What is "the good back-consultation"? A combined qualitative and quantitative study of chronic low back pain patients' interaction with and perceptions of consultations with specialists.

OBJECTIVE: To identify core elements of what patients with chronic low back pain perceive as good clinical communication and interaction with a specialist ("The Good Back-Consultation"). DESIGN: Qualitative study including observation of consultations and a subsequent patient interview. Quantitative data were also recorded. SUBJECTS: Thirty-five patients with chronic low back pain referred to a specialist. METHODS: Thirty-five consultations were observed with respect to history-taking, clinical examination and interaction between patient and doctor. Patients were subsequently interviewed about how they perceived the consultation. Fourteen specialists with various specialty branches and 35 patients (18 males) participated. For 3 of the specialists a positive effect (return to work) on patients with chronic low back pain had been documented in previous randomized controlled trials. Qualitative data analysis was performed using a template method. RESULTS: Most patients thought that the history-taking and clinical examination had been thorough and satisfactory. Patients emphasized the importance of being given an explanation during the examination of what was being done and found, of receiving understandable information on the causes of the pain, of receiving reassurance, discussing psychosocial issues and discussing what can be done. The most important characteristic of "The Good Back-Consultation" was that the specialist took the patient seriously. CONCLUSION: The findings may represent an important potential for enhancing clinical communication with patients.     

Feasibility and logistics of MRI before thrombolytic treatment

Objectives – The study analyzes feasibility and time‐delays in Magnetic resonance imaging (MRI) based thrombolysis and estimate the impact of MRI on individual tissue plasminogen activator (rtPA) treatment. Materials and methods – Feasibility of MRI and time logistics were prospectively recorded in patients referred with presumed acute stroke over a 2 year time period. Door‐to‐needle‐times (DNT) were compared with those of patients treated with rtPA after conventional CT during the same time period, and to published open label studies. Results – We received 174 patients with presumed stroke. MRI was feasible in 141 of 161 (88%) of those requiring acute imaging. MRI supported the decision to treat 11 patients with mild symptoms or seizures, and not to treat four patients with extensive infarctions. Median ‘door‐to‐needle time’ (DNT) in MR scanned patients (70 min), did not differ significantly from DNT after conventional CT (n = 17, DNT = 66 min, P = 0.27) or the Safe Implementation of Thrombolysis in Stroke (SITS‐MOST) registry (DNT = 68 min). Conclusions – Magnetic resonance imaging can be performed in the majority of acute stroke patients without delaying treatment. MRI may affect decision making in a large proportion of patients.     

Prophylaxis of kanamycin-induced ototoxicity by a radioprotectant

S-2 (3-aminopropylamino)ethylphosphorothioate ameliorates hearing losses due to ototoxic doses of kanamycin sulfate in the guinea pig when administered one hour before the antibiotic. Since this radioprotectant is believed to operate as a free-radical scavenger, kanamycin ototoxicity may involve free radicals.     

Associations between small intestine cancer and other primary cancers: an international population-based study

Cancer of the small intestine is a rare neoplasm, and its etiology remains poorly understood. Analysis of other primary cancers in individuals with small intestine cancer may help elucidate the causes of this neoplasm and the underlying mechanisms. We included 10,946 cases of first primary small intestine cancer from 13 cancer registries in a pooled analysis. The observed numbers of 44 types of second primary cancer were compared to the expected numbers derived from the age-, gender- and calendar period-specific cancer incidence rates in each registry. We also calculated the standardized incidence ratios (SIR) for small intestine cancer as a second primary after other cancers. There was a 68% overall increase in the risk of a new primary cancer after small intestine carcinoma (SIR = 1.68, 95% confidence interval [CI] = 1.47-1.71), that remained constant over time. The overall SIR was 1.18 (95% CI = 1.05-1.32) after carcinoid, 1.29 (1.01-1.63) after sarcoma, and 1.27 (0.78-1.94) after lymphoma. Significant (p < 0.05) increases were observed for cancers of the oropharynx, colon, rectum, ampulla of Vater, pancreas, corpus uteri, ovary, prostate, kidney, thyroid gland, skin and soft tissue sarcomas. Small intestine cancer as a second primary was increased significantly after all these cancers, except after oropharyngeal and kidney cancers. Although some of the excess may be attributable to overdiagnosis, it is plausible that most additional cases of second primary cancers were clinically relevant and were due to common genetic (e.g., defects in mismatch or other DNA repair pathways) and environmental (e.g., dietary) factors.     

