Guidelines for the conduction of follow-up studies measuring injury-related disability

BACKGROUND: Scientific knowledge on functional outcome after injury is limited. During the past decade, a variety of measures have been used at various moments in different study populations. Guidelines are needed to increase comparability between studies. METHODS: A working group of the European Consumer Safety Association conducted a literature review of empirical studies into injury-related disability (1995-2005). We included injury from all levels of severity and selected studies using generic health status measures with both short-term and long-term follow up. The results were used as input for a consensus procedure toward the development of guidelines for defining the study populations, selecting the health status measures, selecting the timings of the assessments, and data collection procedures. RESULTS: The group reached consensus on a common core of health status measures and assessment moments. The group advises to use a combination of EuroQol-5D and Health Utilities Mark III in all studies on injury-related disability. This combination covers all relevant health domains, is applicable in all kinds of injury populations and in widely different age ranges, provides a link with utility scores, and has several practical advantages (e.g., brevity, availability in different languages). For specific types of injury, the common core may be supplemented by injury-specific measures. The group advises a common core of assessments at 1, 2, 4, and 12 months after injury. CONCLUSIONS: Our guidelines should be tested and may lead to improved and more consistent epidemiologic data on the incidence, severity, and duration of injury-related disability.     

Mohs micrographic surgery for penile cancer: management and long-term followup

PURPOSE: Mohs micrographic surgery is efficacious for the primary treatment and local recurrence control of nongenital and cutaneous squamous and basal cell cancers. The efficacy of this procedure for squamous cell carcinoma of the penis was reviewed. MATERIALS AND METHODS: We retrospectively reviewed the charts of all patients treated with Mohs micrographic surgery for penile cancer at our institution from 1988 to 2006. RESULTS: We identified 33 patients who underwent a total of 41 Mohs procedures. Average +/- SD lesion size was 509 +/- 699 mm(2). An average of 2.6 +/- 1.4 stages were done using Mohs micrographic surgery. Five procedures were terminated with positive margins, including 3 due to urethral involvement and 2 due to defect size. Of the tumors 26 were stage Tis, 4 were T1, 7 were T2 and 4 were T3. A total of 13 defects were reconstructed by primary repair or granulation, 4 were reconstructed by skin grafts and 25 were reconstructed by tissue flaps and urethroplasty. Followup data were available on 25 patients at a mean of 58 +/- 63 months. Eight patients (32%) had recurrence, which was managed by repeat Mohs micrographic surgery in 7 and by penectomy in 1. There were 2 cases of tumor progression, including 1 from T1 to T3 disease (meatal involvement) and 1 from T1 to inguinal lymph node involvement. Two patients died, of whom 1 had no evidence of penile cancer and 1 had metastatic disease. CONCLUSIONS: Mohs micrographic surgery for low stage penile cancer results in a relatively high local recurrence rate. However, with repeat procedures and vigilant followup cancer specific and overall survival rates are excellent and progression rates are low.     

iso-Kaurenoic acid from Wedelia paludosa D.C

A recent reinvestigation of aerial parts of Wedelia paludosa D.C. is described and reports, for the first time, the isolation of iso-kaurenoic acid from this species.     

Type-D personality mechanisms of effect: the role of health-related behavior and social support

OBJECTIVE: To (a) investigate the prevalence of type-D personality (the conjoint effects of negative affectivity and social inhibition) in a healthy British and Irish population; (b) to test the influence of type-D on health-related behavior, and (c) to determine if these relationships are explained by neuroticism. METHODS: A cross-sectional design was employed; 1012 healthy young adults (225 males, 787 females, mean age 20.5 years) from the United Kingdom and Ireland completed measures of type-D personality, health behaviors, social support, and neuroticism. RESULTS: The prevalence of type-D was found to be 38.5%, significantly higher than that reported in other European countries. In addition, type-D individuals reported performing significantly fewer health-related behaviors and lower levels of social support than non-type-D individuals. These relationships remained significant after controlling for neuroticism. CONCLUSION: These findings provide new evidence on type-D and suggest a role for health-related behavior in explaining the link between type-D and poor clinical prognosis in cardiac patients.     

