Effect of pethidine administered during the first stage of labor on the acid-base status at birth

OBJECTIVE: To evaluate the association between the use of pethidine during the first stage of labor and the presence, type and timing of acidosis in the newborn at birth. STUDY DESIGN: Secondary data analysis of a randomized controlled trial, which included term singleton pregnancies diagnosed with dystocia and requiring active management of labor. Women were randomized to receive either 100 mg of pethidine or placebo. Statistical analyses were performed using chi(2) or Fisher's exact tests for proportions and multiple linear regression for continuous outcomes. RESULTS: Three hundred and eighty-three pregnant women with a valid arterial blood cord sample were included in the final analysis. Lower pH and bicarbonate levels, as well as higher pCO(2) levels were found in the pethidide group. A higher incidence of acidosis was found in the pethidine group (pH<7.12 OR: 8.59 95% C.I. 3.29, 22.46). The highest frequency of acidosis was encountered when pethidine-delivery interval was 5 h. CONCLUSION: Pethidine use during the first stage of labor was associated with an increased risk of acidosis at birth.     

Steroid hormones and leiomyomas

The sex steroid hormones play an important role in myoma maintenance and growth as evidenced by clinical, molecular, biological, and pharmacological models. It is hoped that the next phase of research will elucidate better the mechanisms through which these hormones modulate myoma growth and how they interact with the as yet unidentified other factors that play a role in myoma development and growth.     

Modulation of sympathetic neurotransmission by neuropeptide Y Y2 receptors in rats and guinea pigs

We have investigated the effect of the Y₂ receptor agonist (Y₂ agonist; N-acetyl [Leu^28,31] NPY 24-36), on contractions evoked by transmural electrical stimulation of sympathetic nerves of isolated arteries from a range of vascular beds in rats and guinea pigs. Contractions evoked by transmural stimulation of the rat renal, mesenteric and femoral arteries were significantly attenuated in the presence of the Y₂ agonist. In these arteries, contractions were significantly inhibited in the presence of an α-adrenoceptor antagonist (76–97%). So we conclude that these responses were primarily mediated by noradrenaline and that the Y₂ agonist attenuates the release of noradrenaline via presynaptic Y₂ receptors. Contractions of the rat carotid artery were not attenuated by the Y₂ agonist but were completely abolished in the presence of an α-adrenoceptor antagonist suggesting that in this artery the Y₂ agonist has no effect on release of noradrenaline. In the guinea pig, carotid arteries contractions evoked by transmural nerve stimulation were attenuated in the presence of the Y₂ agonist and inhibited by an α-adrenoceptor antagonist 75–87% suggesting that the Y₂ agonist attenuates the release of noradrenaline via presynaptic Y₂ receptors in this vessel. In the guinea pig femoral artery contractions evoked by transmural stimulation were not modified in the presence of the Y₂ agonist but were completely abolished in the presence of an α-adrenoceptor antagonist. This suggests that the Y₂ agonist does not modify noradrenaline release in this vessel. Contractions of the guinea pig mesenteric artery were significantly potentiated by the Y₂ agonist, possibly by potentiation of neuropeptide Y (NPY) at the Y₁ receptor. The Y₁ antagonist inhibited more than 70 % of the response, indicating that the majority of the contraction was mediated by NPY. The current study demonstrates heterogeneity of neurotransmitter substances in sympathetic nerves supplying vascular beds within and across species and in subsequent functional response.Supported by the National Health and medical Research Council of Australia.     

Comparison and evaluation of mouse cardiac MRI acquired with open birdcage, single loop surface and volume birdcage coils

Although the quality and speed of MR images have vastly improved with the development of novel RF coil technologies, the engineering expertise required to implement them is often not available in many animal in vivo MR laboratories. We present here an open birdcage coil design which is easily constructed with basic RF coil expertise and produces high quality images. The quality and advantages of mouse cardiac MR images acquired with open birdcage coils were evaluated and compared to images acquired with a bent single loop surface, and standard birdcage coils acquired at 4.7 Tesla. Two low pass open birdcage coils, two single loop surface coils, and a low pass volume birdcage coil were constructed and their B(1) distributions were evaluated and compared. The calculated average signal-to-noise ratio for the left ventricular wall was 10, 23 and 32 for the volume birdcage coil, single loop surface coil and open birdcage coil, respectively. The results demonstrate that the open birdcage coil provides greater sensitivity than the volume coil and a higher signal/contrast-to-noise ratio and B(1) homogeneity than the single loop surface coil. The open birdcage coil offers easy access and better quality mouse cardiac imaging than both the single loop surface coil and volume birdcage coil and does not require extensive RF engineering expertise to construct.     

