparoscopic cholecystectomy if they receive their care from adult general surgeons at hospitals that frequently perform this procedure in both adults and children.Level of evidenceIII     

Effect of toremifene on antipyrine elimination in the isolated perfused rat liver

Summary Toremifene is a triphenylethylene antioestrogen with significant antitumour activity. It is structurally very similar to tamoxifen. Both drugs undergo extensive hepatic metabolism and tamoxifen is known to inhibit hepatic mixed-function oxidases (MFO). Using the isolated perfused rat-liver model, we investigated the effect of toremifene on the elimination of antipyrine, a standard marker of MFO activity. Perfusate consisted of 20% red cells in a modified Krebs-Henseleit buffer, and 80 ml was recirculated at 14 ml/min for 3 h. High but clinically relevant steady-state toremifene levels of 3 and 10 g/ml were achieved using bolus plus constant infusion into the reservoir. Elimination of 2.5 mg antipyrine was not inhibited by steady-state toremifene, but methanol (maximal perfusate concentration, 1.29%), the vehicle used for toremifene administration, caused a statistically significant increase in the antipyrine elimination half-life (mean, 1.4±0.2 h for controls vs 2.2±0.3 h for methanol;P<0.05,n=4). Whereas the methanol had no apparent effect on liver viability as assessed by bile flow and perfusate back-pressure, toremifene at a steady-state concentration of 10 g/ml caused a statistically significant decrease in bile flow (value at 180 min, 0,22±0.05 ml/h as compared with 0.52±0.06 ml/h in the methanol control;P<0.05) and a statistically significant increase in perfusate back-pressure (value at 180 min, 17.5±1.8 cm vs 11.0±2.6 cm in the methanol control;P<0.05). Therefore, toremifene used at high doses can impair liver function in the isolated perfused rat liver, but it does not have any effect on antipyrine elimination.     

Comparison of ambulatory and inpatient experiences in five specialties

This study compared medical student evaluations of ambulatory and inpatient components of third-year clerkships in internal medicine, obstetrics/gynaecology, paediatrics, psychiatry, and surgery. Seventy-two students completed evaluation questionnaires at the conclusion of each of five clerkships over 12 months. Although ambulatory and inpatient evaluations were comparable across all five specialties in several areas, ambulatory education was rated more favorably in scheduling, clear definition of student roles and responsibilities, appropriate supervision, timely and constructive feedback, being welcomed, and working in a non-threatening environment.Student feedback thus implied that ambulatory experiences were comparable to, or better than, inpatient experiences and suggests areas for improving clinical education in inpatient settings.     

Dynamic Contrast-Enhanced MR Imaging for Soft Tissue Sarcomas

Dynamic contrast-enhanced magnetic resonance imaging has recently emerged as an important method for evaluating soft tissue sarcomas for biopsy localization, chemotherapeutic response, and long-term follow-up because of its ability to detect viable tumor. This article presents the basic principles of contrast kinetics in soft tissue sarcomas after bolus injection of contrast agent and discusses the current postprocessing methods (subtraction, first-pass image and time-intensity curves with region of interest, and color-encoded techniques) used to display these dynamic studies. Because of its excellent temporal resolution, dynamic MR imaging can delineate the early uptake of contrast agent in sarcomas within seconds after injection, almost synchronous with arterial enhancement, and thereby differentiate the rapidly enhancing viable tumor from the nonenhancing necrotic tumor and the late enhancing changes after surgery, radiation therapy, and chemotherapy.     

Cytogenetic studies of herbicide interactions in vitro and in vivo using atrazine and linuron

The herbicides atrazine and linuron, found in Wisconsin's groundwater, were tested alone and in combination, both in vivo and in vitro, to determine their individual and combined genotoxic effects. Human lymphocytes exposed in vitro to either 1 g/ml linuron or 0.001 g/ml atrazine showed little chromosome damage, whereas significant chromosome damage was observed in lymphocytes simultaneously exposed to 0.5 g/ml linuron and 0.0005 g/ml atrazine, suggesting at least an additive model. In another experiment, mice were fed 20 g/ml atrazine, 10 g/ml linuron, or a combination of 10 g/ml atrazine and 5 g/ml linuron in their drinking water for 90 days, after which bone marrow cells and cultured splenocytes were examined for chromosomal damage. None of the treatment groups showed chromosome damage in bone marrow, whereas the cultured splenocytes demonstrated damage in all treatment groups. These experiments suggest that, prior to assessing the risk of a herbicide, it may be necessary to test it in combinations which mimic the mixtures which would occur under field conditions, such as in contaminated groundwater.