Epidemic infectious gastrointestinal illness aboard U.S. Navy ships deployed to the Middle East during peacetime operations – 2000–2001

Background  

Infectious gastrointestinal illness (IGI) outbreaks have been reported in U.S. Navy ships and could potentially have an adverse mission impact. Studies to date have been anecdotal.     

Pediatric Family Care: An Interdisciplinary Team Approach

Providing adequate psychosocial support for hospitalized pediatric patients and their families is sometimes difficult An interdisciplinary team can help caregivers to assess needs and develop strategics for working with difficult patients and families This paper describes the development of a pediatric family care team that has been effective in one hospital outlining the general steps followed in establishing the team A review of practical considerations related to team membership, costs, and procedures is followed by a discussion of the problems encountered A case study demonstrates how the team helped meet thc psychosocial needs of one pediatric patient.     

Sequential studies on synovial lymphocyte stimulation by rubella antigen, and rubella virus isolation in an adult with persistent arthritis.

The response of synovial lymphocytes from a 65-year-old lady with persistent polyarthritis, to rubella antigen and a number of other microbial agents was studied over a period of 11 months by [3H]thymidine incorporation. The results were correlated with the ability to isolate rubella virus from both peripheral blood and synovial fluid during the same period. The patient showed initially a maximal stimulation index to rubella antigen assayed on five occasions over a five-month period. Rubella virus was detected in both peripheral blood and synovial fluid samples on three occasions during this period. Five months later the lymphoproliferative response of her synovial lymphocytes to rubella antigen had dropped to low levels, and virus could no longer be isolated from synovial exudates. At this time the patient's arthritis had become much less active, indicating that a good correlation existed between the presence of rubella virus, local lymphocyte sensitisation, and the inflammatory reaction.     

Chemotherapy use, outcomes, and costs for older persons with advanced non-small-cell lung cancer: evidence from surveillance, epidemiology and end results-Medicare.

PURPOSE: There is limited published documentation regarding US community patterns of care for older patients with advanced non-small-cell lung cancer (NSCLC). Using the Surveillance, Epidemiology and End Results (SEER)-Medicare database, we examined community treatment patterns for advanced NSCLC, focusing on chemotherapy. METHODS: Patients with locally advanced or metastatic (TNM system stages IIIb and IV) NSCLC diagnosed between January 1, 1994, and December 31, 1999, were stratified based on chemotherapy agents received during the first 3 months following diagnosis. Cox proportional hazards models were used to compare survival, controlling for age, sex, race, noncancer comorbidity, stage at diagnosis, SEER region, and receipt of cancer-related surgery or radiation therapy in the first 3 months following diagnosis. Lifetime medical costs were calculated for each group. RESULTS: 14,875 patients met inclusion criteria: 7,411 (49.8%) stage III and 7,464 (50.2%) stage IV at diagnosis. Thirty-one percent received chemotherapy, 8% received surgery, and 53% received radiation therapy either as initial or adjuvant treatment. Persons > or = 75 years of age, females, African Americans, and those with more than one comorbidity were significantly less likely to receive chemotherapy (P < .01). Survival was inferior for those who did not receive a platinum-containing agent (P < .01). Lifetime costs were highest for those receiving platinum + taxane combinations, exceeding other regimens by more than $10,000 USD per patient. CONCLUSION: Chemotherapy prolongs survival in community settings, but is underutilized for persons with advanced NSCLC. Reasons for lower use in minorities and variation across regions deserve further study.     

