Diagnostic impact of core-needle biopsy on fine-needle aspiration of non-Hodgkin lymphoma

We retrospectively reviewed 74 fine-needle aspiration (FNA) cases of presumptive non-Hodgkin lymphoma (NHL). All the cases had cytology and core-needle biopsy and 53 cases had concurrent flow cytometric analysis. FNA (cytology and flow cytometry) and core-needle biopsy were evaluated independently. FNA was diagnostic of diffuse large B-cell lymphoma (DLBL) in 25% (13/53) of cases and small B-cell NHL in 15% (8/53) of cases, whereas core-needle biopsy was diagnostic of DLBL in 37% (27/74) of cases and small B-cell NHL in 8% (6/74) of cases. Subclassification of small B-cell NHL was reached in 3/6 cases by core-needle biopsy. Insufficient cases were observed in both FNA (47%; 25/53) and core-needle biopsy (28%; 21/74) groups. With the combination of FNA and core-needle biopsy, diagnostic cases of DLBL increased to 43% (32/74) and insufficient samples were reduced to 16% (12/74). There was no clear advantage in the diagnosis and classification of small B-cell NHL by adding core-needle biopsy to FNA (14%; 10/74). We conclude that core-needle biopsy is a useful adjunct to FNA in the diagnosis of DLBL and shall be encouraged. In small B-cell NHL, core-needle biopsy does not add to the diagnostic ability of FNA. Cases insufficient for diagnosis may be seen in both core-needle biopsy and FNA. A combined approach reduces the number of insufficient cases and is recommended in routine FNA practice.     

Detection of genital herpes simplex infections by a tissue culture-fluorescent-antibody technique with biotin-avidin.

Several cell lines were evaluated for their suitability for rapid detection of herpes simplex virus (HSV) from clinical genital specimens. Human foreskin fibroblast (Flow 7000) cells were found to be most suitable in terms of sensitivity and adherence characteristics. HSV in clinical specimens was isolated by a standard tissue culture method by monitoring the cytopathic effect, and the titers of the HSV-positive specimens were determined. More than 65% of the HSV-positive genital specimens showed titers of less than or equal to 10(4) 50% tissue culture infective doses per ml. The standard tissue culture-cytopathic effect method required 3 to 10 days for detection of HSV in clinical specimens of low infectivity. A more rapid technique was developed which involved a short-term tissue culture (24 h) on Lab-Tek chambers followed by staining with biotin-linked HSV antibody and avidin-fluorescein conjugate. Because of the high binding affinity of this system due to multiple binding of biotin to avidin and multiple attachment of biotin to the antibody molecule, the biotin-avidin fluorescent-antibody technique produced a quality of fluorescence far superior to that of the conventional fluorescent-antibody techniques. The tissue culture-biotin-avidin fluorescent-antibody method was as sensitive as the tissue culture-cytopathic effect test. This method provides an improved, more rapid test (26 h) for detecting HSV in clinical specimens.     

Attitudes of medical students and faculty toward cancer

The Cancer Attitude Survey (CAS) was administered to second year students before, during, and after a year-long "Introduction to Clinical Medicine" course. The course contained a 14-hour oncology segment. Faculty of the Clinical Medicine Course and nonclinical faculty teaching oncology related topics also responded to the CAS. The CAS contains four scales: Attitudes toward: I, the patient's inner resources to cope with cancer; IIA, the value of early diagnosis; IIB, aggressive treatment; and III, personal immortality and preparation for and acceptance of death. At the beginning of the course, student attitudes were positive; there was no change in attitudes across the three testing periods. Among faculty, dedicated oncologists had the most positive attitudes; students and nononcology clinical faculty exhibited similar trends in attitudes; nonclinical faculty teaching oncology related material had least positive attitudes.     

Establishing the minimal clinically important difference of the EQ-5D-3L in older adults with a history of falls

Quality of Life Research - Establish the minimal clinically important difference (MCID) of a health-related quality of life (HRQoL) measure—the EuroQol EQ-5 Dimensions-3 Level...     

