Growth rate as a prognostic factor in localized invasive cutaneous melanoma

Background Melanoma is a tumour with a very variable progression. Whilst some melanomas grow slowly over many years, others can reach several millimetres in thickness in just a few weeks. Since melanoma is a visible superficial tumour, the information obtained from the clinical interview may be of use to calculate the speed of growth of the melanoma. Objective This study aims to assess the growth rate (GR) of melanomas and the association of this GR with various clinical and pathological factors and their usefulness as prognostic markers for localized invasive cutaneous melanomas. Methods The GR of melanomas was calculated as the ratio of tumour thickness to time of development, as obtained from the clinical history (in millimetres per month). Results Applying the GR calculation to patients with a localized melanoma showed a significant association between melanomas with a GR greater than 0.4 mm per month and an age of 65 years or over, male sex, nodular melanoma, tumour thickness, level of invasion, the presence of ulceration and a high mitotic index. As an independent prognostic factor for overall survival, the GR proved to be significant (P = 0.024). Conclusion The GR of localized cutaneous melanomas may be a possible prognostic factor for survival. Additionally, rapid GR is associated with male patients more advanced in age at diagnosis, which suggests the need to assess new strategies for the early detection of these melanomas.     

Having a Diagnosis of Diabetes Is Not Associated With General Diabetes Knowledge in Rural Hispanics

Purpose: The prevalence of diabetes among Hispanics in Washington State is 30% greater than it is for non-Hispanic whites. Hispanics also have higher rates of diabetes-related complications and mortality due to the disease. Although interventions have been developed for the Hispanic community, studies in rural settings are limited. To address this we conducted a study to identify factors associated with general diabetes knowledge in a rural Hispanic population. Methods: This study was conducted as part of a larger project in partnership with a local community hospital in Washington State's Lower Yakima Valley. Diabetes knowledge was assessed as part of a screening survey using 5 statements selected from the Diabetes Knowledge Questionnaire. Men and women (N = 1,297) between the ages of 18 and 92 attending community-oriented events took part in the survey. Gender, education, age, birthplace, diabetic status, and family history of diabetes were tested as predictors of diabetes knowledge. Findings: Overall, general knowledge was high with 71%-84% of participants responding correctly to 4 of 5 statements, while only 17% of participants responded correctly to a fifth statement. Although no variable was associated with all statements, family history, gender, and education were most frequently associated with knowledge. Diabetic status, age, and birthplace were less often or not associated with the knowledge statements. Conclusion: Contrary to expectations, having a diagnosis of diabetes was not among the factors most frequently associated with diabetes knowledge. Future research should investigate the roles of family history, gender, and diabetic status as conduits of diabetes education among rural Hispanics.     

Leptin, hunger, and body weight: Influence of gender, tobacco smoking, and smoking abstinence

Leptin is a hormone involved in body weight and hunger regulation, and may contribute to the inverse relationship between cigarette smoking and body weight. Leptin levels, body mass indices (BMIs), and hunger ratings were determined in 22 nonsmokers (12 male, 10 female) and 19 cigarette smokers (11 male, 8 female). Smokers were tested after ad lib smoking and following a 24-h smoking abstinence period; nonsmokers came to the laboratory once. Leptin levels were not different among the groups. Hunger ratings, however, were higher after smoking abstinence compared to after ad lib smoking and nonsmokers (Ps<.05); levels of hunger did not differ between ad lib smokers and nonsmokers. Men reported higher hunger levels than did women, but women had higher serum leptin levels than did men, regardless of smoking condition (P<.05). Leptin levels were correlated with BMI (P<.05) among smokers only. This first study on leptin responses in female smokers suggests that leptin levels do not change following a 24-h smoking abstinence period and that leptin may not contribute to increased hunger following smoking abstinence.     

N400 as an index of semantic expectancies: differential effects of alcohol and cocaine dependence

BACKGROUND: Chronic substance abuse has been associated with decrements in the processing and expression of language. The present study utilized the N400 event-related electroencephalographic potential to index semantic processing in 133 adults with (n=49) or without (n=84) a history of alcohol and/or cocaine dependence. The contributions of age, gender, and comorbid marijuana and nicotine dependence, and antisocial symptomology to N400 decrements were either covaried or controlled. METHODS: A continuous series of 300 stimuli was presented for 150 ms each (interstimulus interval=1475 ms) on a computer screen. The series was arranged such that a word (approximately 17% of stimuli) immediately preceded presentations of its antonym (primed condition; approximately 17% of stimuli), or a semantically unrelated word (unprimed condition; approximately 17% of stimuli). The remaining 50% of stimuli consisted of unpronounceable letter combinations (non-word condition). EEG responses to the antonyms, unrelated words, and letter jumbles were retained for analysis. Throughout the task, the subject pressed response keys to discriminate words from non-words. RESULTS: Analyses revealed a detrimental effect of alcohol dependence on N400 amplitude and no significant main or interactive effects of cocaine dependence. CONCLUSION: The present findings suggest that alcohol-dependent individuals may exhibit verbal processing decrements. These findings also challenge hypotheses suggesting that the combined use of cocaine and alcohol is more deleterious to brain function than alcohol use alone.     

Consensus statement on bladder injuries.

The consensus on genitourinary trauma continues this month with the statement on bladder trauma from several internationally recognised experts on the subject. They describe blunt, penetrating and iatrogenic injuries and their management, considering paediatric injuries separately. They underline the importance of prompt diagnosis and treatment, stressing that problems raised when the diagnosis is delayed.      

Influence of aging on peripheral nerve function and regeneration

Aging deeply influences several morphologic and functional features of the peripheral nervous system (PNS). Morphologic studies have reported a loss of myelinated and unmyelinated nerve fibers in elderly subjects, and several abnormalities involving myelinated fibers, such as demyelination, remyelination and myelin balloon figures. The deterioration of myelin sheaths during aging may be due to a decrease in the expression of the major myelin proteins (P0, PMP22, MBP). Axonal atrophy, frequently seen in aged nerves, may be explained by a reduction in the expression and axonal transport of cytoskeletal proteins in the peripheral nerve. Aging also affects functional and electrophysiologic properties of the PNS, including a decline in nerve conduction velocity, muscle strength, sensory discrimination, autonomic responses, and endoneurial blood flow. The age-related decline in nerve regeneration after injury may be attributed to changes in neuronal, axonal, Schwann cell and macrophage responses. After injury, Wallerian degeneration is delayed in aged animals, with myelin remnants accumulated in the macrophages being larger than in young animals. The interaction between Schwann cells and regenerative axons takes longer, and the amount of trophic and tropic factors secreted by reactive Schwann cells and target organs are lower in older subjects than they are in younger subjects. The rate of axonal regeneration becomes slower and the density of regenerating axons decrease in aged animals. Aging also determines a reduction in terminal and collateral sprouting of regenerated fibers, further limiting the capabilities for target reinnervation and functional restitution. These age-related changes are not linearly progressive with age; the capabilities for axonal regeneration and reinnervation are maintained throughout life, but tend to be delayed and less effective with aging.     

Diagnóstico prenatal de una trisomía parcial del cromosoma 1 (q25-qter) por translocación paterna

We report the prenatal diagnosis of a case of partial trisomy of chromosome 1 (q25-qter) due to paternal translocation in a 31-year-old patient. Amniocentesis for chromosomal analysis was performed in the 16th week of pregnancy because ultrasound examination had revealed certain anomalies. A necropsy of the foetus was carried out and the anomalies found were compared with those in other cases of partial trisomy of chromosome 1.