Heparin sodium versus 0.9% sodium chloride injection for maintaining patency of indwelling intermittent infusion devices

In a double-blind study, heparin sodium was compared with 0.9% sodium chloride injection for use in maintaining patency of indwelling devices for intermittent intravenous infusion. Adult patients who required intermittent intravenous devices were randomly assigned to receive 1 mL of a heparin sodium 100 units/mL flush solution or a 0.9% sodium chloride flush solution. Observations were recorded for each catheter, rather than for each patient. Patients were evaluated daily for the development of phlebitis. In the 160 patients for whom complete data on catheter patency were available, there were 307 observations (170 for the heparin group and 137 for the sodium chloride group). No significant difference in the duration of catheter patency or incidence of phlebitis was observed between the groups. A difference in the incidence of phlebitis could not be excluded with confidence, but inasmuch as there was no effect on duration of catheter patency, the clinical importance of this superficial venous phlebitis is questionable. The duration of patency was significantly greater in men than in women. The use of penicillins, cephalosporins, or clindamycin, alone or in combination, was significantly associated with the development of phlebitis for both treatment groups. No other factors were found to correlate with either the duration of catheter patency or incidence of phlebitis. The results of this study indicate that heparin offers no advantage over 0.9% sodium chloride injection in maintaining the patency of intermittent intravenous devices.     

Mammalian-like features of sleep structure in zebra finches

A suite of complex electroencephalographic patterns of sleep occurs in mammals. In sleeping zebra finches, we observed slow wave sleep (SWS), rapid eye movement (REM) sleep, an intermediate sleep (IS) stage commonly occurring in, but not limited to, transitions between other stages, and high amplitude transients reminiscent of K-complexes. SWS density decreased whereas REM density increased throughout the night, with late-night characterized by substantially more REM than SWS, and relatively long bouts of REM. Birds share many features of sleep in common with mammals, but this collective suite of characteristics had not been known in any one species outside of mammals. We hypothesize that shared, ancestral characteristics of sleep in amniotes evolved under selective pressures common to songbirds and mammals, resulting in convergent characteristics of sleep.     

Demonstration of an association between detection of IgG antibody reactivity towards the C-terminal region of the preS1 protein of hepatitis B virus and the capacity to respond to interferon therapy in chronic hepatitis B

Background and Aim: The treatment of hepatitis B virus (HBV) remains complex, with somewhat unpredictable responses. The aim of this study was to determine the predictive value of the pretreatment presence of circulatory antibodies towards a synthetic peptide mimicking the amino acids 94–117 of the preS1 protein of HBV and the capacity to respond to alpha‐inteferon (IFN‐alpha) treatment. Methods: The anti preS1(94–117) antibodies were measured by a peptide‐based enzyme‐linked immunosorbent assay (ELISA) and the response to INF‐alpha therapy was judged by the effect on the viral kinetics as measured by an assay based on quantitative polymerase chain reaction during the treatment and follow up. Results: We found a significant (P < 0.001) correlation between the pretreatment presence of anti preS1(94–117) antibodies and a decrease in viral levels on follow up after the end of IFN‐alpha therapy. The combined response of HBV DNA suppression (P < 0.001), hepatitis B e antigen (HBeAg) loss (P < 0.0001), anti‐HBe seroconversion (P < 0.005) and AST aminotransferase normalization (P < 0.01) was also highly associated with the pretreatment presence of anti preS1(94–117) antibodies. Conclusion: The positive predictive value (PPV) of anti preS1(94–117) in determining a virological response was 83% and the negative predictive value (NPV) was 100%, indicating that in the absence of pretreatment anti preS1 reactivity virtually no patient has the capacity to respond to IFN‐alpha therapy. Our findings may help to improve the efficacy of INF‐alpha therapy for chronic hepatitis B (CHB) by guiding the selection of patients for treatment and optimizing the clinical management of the individual patient.     

Postmenopausal hormone therapy and body composition--a substudy of the estrogen plus progestin trial of the Women's Health Initiative

BACKGROUND: It has been suggested that hormone therapy may help counter undesirable changes in body composition in older women. OBJECTIVE: This study was designed to test whether estrogen plus progestin (E+P) therapy favorably affects age-related changes in body composition in postmenopausal women. DESIGN: The substudy was composed of 835 women from the estrogen plus progestin trial of the Women's Health Initiative who were randomly assigned to receive either E+P therapy (n = 437) or placebo (n = 398). The women had a mean age of 63.1 y and, on average, were 13.8 y past menopause. More than 17% of the participants were from an ethnic minority. No significant differences in baseline body composition (measured with dual-energy X-ray absorptiometry) by intervention assignment were observed. RESULTS: After 3 y of intervention, the women who received active E+P therapy lost less lean soft tissue mass (-0.04 kg) than did the women who received placebo (-0.44 kg; P = 0.001). Additionally, the women in the E+P group had less upper-body fat distribution than did the women in the placebo group (change in ratio of trunk to leg fat mass: -0.025 for the E+P group and 0.004 for the placebo group; P = 0.003). A sensitivity analysis, which was conducted on the women who took > or = 80% of the study medication during the intervention period, corroborated the findings from the intent-to-treat analysis. CONCLUSIONS: A 3-y E+P intervention significantly reduced both the loss of lean soft tissue mass and the ratio of trunk to leg fat mass in postmenopausal women. However, the effect sizes were small, and whether these changes in body composition lead to significant health benefits remains to be confirmed.     

Intraoperative sentinel lymph node examination by frozen section, immunohistochemistry and imprint cytology during breast surgery--a prospective study

The aim of this study was to compare the sensitivity of intraoperative frozen section with hematoxyllin-eosin (H&E) staining, immunohistochemistry (IHC) or imprint cytology (IC) in the analysis of sentinel node (SN) in breast cancer. Towards this end, a prospective study of 102 patients undergoing mastectomy or sector resection with SN biopsy was conducted. Frozen sections of SN with H&E, IHC staining and IC had sensitivities of 73.5%, 75.5% and 51.0%, respectively. The combination of H&E and IHC raised the overall sensitivity to 83.7%. Macrometastases (>2 mm) were detected in 100% of the cases with H&E, 92.6% with IHC and 81.5% with IC; and micrometastases (2 mm) in 35.0%, 45.0% and 5.0%, respectively. The combination of H&E and IHC staining raised the sensitivity to 55.0%. Frozen-section analysis with H&E staining showed high sensitivity in detecting macrometastases but not micrometastases. The sensitivity for detection of micrometastases was not substantially increased by the use of intraoperative IHC. Imprint cytology did not provide any additional information.