Dietary Patterns in Runners with Gastrointestinal Disorders

Individuals with inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) and reflux frequently experience gastrointestinal symptoms (GIS), potentially enhanced by high-intensity running. Food avoidances, food choices, and GIS in runners with IBS/IBD (n = 53) and reflux (n = 37) were evaluated using a reliability and validity tested questionnaire. Comparisons to a control group of runners (n = 375) were made using a Fisher’s Exact test. Runners with IBS/IBD experienced the greatest amount of exercise-induced GIS followed by those with reflux. Commonly reported GIS were stomach pain/cramps (77%; 53%), bloating (52%; 50%), intestinal pain/cramps (58%; 33%), and diarrhea (58%; 39%) in IBS/IBD and reflux groups respectively. In the pre-race meal, those with IBS/IBD frequently avoided milk products (53%), legumes (37%), and meat (31%); whereas, runners with reflux avoided milk (38%), meat (36%), and high-fibre foods (33%). When considering food choices pre-race, runners with IBS/IBD chose grains containing gluten (40%), high fermentable oligo-, di-, mono-saccharides and polyols (FODMAP) fruits (38%), and water (38%). Runners with reflux chose water (51%), grains containing gluten (37%), and eggs (31%). In conclusion, while many runners with IBS/IBD and reflux are avoiding trigger foods in their pre-race meals, they are also consuming potentially aggravating foods, suggesting nutrition advice may be warranted.     

Validation of the factors influencing family consent for organ donation in the UK

Between 2013 and 2019, there was an increase in the consent rate for organ donation in the UK from 61% to 67%, but this remains lower than many European countries. Data on all family approaches (16,896) for donation in UK intensive care units or emergency departments between April 2014 and March 2019 were extracted from the referral records and the national potential donor audit held by NHS Blood and Transplant. Complete data were available for 15,465 approaches. Consent for donation after brain death was significantly higher than for donation after circulatory death, 70% (4260/6060) vs. 60% (5645/9405), (OR 1.58, 95%CI 1.47–1.69). Patient ethnicity, religious beliefs, sex and socio-economic status, and knowledge of a patient's donation decision were strongly associated with consent (p < 0.001). These factors should be addressed by medium- to long-term strategies to increase community interventions, encouraging family discussions regarding donation decisions and increasing registration on the organ donor register. The most readily modifiable factor was the involvement of an organ donation specialist nurse at all stages leading up to the approach and the approach itself. If no organ donation specialist nurse was present, the consent rates were significantly lower for donation after brain death (OR 0.31, 95%CI 0.23–0.42) and donation after cardiac death (OR 0.26, 95%CI 0.22–0.31) compared with if a collaborative approach was employed. Other modifiable factors that significantly improved consent rates included less than six relatives present during the formal approach; the time from intensive care unit admission to the approach (less for donation after brain death, more for donation after cardiac death); family not witnessing neurological death tests; and the relationship of the primary consenter to the patient. These modifiable factors should be taken into consideration when planning the best bespoke approach to an individual family to discuss the option of organ donation as an end-of-life care choice for the patient.     

Effects of mental state on heart rate and blood pressure variability in men and women

Summary. The effect of different mental states on autonomic modulation of the cardiovascular system was assessed in healthy, normotensive men (n=18) and women (n=12). Heart rate variability (HRV), systolic blood pressure variability (BPV) and arterial baroreflex function were assessed during 4 tests at rest ((10 min+5 min recovery)×4):

• 1 Control (spontaneous breathing, (SB)
• 2 Mental distraction (SB+word puzzle)
• 3 Conscious control of breathing (paced at SB rate) and
• 4 Mental stress (SB+computer quiz).

There were no significant gender differences in the responses to the interventions in terms of arterial (spontaneous) baroreflex (SPBX) control of HR, and indices of time and frequency domains of HRV and BPV, with the exception of the sympathetic indicator of HRV (low frequency power/total power; P<0.01) which was lower in women during control and mental stress tests. Conscious control of breathing at SB did not alter HRV, BPV or SPBX in either men or women. Mental distraction and mental stress led to decreases in indices of time and frequency domains of HRV and BPV in all subjects, as well as increases in HR during distraction and in systolic BP during stress. These findings suggest that in studies of cardiovascular control:

• 1 Paced breathing at SB can be used for individuals with irregular breathing patterns
• 2 The extent of mental stress achieved is intervention-specific and for the most part, independent of gender and
• 3 Resting assessment of HRV, BPV and SPBX can be made by having subjects sit quietly without interventions in a controlled laboratory setting.