Water turnover and changes in body composition during arduous wildfire suppression

INTRODUCTION: Our lab has recently documented the total energy expenditure during arduous wildfire suppression using the doubly labeled water methodology. The elevated rates of isotopic elimination indicate an arduous working environment that may often compromise energy balance and overall hydration. PURPOSE: The purpose of this investigation was to determine the effects of arduous wildfire suppression on water turnover and changes in body composition in wildland firefighters (WLFF). METHODS: WLFF (N = 14) were studied during a 5-d period of arduous fire suppression work. A comparison group (N = 13) of recreationally active college students (RACS) was also studied. Water turnover was measured from rates of 2H elimination (rH2O). Urine osmolality, specific gravity, and skinfold measures were also collected. RESULTS: WLFF demonstrated a decrease in nude body weight (pre = 71.9 +/- 10.4 kg, post = 70.9 +/- 10.2 kg, P = 0.0001) and total body water (pre = 42.9 +/- 7.2 kg, post = 42.0 +/- 6.7 kg, P = 0.0046). RACS maintained total body water and body weight during the experimental period. Isotope (2H2O) dilution demonstrated that rH2O was significantly higher for the WLFF (rH2O = 6.7 +/- 1.4 and 3.8 +/- 1.0 L.24 h-1 for the WLFF and RACS, respectively). CONCLUSION: These results demonstrate an arduous work environment that threatens hydration, energy balance, and perhaps normal glycogen status.     

Case study of training, fitness, and nourishment of a dog driver during the Iditarod 1049-mile dogsled race

The purpose of the present case study was threefold: (a) to estimate intake and expenditure of a dog driver (musher) while participating in the Iditarod, (b) to determine the hydration status of the musher at the completion of the event, and (c) to evaluate training related changes in aerobic capacity and body composition of a long-distance dog sled driver in preparation for and following completion of a 1049-mile (1692-km) sled dog race. Actual energy intake during the Iditarod Sled Dog Race was estimated at 8,921 kilojoules (kJ) per day. Nutrient intake expressed as percentage kJ of total energy (14%, 44% and 42% for protein, carbohydrates, and fat, respectively). Weight loss of .72 kg of body weight indicated an energy deficit of 1819 kJ per day during the race. Total energy needs per day were calculated to be 10,740 kJ/day. An increase in hematocrit and hemoglobin during the race may indicate dehydration during the event. There was an improvement in aerobic fitness during on-snow training as determined by ventilatory threshold and VO2peak data. Fat-free mass was maintained during training (46.4 kg), with a concomitant decrease in fat (2.4 kg). Fat-free mass was also maintained during the 12-day race.     

Tarsal-conjunctival disease associated with Wegener's granulomatosis

OBJECTIVE: To describe the clinical characteristics of tarsal-conjunctival disease in a cohort of patients with Wegener's granulomatosis (WG). DESIGN: Retrospective, case-controlled study. PARTICIPANTS: The medical records of 82 consecutive WG patients who underwent an eye examination between January 1996 and June 2002 at the National Institutes of Health were reviewed. METHODS: Details of the ophthalmic examination, results of medical therapy, and histopathologic analysis results were recorded. Tarsal-conjunctival disease was defined by (1). conjunctival hyperemia and granuloma formation, areas of necrosis, or active fibrovascular changes in the tarsus or conjunctiva, or (2). evidence of inactive fibrovascular scar. The association of tarsal-conjunctival disease with major organ system involvement was assessed using Bayesian methods. MAIN OUTCOME MEASURES: The occurrence and clinical characteristics of tarsal-conjunctival disease in a cohort of patients with WG and associations with major organ system involvement. RESULTS: Tarsal-conjunctival disease occurred in 13 of 82 patients (16%) with WG examined over a 6.5-year period. The palpebral surface of the upper lid was involved most commonly, showing conjunctival hyperemia in seven patients, granulomatous lesions in three patients, tarsal-conjunctival necrosis in four patients, active fibrovascular proliferation in six patients, and inactive fibrous scar tissue in seven patients. Histopathologic analysis of eyelid biopsy specimens showed granulomatous inflammation, focal necrosis, and areas of occlusive vasculitis in the tarsus and conjunctiva. In reviewing the patterns of organ involvement in patients with and without tarsal-conjunctival disease, the association of subglottic stenosis and nasolacrimal duct obstruction with tarsal-conjunctival disease showed a high probability of clinical significance. CONCLUSIONS: Tarsal-conjunctival disease, a previously uncommon finding in patients with WG, was characterized by inflammation of the palpebral conjunctiva and tarsus followed by a fibrovascular proliferation and scar formation. Because of the important association of tarsal-conjunctival disease with subglottic stenosis, which can progress and lead to laryngeal obstruction and respiratory failure, patients with tarsal-conjunctival disease should be referred to an otolaryngologist for evaluation.     

