Promotion of breast cancer screening in a work site population

We investigated whether attitudes, intentions, and practices regarding breast cancer screening by mammography and clinical breast examination could be positively influenced through a brief educational intervention administered to women employees at diverse work sites. The educational intervention involved the mailing of American Cancer Society brochures that discussed breast cancer screening and contained guidelines on the recommended frequency for each screening modality according to age. Effects of the intervention were measured through pre/post questionnaires. The results were positive for the entire group of women who participated, as evidenced by their increased perception of the importance of mammography and clinical breast examination and of the priority of getting a mammogram regularly, their decreased perception of mammography as an uncomfortable procedure, and the increased frequency of discussions of breast cancer screening at work. Employers, particularly large corporations and agencies, must realize that by introducing effective work site cancer screening programs they not only fulfill their social responsibility to contribute to their employees’ health, but also achieve reductions in health care costs.     

PPARα agonists regulate lipid metabolism and nitric oxide production and prevent placental overgrowth in term placentas from diabetic rats

Maternal diabetes impairs fetoplacental metabolism and growth. Peroxisome proliferator-activated receptor α (PPARα) is a nuclear receptor capable of regulating lipid metabolism and inflammatory pathways. In this study, we analyzed whether placental and fetal PPARα activation regulates lipid metabolism and nitric oxide (NO) production in term placentas from diabetic rats. Diabetes was induced by neonatal streptozotocin administration. On day 21 of pregnancy, placentas from control and diabetic rats were cultured in the presence of PPARα agonists (clofibrate and leukotriene B(4) (LTB(4))) for further evaluation of levels, synthesis, and peroxidation of lipids as well as NO production. Besides, on days 19, 20, and 21 of gestation, fetuses were injected with LTB(4), and the placentas were explanted on day 21 of gestation for evaluation of placental weight and concentrations of placental lipids, lipoperoxides, and NO metabolites. We found that placentas from diabetic rats showed reduced PPARα concentrations. They presented no lipid overaccumulation but reduced lipid synthesis, parameters negatively regulated by PPARα activators. Lipid peroxidation and NO production, increased in placentas from diabetic rats, were negatively regulated by PPARα activators. Fetal PPARα activation in diabetic rats does not change placental lipid concentrations but reduced placental weight and NO production. In conclusion, PPARα activators regulate lipid metabolism and NO production in term placentas from diabetic rats, an activation that regulates placental growth and can partly be exerted by the developing fetus.     

Use of platelet-derived growth factor for delayed perineal wound healing in patients with inflammatory bowel disease: a case series

Abdominoperineal resection (APR) is the operative procedure of choice in patients with anorectal complications of inflammatory bowel disease (IBD) where a restorative proctocolectomy is either undesirable or impossible to perform. The challenge in these patients is poor perineal wound healing. A retrospective chart review was conducted of 118 patients (average age 44 years, range 28-73) with intractable IBD who underwent APR to evaluate perineal wound healing outcomes. Forty-four (44) had Crohn's disease (CD) and 74 had ulcerative colitis (UC). Three months after surgery, the wounds of 10 patients (six with CD and four with UC) remained unhealed with a standard protocol of sterile gauze dressings, sitz baths, and irrigation as needed. In these patients, daily topical application of a small amount of platelet-derived growth factor (rhPDGF) was added to the regimen of care. Six of the 10 unhealed wounds healed following rhPDGF application (average 80 days). The four patients whose wounds did not heal after 6 to 12 months had CD and underwent surgical revision followed by topical rhPDGF application. These wounds healed after an average of 107 days. The results of this case series confirm that delayed perineal wound healing is common following APR, especially in patients with CD, and may confirm previously reported observations that the effects of rhPDGF are most encouraging in small area defects that can be filled. Studies to evaluate the safety, efficacy, and effectiveness of this treatment modality are warranted.     

Neurocognition, insight into illness and subjective quality-of-life in schizophrenia: what is their relationship?

Subjective quality-of-life (SQOL) has been recognized as a crucial domain of outcome in schizophrenia treatment, and yet its determinants are not well understood. In a recent meta-analytic investigation of 10 studies of neurocognition and SQOL in schizophrenia (Tolman and Kurtz, Scz Bull, 2010) measures of crystallized verbal ability and processing speed were moderately negatively correlated with SQOL. One potential explanation for inverse relationships between measures of elementary neurocognition and SQOL is that higher levels of cognition may serve as a proxy for better insight into the illness, and better consequent recognition of illness-related functional impairment. This study sought to determine whether: (1) symptoms, neurocognitive variables, and insight into illness influence SQOL; and, (2) whether insight mediated or moderated a relationship between elementary neurocognitive function and SQOL. Seventy-one stabilized clients with schizophrenia or schizoaffective disorder were administered a neuropsychological test battery, symptom and subjective quality-of-life measures. Elementary neuropsychological measures of crystallized verbal ability, attention and working memory, and problem-solving were all inversely related to SQOL. Insight into illness and depression severity, but not positive and negative symptoms, was also inversely related to SQOL. Insight was not found to mediate or moderate any of the relationships between elementary neurocognition and SQOL. Taken together, these findings suggest that neurocognition and insight into illness have inverse relationships to SQOL and that elementary neurocognition does not influence SQOL through its link with illness insight.     

