A new skatepark: the impact on the local hospital

BACKGROUND: There has been a resurgence of skateboarding, rollerblading and BMX riding in recent years and in response dedicated skateparks have opened in many cities across the UK. It is acknowledged that these sports are associated with risk of injury and it is recommended that participants wear protective clothing. OBJECTIVE: We aimed to determine if the opening of a skatepark near our hospital had any effect on the number of skatepark related injuries attending the emergency department and to describe the types of injuries sustained. METHODS: All patients attending the emergency department with sports injuries were identified over 24 consecutive weeks. At the end of the 12th week a skatepark opened nearby. Data recorded prospectively included age and sex of subjects, the delay from injury to presenting to hospital, whether or not protective equipment was worn and if first aid was administered before attending hospital. The investigations performed in the emergency department, the diagnosis, treatment received and disposal from the hospital were also recorded. RESULTS: After the skatepark opened there was a significant increase in the number of skatepark related attendances from 7 to 32. Protective clothing was only worn by 9 out of 39 of those with injuries. The commonest injuries were musculoskeletal and the limbs were injured more frequently than the head and trunk. CONCLUSION: We demonstrated a significant increase in the number of skatepark related injuries attending the emergency department following the opening of a nearby skatepark.     

Up-regulation of TLK1B by eIF4E overexpression predicts cancer recurrence in irradiated patients with breast cancer

BACKGROUND: The overexpression of eukaryotic initiation factor 4E (eIF4E), which is a critical component of the RNA helicase complex important in the translation of messenger RNAs with long and/or complex 5' untranslated regions, appears to impact malignant transformation and predict cancer recurrence in patients with breast cancer, independent of nodal status. Tousled-like kinase (TLK1B) is a mammalian threonine kinase with a long 5' untranslated regions in the messenger RNA. In vitro, malignant cells with eIF4E overexpression appear to have corresponding TLK1B elevation. Additionally TLK1B phosphorylates histone 3, which is a protein that is involved in chromatin assembly, plays an integral role in radioresistance in cell lines. Our hypothesis is that patients with breast cancer with high eIF4E overexpression have increased TLK1B and a higher risk for recurrence after adjuvant radiation therapy. METHODS: One hundred fifty-eight patients with stage I to III breast cancer were accrued in a prospective study that was designed to detect cancer recurrence in patients who had been treated with adjuvant radiation therapy. A standardized surveillance and treatment protocol was used to maximize treatment homogeneity and to detect the study primary end point, cancer recurrence. All patients received adjuvant radiation therapy either for high-risk node-positive disease or as a part of breast conservation therapy. TLK1B and eIF4E levels were quantified by Western blot. Statistical analysis was performed and included Spearman correlation, survival analysis by the Kaplan-Meier method, log-rank test, and Cox proportional hazard model. RESULTS: Both eIF4E (15.4 +/- 0.6, mean +/- SD) and TLK1B (18.8 +/- 1.5) were increased in all breast cancer specimens. Increasing eIF4E overexpression was correlated highly with increasing TLK1B (r = 0.35; P < .0001, Spearman coefficient). Tertile distribution of patients, based on the degree of eIF4E and TLK1B increase, demonstrated that the patients in the highest eIF4E group and the highest TLK1B group had a higher rate of cancer recurrences (P = .015 and .049, log rank test, respectively). After adjustment for stage of disease, age, and estrogen/progesterone receptor status, data showed that patients in the highest TLK1B group had a 3.0-fold increase in relative risk for cancer recurrence after adjuvant radiation therapy (P = .036; 95% CI, 1.0-5.0), compared with patients in the low TLK1B group. CONCLUSION: The overexpression of eIF4E is correlated with TLK1B increase in cancer specimens from patients with stage I to III breast cancer. High TLK1B increase in tumor specimens was associated with a higher risk for cancer recurrence after adjuvant radiation therapy. Resistance to radiotherapy may be 1 mechanism whereby eIF4E overexpression in breast cancer portends a worse prognosis.     

Sensitivity to stress-induced reproductive dysfunction linked to activity of the serotonin system

OBJECTIVE: To use a nonhuman primate model and determine whether individuals sensitive to stress-induced reproductive dysfunction have lower activity of central serotonergic neurons under nonstressed conditions. DESIGN: The activity of the central serotonergic system was assessed by measuring responsiveness to a fenfluramine challenge (5 mg/kg, IV) in sedated monkeys previously categorized as highly stress resistant (HSR; n = 4; normal menstrual cyclicity through two stress cycles), medium stress resistant (MSR; n = 5; ovulatory in the first stress cycle but anovulatory in the second stress cycle), or low stress resistant (i.e., stress sensitive, SS; n = 4; anovulatory as soon as stress is initiated). To control for differences in pituitary stores of prolactin or ACTH, the animals were subsequently administered a bolus of thyrotropin-releasing hormone (3 microg/kg) plus corticotropin releasing factor (CRF), (3 microg/kg). SETTING: Oregon National Primate Research Center, Animal Services Building. PATIENT(S): Female cynomolgus macaques exhibiting normal menstrual cycles. INTERVENTION(S): Administration of fenfluramine, a serotonin-releasing drug. MAIN OUTCOMES MEASURE(S): Serum concentrations of prolactin (PRL) and cortisol (F). RESULT(S): Prolactin release in response to fenfluramine was significantly greater in the HSR group compared with the MSR or SS groups. In contrast, cortisol was higher in the SS group compared with the other two groups. Similar responses were not evident after thyrotropin-releasing hormone + CRF stimulation. CONCLUSION(S): The lower PRL response to fenfluramine in the stress-sensitive animals suggests that stress-sensitive individuals have decreased activity in central serotonergic neurons. However, the F data suggest that the hypothalamic-pituitary-adrenal axis in stress-sensitive individuals is highly responsive to even small increases in serotonin.     