Adjuvant therapy for HER2+ breast cancer: practice, perception, and toxicity

Multiple adjuvant regimens are used for HER2+ breast cancer, but experience in routine practice is not reported. We evaluated whether oncologists' perceptions of these regimens matches clinical experience. We surveyed Wisconsin medical oncologists throughout the state regarding factors impacting selection of TCH (docetaxel, carboplatin, and trastuzumab) or anthracycline-based therapy. We also reviewed 200 cases of HER2+ breast cancer treated at the University of Wisconsin and the Marshfield Clinic and collected data on patient and tumor characteristics, chemotherapy regimen, and toxicities. Two-thirds of surveyed oncologists prefer anthracycline-based therapy, particularly for node-positive cancers. However, TCH was preferred for early-stage (T1a-bN0) tumors. Half of oncologists use prophylactic G-CSF with TCH. In the 200 cases reviewed at our centers, acute toxicity occurred more frequently with TCH. There were fewer dose modifications or delays for AC-TH (doxorubicin, cyclophosphamide, paclitaxel, and trastuzumab) than TCH (31% vs. 47%, P?=?0.07), possibly due to higher use of prophylactic G-CSF with AC-TH (77% vs. 34% with TCH, P?相似文献   

Incidence and risk factors for axillary web syndrome after breast cancer surgery

The objective of the study is to estimate the incidence and risk factors of axillary web syndrome (AWS) in early postoperative period (45 days). From the prospective cohort of women undergoing breast cancer surgery, we collected the variables related to patient characteristics, treatment, tumor, and postoperative complications. We performed bivariate and logistic regression. A total of 193 patients are included with a mean age of 58.26 years, majority of which are women who are overweight or obese (72.3%). The incidence of AWS was 28.1%. The presence of pain in the ipsilateral upper-limb associated with AWS was reported in 5.4% of the patients, and the shoulder joint restriction was observed in 11.4%. When controlling for confounding between AWS and the factors that showed statistical significance in bivariate analysis, the variables that explain the occurrence of the AWS were the type of axillary surgery, where women who underwent sentinel lymph node biopsy showed 68% less risk compared with those that underwent axillary lymphadenectomy (AL) (RR = 0.32; 95% CI, 0.13−0.79; P value = 0.014) and numbness in the arm after an injury of the intercostobrachial nerve, which is 3.19 times the risk of the AWS (RR = 3.19; 95% CI, 1.40−7.29, P value = 0.006). From the above findings, we concluded that the incidence of AWS was 28.1%, and it was associated with AL and numbness in the arm after injury of the intercostobrachial nerve.     

Adverse events in cancer genetic testing: medical, ethical, legal, and financial implications

ABSTRACT: Cancer genetic counseling and testing are now integral services in progressive cancer care. There has been much debate over whether these services should be delivered by providers with specialized training in genetics or by all clinicians. Adverse outcomes resulting from cancer genetic counseling and testing performed by clinicians without specialization in genetics have been reported, but formal documentation is sparse. In this review, we present a series of national cases illustrating major patterns of errors in cancer genetic counseling and testing and the resulting impact on medical liability, health care costs, and the patients and their families.     

Chemokine Ligand 5 (CCL5) and chemokine receptor (CCR5) genetic variants and prostate cancer risk among men of African Descent: a case-control study

Background

Chemokine and chemokine receptors play an essential role in tumorigenesis. Although chemokine-associated single nucleotide polymorphisms (SNPs) are associated with various cancers, their impact on prostate cancer (PCA) among men of African descent is unknown. Consequently, this study evaluated 43 chemokine-associated SNPs in relation to PCA risk. We hypothesized inheritance of variant chemokine-associated alleles may lead to alterations in PCA susceptibility, presumably due to variations in antitumor immune responses.

Methods

Sequence variants were evaluated in germ-line DNA samples from 814 African-American and Jamaican men (279 PCA cases and 535 controls) using Illumina’s Goldengate genotyping system.

Results

Inheritance of CCL5 rs2107538 (AA, GA+AA) and rs3817655 (AA, AG, AG+AA) genotypes were linked with a 34-48% reduction in PCA risk. Additionally, the recessive and dominant models for CCR5 rs1799988 and CCR7 rs3136685 were associated with a 1.52-1.73 fold increase in PCA risk. Upon stratification, only CCL5 rs3817655 and CCR7 rs3136685 remained significant for the Jamaican and U.S. subgroups, respectively.

Conclusions

In summary, CCL5 (rs2107538, rs3817655) and CCR5 (rs1799988) sequence variants significantly modified PCA susceptibility among men of African descent, even after adjusting for age and multiple comparisons. Our findings are only suggestive and require further evaluation and validation in relation to prostate cancer risk and ultimately disease progression, biochemical/disease recurrence and mortality in larger high-risk subgroups. Such efforts will help to identify genetic markers capable of explaining disproportionately high prostate cancer incidence, mortality, and morbidity rates among men of African descent.