Significance of acute pulmonary embolism for the exacerbation of chronic obstructive pulmonary disease

The clinical diagnosis of acute pulmonary embolism in patients with chronic obstructive pulmonary disease is often difficult because there is no characteristics sign of acute pulmonary embolic event. The presentation of an acute embolic event may mimic the symptoms of acute airway obstruction which is caused by different reasons. The presence of chronic obstructive pulmonary disease was recorded on a clinical history, physical examination, chest roentgenogram, and the result of pulmonary function studies. Among the 178 patients with chronic obstructive pulmonary disease in 49 patients (27.5 percent) were suspected of having pulmonary embolism. Pulmonary embolism was excluded by normal or low probability V/Q scan in 19 patients. Among 23 patients who demonstrated a high probability lung scan there was a high positive predictive value for pulmonary embolism effectively avoiding the need for further studies. Among the 7 patients with nondiagnostic or intermediate probability lung scan contrast-enhanced helical computed tomography was detected the pulmonary embolism in 3 patients. The present study was undertaken to better define the noninvasive clinical, laboratory, roentgenographic, lung scan, and computed tomography characteristics of acute pulmonary embolism in patients with chronic obstructive pulmonary disease.     

Phase III quality-of-life study results: impact on patients' quality of life to reducing xerostomia after radiotherapy for head-and-neck cancer--RTOG 97-09

PURPOSE: To determine whether prevention of hyposalivation after curative radiotherapy (RT) to the head and neck improves patients' quality of life (QOL). METHODS AND MATERIALS: Patients were to receive at least 50 Gy to 50% of the volume of the major salivary glands, provide unstimulated and stimulated saliva samples, and complete the University of Washington head-and-neck QOL tool before RT and 3 and 6 months after RT. Patients were randomized to receive pilocarpine 5 mg or placebo q.i.d. RESULTS: A total of 249 patients was randomized between March 1998 and January 2000. Of these, 214 were eligible for QOL analysis. Patients were evenly distributed between arms by race, gender, tobacco use, tumor site, T stage (50% T2-T3), and salivary function. A Karnofsky performance status of 90% was more common in the pilocarpine arm. Twenty percent of the patients on the pilocarpine arm and 29% of the patients on the placebo arm were taking nutritional supplements. The placebo arm patients had greater mouth pain and chewing difficulties. Compliance for the QOL tool at 3 and 6 months was 65% and 50%, respectively. Despite statistically significant (p = 0.047 and p = 0.049, respectively) preservation of salivary function in the pilocarpine arm, patients on the pilocarpine arm reported difficulties with swallowing (75%), activity (80%), hyposalivation (64%), and taste (81%). No difference was noted between arms at 3 months in mucositis scores, with both arms demonstrating increased requirement for oral nutrients. CONCLUSION: Objective prevention of hyposalivation did not affect patients' assessment of salivary function or QOL because of the greater impact mucositis plays in QOL after RT.     

Mortality rates and causes of death in a cohort of HIV-infected and uninfected women, 1993–1999