Antinociceptive Effect of a Novel Tosylpyrazole Compound in Mice

Abstract: Pain is the most common complaint in the medical field and the identification of compounds that can effectively treat painful states without induction of side‐effects remains a major challenge in biomedical research. The aim of the present study was to investigate the antinociceptive effect of a novel compound, 3‐(4‐fluorophenyl)‐5‐trifluoromethyl‐1H‐1‐tosylpyrazole (compound A) in several models of pain in mice and compare with those produced by the known trifluoromethyl‐containing pyrazole compound celecoxib. Compound A or celecoxib were administrated by oral (78–780 µmol/kg), intrathecal (9–22.5 nmol/site) or intracerebroventricular (9–22.5 nmol/site) routes. Oral administration of either compound A or celecoxib abolished the mechanical allodynia, but not the oedema caused by intraplantar injection of carrageenan. Similarly, compound A reduced the overt nociception, but not the oedema, produced by bradykinin or capsaicin. However, compound A (500 µmol/kg, orally) did not alter nociception nor oedema caused by intraplantar injection of prostaglandin E₂ or glutamate, whereas celecoxib reduced only the nociception induced by the former. Moreover, oral and intrathecal administration of compound A or celecoxib also reduced the nociception induced by acetic acid. However, only celecoxib reduced the acetic acid‐induced nociception when it was injected by the intracerebroventricular route. Finally, neither compound A nor celecoxib was able to produce antinociceptive effect in the tail‐flick test or to alter the motor performance and the body temperature. Besides, compound A or celecoxib did not induce gastric lesion. Thus, compound A seems to be an interesting prototype for the development of novel analgesic drugs.     

Novel Abl kinase inhibitors in chronic myeloid leukemia in blastic phase and Philadelphia chromosome-positive acute lymphoblastic leukemia

Chronic myeloid leukemia (CML) is characterized by the presence of the Philadelphia chromosome, which is associated with a balanced translocation involving chromosomes 9 and 22 to produce a fusion gene (bcr-abl) that gives rise to a constitutively activated Abl tyrosine kinase. This kinase led to the discovery of several small-molecule inhibitors, imatinib being the first and most successful of these. Resistance to imatinib results in some patients from Abl kinase point mutations. Overcoming imatinib resistance represents one of the biggest challenges facing clinicians in the modern management of CML. In this review, we discuss the current understanding of CML pathophysiology and mechanisms of imatinib resistance and how advancing this knowledge has led to the design of novel therapies in the area of blastic phase CML and Philadelphia chromosome-positive acute lymphoblastic leukemia with previous imatinib failure.     

What＇s wrong with sentinel node mapping in colon cancer？

Despite near-universal embrace of the concept and clinical relevance of lymphatic mapping for sentinel node identification and analysis for cancers of the breast and integument, the same technique has struggled to a find a role in gastrointestinal cancers in general and, perhaps, in colon cancer in particular. Despite many studies demonstrating its feasibility in malignancies of the large bowel, concern is continually aroused by the variable and often unacceptably low sensitivity rates. Additionally, many confess uncertainty as to what benefit it could ever confer to patients even if it were proven sufficiently accurate given that standard surgical resection incorporates mesenteric resection anyway. However, the huge impact sentinel node mapping has had on clinical practice in certain cancers means that each of these aspects merit careful reconsideration, from very first principles.     

Penetrating ectopic peptic ulcer in the absence of Meckel＇s diverticulum ultimately presenting as small bowel obstruction

We report here how a heterotopic penetrating peptic ulcer progressed to cause small bowel obstruction in a pa- tient with multiple previous negative investigations. The clinical presentation, radiographic features and patho- logical findings of this case are described, along with the salient lessons learnt. The added value of wireless cap- sule endoscopy （WCE） in such circumstances is debated.