Synaptic transmission of graded membrane potential changes and spikes between identified visual interneurons

Several physiological mechanisms allow sensory information to be propagated in neuronal networks. According to the conventional view of signal processing, graded changes of membrane potential at the dendrite are converted into a sequence of spikes. However, in many sensory receptors and several types of mostly invertebrate neurons, graded potential changes have a direct impact on the cells' output signals. The visual system of the blowfly Calliphora vicina is a good model system to study synaptic transmission in vivo during sensory stimulation. We recorded extracellularly from an identified motion-sensitive neuron while simultaneously measuring and controlling the membrane potential of individual elements of its presynaptic input ensemble. The membrane potential in the terminals of the presynaptic neuron is composed of two components, graded membrane potential changes and action potentials. To dissociate the roles of action potentials and graded potential changes in synaptic transmission we used voltage-clamp-controlled current-clamp techniques to suppress the graded membrane potential changes without affecting action potentials. Our results indicate that both the graded potential and the action potentials of the presynaptic neuron have an impact on the spiking characteristics of the postsynaptic neuron. Although a tight temporal coupling between pre- and postsynaptic spikes exists, the timing between these spikes is also affected by graded potential changes. We propose that the control of synaptic transfer of a dynamically complex signal by graded changes in membrane potential and spikes is useful to enable a temporally precise coupling of spikes in response to sudden transitions in stimulus intensity.     

Survival analysis of breast cancer liver metastasis treated by hepatectomy: A propensity score analysis for Chinese women in Hong Kong

Background: Survival of patients with breast cancer liver metastasis is very poor. This study aimed to analyze the survival outcome of hepatectomy for this patient population. Methods: From January 1995 to December 2014, 2522 patients with liver cancer received hepatectomy at our hospital. Twenty-one of them, all female, received the operation for breast cancer liver metastasis. Performance was compared with patients with colorectal liver metastasis treated with hepatectomy after propensity score analysis in a ratio of 1:3. Results: Twenty-one patients received hepatectomy for breast cancer. After propensity score matching, 63 patients who had hepatectomy for colorectal cancer were selected for comparison. There was no significant difference in immediate or short-term outcomes between the two groups of patients in terms of operative time, blood loss and surgical morbidities. All patients with breast cancer had R0 resection. No hospital death occurred. After hepatectomy, the 1-, 3-and 5-year overall survival rates were 100.0%, 58.9% and 58.9% respectively in patients with breast cancer. The 1-, 3-and 5-year overall survival rates were 95.0%, 57.2% and 39.7% respectively in patients with colorectal cancer( P = 0.572). On multivariate analysis, triple negative status was the only independent poor prognostic factor in breast cancer liver metastasis(OR = 6.411; 95% CI: 1.351–30.435; P = 0.019). Conclusions: Hepatectomy is a safe and effective way of treating breast cancer liver metastasis at experienced centers where multidisciplinary adjuvant treatments are available. It can be considered more frequently as part of the multidisciplinary care for this patient population.     

In Vivo Oxidation Contributes to Delamination but not Pitting in Polyethylene Components for Total Knee Arthroplasty

The aim of this study was to better understand how in vivo oxidation contributes to fatigue damage in total knee arthroplasty (TKA). A total of 119 tibial inserts were consecutively collected after revision surgery. Of the 119 polyethylene retrievals, 29 were gamma sterilized in air (historical), whereas the remaining 90 were gamma sterilized in nitrogen (conventional). Surface damage assessment and characterization of oxidation were performed on all the retrievals. Delamination was significantly more prevalent and extensive in the longer-term, highly oxidized, historical tibial inserts. Pitting damage, in contrast, seemed to be equally prevalent between both retrieval groups and was not correlated with in vivo oxidation. Our findings support our hypothesis that in vivo oxidation is a contributing factor to delamination, but not pitting, in TKA. Despite the lower oxidation displayed by conventional retrievals, this study provides strong evidence that delamination secondary to in vivo oxidation may occur during the second decade of implantation.