Polymorphisms of DNA repair genes and risk of non-small cell lung cancer

Lung cancer is a leading cause of cancer mortality with an inter-individual difference in susceptibility to the disease. The inheritance of low-efficiency genotypes involved in DNA repair and replication may contribute to the difference in susceptibility. We investigated 44 single nucleotide polymorphisms (SNPs) in 20 DNA repair genes including nucleotide excision repair (NER) genes XPA, ERCC1, ERCC2/XPD, ERCC4/XPF and ERCC5/XPG; base excision repair (BER) genes APE1/APEX, OGG1, MPG, XRCC1, PCNA, POLB, POLiota, LIG3 and EXO1; double-strand break repair (DSB-R) genes XRCC2, XRCC3, XRCC9, NBS1 and ATR; and direct damage reversal (DR) gene MGMT/AGT. The study included 343 non-small cell lung cancer (NSCLC) cases and 413 controls from Norwegian general population. Our results indicate that SNPs in the NER genes ERCC1 (Asn118Asn, 15310G>C, 8902G>T), XPA (-4G>A), ERCC2/XPD (Lys751Gln) and ERCC5/XPD (His46His); the BER genes APE1/APEX (Ile64Val), OGG1 (Ser326Cys), PCNA (1876A>G) and XRCC1 (Arg194Trp, Arg280His, Arg399Gln); and the DSB-R genes ATR (Thr211Met), NBS1 (Glu185Gln), XRCC2 (Arg188His) and XRCC9 (Thr297Ile) modulate NSCLC risk. The level of polycyclic aromatic hydrocarbon-DNA (PAH-DNA) adducts in normal lung tissue from 211 patients was analysed. The variant alleles of XRCC1(Arg280His), XRCC1 (Arg399Gln), ERCC1(G8092T), ERCC5(His46His) and MGMT/AGT(Lys178Arg) were more frequent in patients with PAH-DNA adduct levels lower than the mean whereas the XRCC1(Arg194Trp) variant was more frequent in cases with higher adduct levels than the mean.     

Effects of PCB99 and PCB153 exposure on spermatogenesis in young adult C57BL6 mice

This study examined the effects of acute exposure to PCB99 (2,2',4,4',5-pentachlorobiphenyl), and PCB153 (2,2',4,4'5,5'-hexachlorobiphenyl), on spermatogenesis in 8-week-old C57BL6 mice. The mice were randomly allocated to PCB99 and PCB153 and a single dose of respectively 10 and 100 mg/kg was given by oral gavage. During the 6-week experiment, six mice per treatment group were sacrificed weekly, body weights were recorded and samples with respect to the male reproductive system were collected until further analysis. None of the treatments, showed changes in body weight or reproductive endpoints. Flow cytometric analysis revealed spermatogenesis to be unaffected. However, PCB99 and PCB153 showed a significant increase in Leydig cell apoptosis. The results from the present study indicate that the male reproductive system is relatively refractory to PCB99 and PCB153 at levels exceeding those of wildlife and humans, when exposed during adult life. However, the finding of apoptotic Leydig cells merits further investigation.     

Mapping the amphetamine-evoked dopamine release in the brain of the Göttingen minipig

The availability of dopamine D(2/3) binding sites in brain of six male and six female G?ttingen minipigs was measured in a baseline condition and after challenge with amphetamine sulfate (1mg/kg, i.v.) in PET studies with [(11)C]raclopride. Maps of the binding potential (pB; B(max)/K(d)) of [(11)C]raclopride were spatially normalized and co-registered to a common stereotaxic coordinate system for pig brain. The pB maps were then analyzed by volume of interest and voxel-wise comparisons of gender and condition. The mean baseline pB tended to be 10-20% higher in striatum of the female group, but this gender difference was not significant. Variance of the mean baseline pB was higher in the males (44%) than in females (30%), but there was no correlation between pB and individual plasma cortisol or testosterone concentrations. Using statistical parametric mapping, we detected a focus in the right posterior putamen where the magnitude of the amphetamine-evoked decrease in pB was greater in the male than in the female group. Thus, the spatial pattern of reactivity of dopamine D(2/3) receptor availability to amphetamine challenge is not identical in male and female pigs. Within the entire population, the decline in pB evoked by amphetamine (Delta pB) was greater in the ventral striatum (-28%) than in the caudate nucleus (-17%), consistent with earlier reports in monkeys and humans. The magnitude of Delta pB correlated highly with the baseline pB values in all divisions of the striatum. Based upon the principles of competitive binding, the slope of this empirical relationship, f(i), is equal to the fraction of [(11)C]raclopride binding sites sensitive to endogenous dopamine; the magnitude of this fraction ranged from 0.29 in the caudate to 0.36 in the ventral striatum.     

Residential and occupational exposures to 50-Hz magnetic fields and breast cancer in women: a population-based study

A case-control study was conducted to investigate whether residential and occupational exposures to magnetic fields increased the risk for breast cancer among women. Cases of breast cancer diagnosed during 1980-1996 were identified in a cohort of women living near a high-voltage power line in Norway in 1980 or between 1986 and 1996. Each case was matched by year of birth, municipality, and first year of entry into the cohort with two randomly selected controls without cancer. Residential exposure to magnetic fields was calculated as that generated by the lines before diagnosis, and occupational exposure was based on exposure matrix data. Women with residential exposure had an odds ratio of 1.58 (95% confidence interval (CI): 1.30, 1.92) when compared with unexposed women. The odds ratios for exposed women versus unexposed women with estrogen receptor (ER)-positive and ER-negative breast cancer were 1.33 (95% CI: 0.93, 1.90) and 1.40 (95% CI: 0.78, 2.50), respectively (ER status was available for 44% of the cases). Women with the highest occupational exposure had an odds ratio of 1.13 (95% CI: 0.91, 1.40) when compared with those unexposed at work. The findings suggest an association between exposure to magnetic fields and breast cancer in women.