Childhood circumstances and anthropometry: The Boyd Orr cohort

Background: Childhood environment is known to affect stature in childhood and adulthood. Peak growth for different anthropometric measures occurs at different times and so associations with childhood conditions that vary across different components of stature may indicate periods of growth that are particularly influenced by environmental factors.

Methods: The study examined relationships between anthropometric measurements (foot length, shoulder breadth, height, trunk and leg length) and childhood exposures (breast-feeding, birth order, household income, household food expenditure, social class, crowding, number of children in the household, and household diet) in 2376 members of the Boyd Orr cohort aged 2–14 years.

Results: All childhood exposures were associated with childhood anthropometric measures to some degree. In multivariable models, the most consistent relationships were positive associations of anthropometric measures with ever being breast-fed, decreasing number of children in the household and, in boys, increasing household income. There was a steadily decreasing gradient in the strength of associations across different anthropometric measures; the strongest were observed with height followed by leg length, foot length, trunk and shoulder breadth.

Conclusions: The individual components of stature most strongly associated with childhood environment in this age group were leg and foot length.     

The relationship between tumor size and stage in early versus advanced ovarian cancer

Background

Ovarian cancer has a different prognosis between early (I and II) and advanced stage (III and IV). The mechanism of disease progression is unknown, but patients with advanced disease may have a higher propensity for seeding of the abdominal cavity early in the disease process than those with early stage. Theoretically if this is so, then patients with advanced stage should have smaller sized tumors than patients with early stage.

Methods

This was a retrospective chart review of patients in the tumor registry in 2003–2006. Patients had epithelial ovarian cancer, other cell types were excluded. Only cases with documentation of surgical and pathologic staging and measured dimensions on pathologic specimen were included. Patient stage and all available dimensions measured on diseased ovaries were recorded. The dimensions for each patient were averaged into a single dimension for that patient, and then these measurements were totaled and averaged.

Results

There were 110 patients analyzed: 85 with advanced disease, 25 with early stage. The average measurement was 4.8 cm in advanced disease, and was 10.7 cm in early stage disease. This difference was statistically significant (p < 0.001).

Conclusions

Overall, patients with early stage ovarian cancer have diseased ovaries that are more than twice as large as those found in advanced disease. This finding supports the fact that early versus advanced ovarian cancer are 2 separate disease processes. Early stage grows locally and does not disseminate, and advanced stage disseminates while the tumor is still relatively small. Theoretically there may be a factor that separates these 2 into different diseases, where advanced disease patients have a substance produced by their tumor that allows for early dissemination, and early stage lacks this substance and only grows locally. Basic science research comparing the tissue microarrays of early versus advanced stage disease may be able to identify this difference. If the difference is found, perhaps therapy can be targeted against this difference, and screening tests for advanced ovarian cancer can be improved.     

Detection of severe pulmonary hypertension based on computed tomography pulmonary angiography

The International Journal of Cardiovascular Imaging - Pulmonary hypertension (PH) is often diagnosed late in the disease course. As many patients may undergo computed tomography pulmonary...     

Promoting mental health in Asia‐Pacific: Systematic review focusing on Thailand and China

Mental health is essential for functioning, general health, and quality of life in low and middle‐income countries (LAMICs), as for high‐income countries. This study aimed first to search in the English language peer‐reviewed literature for reviews of mental health promotion interventions in the Asia‐Pacific region. A global rapid review by Barry and colleagues indicated a paucity of publications on this topic in the peer‐reviewed literature. The second aim of the study followed from this observation. Two systematic reviews of English language literature were conducted as case studies in two countries with known interest in mental health promotion, Thailand and China. The reviews covered publications in peer‐reviewed journals and the “grey” literature. In Thailand, the review demonstrated: strong evidence for an empowerment program for human immunodeficiency virus (HIV)‐infected mothers; a reduction in HIV‐related stigma in a community‐based program; and a coping program for adolescents. The second review concerned suicide prevention interventions in China. It found one relevant study, a WHO multi‐site study of suicide prevention. We found surprisingly little evidence in either country of interventions focused on health equity or modifying the social determinants of mental health. We agree with Barry and colleagues that there is an urgent need to invest in the policy, practice, and research capacity for mental health promotion in LAMICs so that mental health promotion can be incorporated into the wider health promotion and global health development agenda. This includes the Global Action for Health Equity Network. Evidence‐based interventions in parenting, schools, workplaces, and among older people can be initiated or adapted and evaluated in LAMIC settings.     

Dental surgery in patients with severe factor XI deficiency without plasma replacement.

Bleeding following dental extraction is frequently the first manifestation of severe factor XI deficiency. Safe oral surgery has previously been performed in such patients by using plasma replacement therapy with or without concomitant administration of antifibrinolytic agents. The aim of this study was to determine whether such patients can undergo safe dental extractions using only an antifibrinolytic agent. The study group consisted of 19 patients with severe factor XI deficiency (factor XI:C level less than 14 U/dl) who had previously bled following dental extractions (14 patients) or other trauma (five patients). Tranexamic acid, 1 g q.i.d., was given from 12 h before surgery, until 7 days afterwards. No excessive bleeding was observed following dental extractions. One patient had slight oozing after 3 days which ceased spontaneously. Thus, plasma replacement no longer appears necessary for patients with severe factor XI deficiency requiring dental extractions.     

Pharmacodynamic Profiling of a Siderophore-Conjugated Monocarbam in Pseudomonas aeruginosa: Assessing the Risk for Resistance and Attenuated Efficacy

The objective of this study was to investigate the risk of attenuated efficacy due to adaptive resistance for the siderophore-conjugated monocarbam SMC-3176 in Pseudomonas aeruginosa by using a pharmacokinetic/pharmacodynamic (PK/PD) approach. MICs were determined in cation-adjusted Mueller-Hinton broth (MHB) and in Chelex-treated, dialyzed MHB (CDMHB). Spontaneous resistance was assessed at 2× to 16× the MIC and the resulting mutants sequenced. Efficacy was evaluated in a neutropenic mouse thigh model at 3.13 to 400 mg/kg of body weight every 3 h for 24 h and analyzed for association with free time above the MIC (fT>MIC). To closer emulate the conditions of the in vivo model, we developed a novel assay testing activity mouse whole blood (WB). All mutations were found in genes related to iron uptake: piuA, piuC, pirR, fecI, and pvdS. Against four P. aeruginosa isolates, SMC-3176 displayed predictable efficacy corresponding to the fT>MIC using the MIC in CDMHB (R² = 0.968 to 0.985), with stasis to 2-log kill achieved at 59.4 to 81.1%. Efficacy did not translate for P. aeruginosa isolate JJ 4-36, as the in vivo responses were inconsistent with fT>MIC exposures and implied a threshold concentration that was greater than the MIC. The results of the mouse WB assay indicated that efficacy was not predictable using the MIC for JJ 4-36 and four additional isolates, against which in vivo failures of another siderophore-conjugated β-lactam were previously reported. SMC-3176 carries a risk of attenuated efficacy in P. aeruginosa due to rapid adaptive resistance preventing entry via the siderophore-mediated iron uptake systems. Substantial in vivo testing is warranted for compounds using the siderophore approach to thoroughly screen for this in vitro-in vivo disconnect in P. aeruginosa.