HIV/AIDS-associated and non-HIV/AIDS-associated death rates and causes of death between 1993 and 1999 were examined in 885 HIV-infected women and 425 uninfected women of the HIV Epidemiology Research Study cohort. Causes of death were determined by review of death certificates and the National Death Index. Adjusted bazard ratios were calculated for mortality risk factors. In the 885 HIV-infected women and 425 uninfected women, 234 deaths and 8 deaths, respectively, occurred by December 31, 1999. All-cause death rates in the HIV-infected women were unchanged between the pre-HAART (1993–1996) and HAART eras (1997–1999) —5.1 versus 5.4 deaths per 100 person-years (py). AIDS as a cause of death decreased from 58% of all deaths in 1996 to 19% in 1999, while HAART use increased to 42% by the end of 1999. In spite of the modest proportion ever using HAART, HIV-related mortality rates did decline, particularly in women with CD4+cell counts less than 200/mm³. Drug-related factors were prominent: for the 129 non-AIDS-defining deaths, hepatitis C positivity (relative bazard [RH] 2.6, P<0.001) and injection drug use (RH 1.7, P=0.02) were strong predictors of mortality, but were not significant in the Cox model for 105 AIDS-defining deaths (RH 0.9, P>30 and RH 0.7, P>.30, respectively. The regression analysis findings, along with the high percentage of non-AIDS deaths attributable to illicit drug use, suggest that high levels of drug use in this population offset improvements in mortality from declining numbers of deaths due to AIDS. Supported by cooperative agreements No. U64/CCU106795, U64/CCU206798, U64/CCU306802, and U64/CCU506831 with the Centers for Disease Control and Prevention including supplementary support from the National Institute on Drug Abuse. Centers for Disease Control and Prevention, Division of HIV     

Comparison of methods for predicting myelotoxicity for non-marrow targeting I-131-antibody therapy

Although marrow suppression is usually the dose-limiting toxicity in non-marrow ablative radionuclide therapy, calculated marrow dose has rarely been used for prescribing the radioactivity to be administered. This study assesses the correlation of myelotoxicity with mCi/m(2), patient-specific lean body dose, marrow dose from blood and body of reference man, or from blood and body using the patient-specific mass. Fourteen prostate cancer patients were treated with (131)I-CC49. Radioactivity in blood and body was determined and used to calculate their contributions to the marrow dose. Platelet nadir expressed as percentage (%) of the initial baseline was used as an indicator for myelotoxicity. Correlation between platelet nadir (%) and myelotoxicity predictors was evaluated. Platelet nadirs (%) varied substantially (5-33%) for a small range of injected radioactivity/m(2) (68-78 mCi/m(2), 2.5-2.9 GBq/m(2)). Patient-specific total body dose based on lean body mass exhibited a weak correlation (r = 0.48) with platelet nadir. Marrow dose from blood and body of reference man had a better correlation (r = 0.73). Patient-specific marrow dose from blood and body (or lean body) had a similar correlation (r = 0.74 or 0.73). Radioactivity in the remainder of the body contributed only 28% of the total dose, and thus changes to this dose component had small impact on total marrow dose. Marrow dose was a better predictor for myelotoxicity than mCi/m(2) or lean total body dose in this non-marrow targeting (131)I-antibody therapy with high blood contributions to total dose.     

Gonadal steroids, selective serotonin reuptake inhibitors, and mood disorders in women

That gonadal steroids influence the limbic system and that they affect neurotransmitter activity is undisputed. Because of these known actions, and because ET and HT alleviate hot flushes and resultant sleep disturbances, they may improve mood and sense of well-being in healthy climacteric women. However, estrogen plus progestin did not decrease depressive symptoms in the WHI, the largest double-blind, placebo-controlled trial of hormone replacement yet performed. In addition, although several studies have suggested efficacy in this regard, neither ET nor HT has been proved to be therapeutic for major depression in perimenopausal and menopausal women. Certainly, further studies are needed on the potential of estrogen as an antidepressant. Based on current evidence, however, one cannot prescribe ET or HT as primary treatment for major depression in good conscience. When treating patients far this serious problem, one cannot rely on theory and the desire that it be borne out. As Sigmund Freud wrote: "Thus we call a belief an illusion when a wish-fulfillment is a prominent factor in its motivation, and in doing so we disregard its relation to reality, just as the illusion itself set, no store by verification". Since the initial publication of the results of the WHI, clinicians have learned to be cautious when making decisions about therapy that has not been proved in randomized controlled trials. In addition, attention has shifted away from potential global effects of ET and HT toward more specific management of each specific clinical sequela of menopause. If major depression is to be addressed in this way, SSRIs become first-line therapy, with TCAs considered second-line because of reduced tolerability. ET and HT may be added separately as appropriate, and may be helpful on an individual basis. Indeed, treatment for major depression in any person, male or female, at any age, is best chosen based on life situation and the neuropsychology of the condition, and not based on gender alone.