Mutation analysis of the RET receptor tyrosine kinase in Hirschsprung disease

Hirschsprung disease (HSCR), or congenital agangiionic megacolon,is the most common cause of congenital bowel obstruction withan incidence of 1 in 5000 live births. Recently, linkage ofan incompletely penetrant, dominant form of HSCR was reported,foilowed by identification of mutations in the RET receptortyrosine kinase. To determine the frequency of RET mutationsin HSCR and correlate genotype with phenotype, we have screenedfor mutations among 80 HSCR probands representing a wide rangeof phenotypes and family structures. Polymerase chain reaction(PCR) and single-strand conformation polymorphism (SSCP) analysisof RET's 20 exons for mutations among probands revealed eightputative mutations (10%). Sequence changes, which included missense,frameshift and complex mutations, were detected in both familialand isolated cases, among patients with both long-and short-segmentHSCR and in three kindreds with other phenotypes (maternal deafness,talipes and mairotation of the gut, respectively). Two mutations(C609Y and C620R) we identified have previously been associatedwith multiple endocrine neoplasla type 2A (MEN2A), medullarythyroid carcinoma (MTC) and, on rare occasions, HSCR. Thus,while HSCR family members may be at risk for developing neuroendocrinetumors, it follows that identical mutations in RET may be ableto participate in the pathogenesis of distinct phenotypes. Ourdata suggest that: (i) the overall frequency of RET mutationsin HSCR patients is low and therefore, other genetic and/orenvironmental determinants contribute to the majority of HSCRsusceptibility, and (ii) at present, there is no obvious relationshipbetween RET genotype and HSCR phenotype.     

Immunohistochemical localization of cathepsin B in neoplastic human prostate

Cathepsin B (CB) has been shown to degrade extracellular matrix (ECM) proteins, and has been reported to be involved in invasion and metastasis of several types of solid organ tumors in human and animals, but CB has not been studied in human prostate cancer (CAP). Our objective was to determine the CB protein immunostaining pattern in CAP and to correlate the immunostaining with the degree of malignancy as reflected in the Gleason grading system. We used two types of CB antibodies (namely, monospecific, polyclonal antibodies to human liver CB prepared in rabbits, and polyclonal antibody produced in sheep) to establish CB localization patterns in neoplastic prostate. Our analysis showed a heterogeneous CB immunostaining pattern in the neoplastic human prostate. CB immunostaining occurred in many, but not all, of the neoplastic columnar/cuboidal cells of acini and isolated cells, i.e., in small ragged glands and clusters (groups) of invasive cells in the prostatic stroma. We have shown that, in general, there was a positive correlation of the intensity of CB immunostaining with the Gleason histologic score (or Gleason grade sum) tumors, i.e., from the lowest scores through score 8, but many of the tumors with scores 9 and 10 showed little CB immunostaining. Our study indicated that the increased CB immunostaining in the Gleason grade sum 5–8 tumors may be associated with increased degradation of ECM, but not in 9 and 10 despite the fact that the latter tumors are more malignant clinically. In well-differentiated tumors, fewer CB immunostaining cells were present than the moderately-differentiated tumors. In other words, most of the stromal invasion of the prostatic ECM occurred in tumors of Gleason grade sums 5–8. We suggest that CB immunostaining might be a useful method to assess stromal invasion of prostatic carcinoma, especially in the higher grade tumors.     

The relationship of language and emotion regulation skills to reticence in children with specific language impairment.

This study examined the relationship between emotion regulation, language ability, and reticent behavior in children with specific language impairment (SLI) and their typical peers. Participants included 43 children with SLI and 43 typically developing children, for a total sample of 86 participants. Children were selected from 2 age ranges: 5-8 years and 9-12 years. The Emotion Regulation Checklist (ERC; A. Shields and D. Cicchetti, 1997, 1998) and the Teacher Behavior Rating Scale (TBRS; C. H. Hart and C. C. Robinson, 1996) were completed by each child's teacher to provide measures of emotion regulation and reticence, respectively. The Comprehensive Assessment of Spoken Language (CASL; E. Carrow-Woodfolk, 1999) was administered to provide a measure of language ability. A regression analysis including all participants indicated that the emotion regulation scores and the CASL scores were significant predictors of the reticence scores, accounting for 43% of the variance. Group-specific analyses were then conducted to determine whether the 2 predictor scales differentially predicted reticence based on language and age groups. None of the tests exceeded the.05 level, indicating that there was no significant difference in predictive power on the 2 factors in question.