Reorganization of a Medical house staff (Firm System)

In 1975, the Johns Hopkins Medical house staff was reorganized into four Firms. Each Firm provides inpatient and outpatient care to a group of patients. Two of the goals of the reorganization were to improve accessibility and continuity of care. This study, based on a before and after research design utilizing routinely collected data, sought to determine whether these goals had been attained. Accessibility was assessed by observing changes in waiting time for appointments, broken appointments, and number of patients seen before their scheduled appointments. The results showed that mean waiting time for a Medical Clinic appointment fell from 15 days to 1 day (p<0.01); broken appointments for new patients fell from 54% to 34% (p<0.01); no significant changes occurred in broken appointments for old clinic patients (34% vs 32%); and patients seen before their scheduled appointments increased from 30% to 38% (p<0.001).Continuity was assessed by observing changes in use of emergency and walk-in clinic services, the proportion of Medical Clinic patients lost to follow-up care, the proportion of hospital readmissions returning to the same nursing unit, and the proportion of patients discharged from the hospital who returned to the Medical Clinic. The results showed that use of emergency and walk-in clinic services fell slightly, from 24% of all visits before to 22% of all visits after the Firm System (p<0.001); no change occurred in the proportion of patients lost to Medical Clinic follow-up (21% before and after the Firm System); the proportion of hospital readmissions returning to the same nursing unit increased from 35% to 73% (p<0.005); and the proportion of patients discharged from the hospital who returned to the Medical Clinic increased from 21% to 35% (p<0.001). These data suggest that implementing the Firm System led to improvement in several selected aspects of accessibility and continuity of care but that further improvements could be made.From the Johns Hopkins University, Baltimore, Maryland. Supported in part by the Robert Wood Johnson Foundation Clinical Scholars Program and the Health Services Research and Development Center (PHS Grant HSO 1964) and the Department of Medicine of the Johns Hopkins University. Dr. Horan is an instructor in the Department of Medicine; Dr. Steinwachs is Research Manager, Health Services Research and Development Center; Dr. Smith is Chief, Division of Internal Medicine; Mr. Shapiro is Director, Health Services Research and Development Center. The authors wish to express thanks to Dr. Victor A. McKusick, Dr. David M. Levine, Mr. John Stiney, Ms. Gail Otis, Ms. Sharon Mitchell, and to the Faculty of the Division of Health Care Organization, School of Hygiene and Public Health. Reprint requests should be sent to Dr. Horan, Johns Hopkins Hospital, Harvey 402, 600 N. Wolfe Street, Baltimore, Maryland, 21205.     

Morphine induced increases in the incorporation of 3H-thymidine into brain striatal DNA

³H-thymidine uptake into DNA fractions of rat brain regions was measured following in vivo administration of (methyl-³H)-thymidine and morphine. Acute morphine administration (10 mg/kg; 30 min prior to ³H-thymidine) increased incorporation of ³H-thymidine into DNA of rat striatum. This effect was antagonized by naloxone (1 mg/kg). Further, the observed change in incorporation of ³H-thymidine into DNA in striatum could not be accounted for by differences in the local availability of the label in morphinized rats. An autoradiographic study revealed that the ³H-thymidine was localized in nuclei in cells of the sub-ependymal layer lining the lateral ventricles, an area of glial cell proliferation in adult rats. No change in ³H-thymidine incorporation into DNA was observed in any area of the brain in morphine-addicted rats or in rats undergoing naloxone-precipitated withdrawal. The results indicate that opiates may induce permanent anatomical changes in the brain, including alterations of neuroglial interactions.     

INCORPORATION OF SULFATE BY THE MOUSE THYMUS: ITS RELATION TO SECRETION BY MEDULLARY EPITHELIAL CELLS AND TO THYMIC LYMPHOPOIESIS

The thymus was examined in suckling mice during normal development and the involution and regeneration produced by injection of cortisol, in experiments designed to test the hypothesis that medullary epithelial cells secrete a ymphopoietic hormone responsible for controlling the magnitude of thymic lymphopoiesis. Cellular events were observed by light and electron microscopy. Lymphopoiesis was assessed, after injection of thymidine-³H, by counting the proportion of lymphocytes labeled in radioautographs of thymus. Cortical lymphopoiesis was distributed heterogeneously, being concentrated in the subcapsular region, but medullary lymphopoiesis was statistically homogeneous in distribution and similar in magnitude to the average level of cortical lymphopoiesis in suckling mice. Therefore counts of the labeling index in the medulla were used to estimate the size of the proliferating population of lymphocytes. Epithelial secretory activity was estimated by measuring the incorporation of ³⁶sulfate by the thymus, using gel filtration chromatography to isolate soluble macromolecular ³⁵sulfate—presumed on radioautographic evidence to represent the mucoid epithelial secretory product. Incorporated ³⁵sulfate accumulated rapidly for 4 hr, reached a peak at 12 hr, and had fallen to half that level by 24 hr after a single injection—as would be expected of a secretory product. During normal postnatal development the size of the proliferating population of lymphocytes and the magnitude of ³⁵sulfate incorporation increased in parallel. During acute involution induced by cortisol both parameters diminished greatly but rose to high levels during subsequent regeneration. Accordingly, lymphopoiesis and sulfate incorporation —as defined and measured in these experiments—correlated linearly over a wide range of variation, providing circumstantial evidence to support the hypothesis that medullary epithelial cells secrete a sulfated mucoid lymphopoietic hormone. This conclusion is discussed in terms of the roles of thymus and adrenal cortex in development of the lymphoid system and maturation of immunological competence.