Analysis of seasonal training volume and working capacity in elite female rowers.

Preceding the 1988 Olympic Games 6 elite female rowers were regularly subjected to an exercise test on a rowing ergometer (REM-test) with a time interval of about 5 weeks. Daily training volume was analysed in terms of rowed kilometres (RKM) and training time (TOTMIN, rowing and land training). The purpose of this study was to investigate the training volume during a season and to study possible changes in the working capacity of elite female rowers. The REM-test consisted of 3 consecutive blocks: 3 min warming up, 5 min standard load at anaerobic threshold and 2 min "all-out". Blood lactic acid concentration (LA) was determined for the construction of a LA-power curve. The power at 4.0 mmol/l (P4) was estimated as a measure of the aerobic capacity. The "all-out" score was used for calculating the maximal power (PM). Results show that both RKM and TOTMIN increase (range resp. 40-400% and 20-25%) when compared with the initial value. P4 also increases, in parallel with changes in both RKM and TOTMIN, with 8-10% of the initial value. PM increases continuously during the season up to 10% of its initial value. However, based on maximal heart rate and lactate values, it is concluded that PM was maximal in only 15% of the tests. Our data suggests that evaluation of training volume in elite female rowers is better done with P4 than with PM. The behaviour of P4 shows a parallel with the seasonal changes in the training load.(ABSTRACT TRUNCATED AT 250 WORDS)     

Kinetic versus thermodynamic factors in calcium renal lithiasis

Calcium renal lithiasis formation depends on the balance between thermodynamic (supersaturation) and kinetic (inhibitors, nucleants)factors. In this paper, the importance of both groups was evaluated using(a) the complete urine analysis data obtained from 32 healthy volunteers and 141 active stone-formers, and (b) a comprehensive computer model to calculate the supersaturation values of calcium oxalate monohydrate,hydroxyapatite and brushite in each urine sample. The results of this evaluation were used to assess the possible effectiveness of a given pharmacological treatment. This revised version was published online in August 2006 with corrections to the Cover Date.     

Reduced expression of the small leucine-rich proteoglycans, lumican, and decorin is associated with poor outcome in node-negative invasive breast cancer.

PURPOSE: To examine the prognostic significance of lumican and decorin, two abundant small leucine-rich proteoglycans in breast tissue stroma. EXPERIMENTAL DESIGN: Lumican and decorin expression was examined in a cohort of 140 invasive breast carcinomas by Western blot analysis. All cases were axillary lymph node-negative and treated by adjuvant endocrine therapy. RESULTS: Lumican and decorin expression was highly correlated (r = 0.45, P < 0.0001), but although low levels of lumican were associated with large tumor size (P = 0.0496), negative estrogen receptor (P = 0.0024) and progesterone receptor status (P = 0.0116), and increased host inflammatory response (P = 0.0077), low decorin levels were associated only with large tumor size (P = 0.0496). However, using univariate analysis, low levels of lumican and decorin were both associated with a shorter time to progression (P = 0.0013 and 0.0262) and poorer survival (P = 0.001 and 0.0076). In multivariate analysis using the Cox regression model, low decorin was also shown to be an independent predictive factor for recurrence (hazard ratio 2.25: 95% confidence interval 1-5, P = 0.047) and survival (hazard ratio 3.39: 95% confidence interval 1.2-9.6, P = 0.021). CONCLUSIONS: These results suggest that low levels of small leucine-rich proteoglycans in breast tumors may be associated with a worse prognosis in lymph node-negative invasive breast carcinomas and warrant further study with larger patient cohorts.     

Euthanasia, Physician Assisted Suicide and Other Methods of Helping Along Death

This paper introduces a series of papers dealing with the topic of euthanasia as an introduction to a variety of attitudes by health-care professionals and philosophers interested in this issue. The lead in paper--and really the lead in idea--stresses the fact that what we are discussing concerns only a minority of people lucky enough to live in conditions of acceptable sanitation and who have access to medical care. The topic of euthanasia and PAS really has three questions: (1) is killing another ever ethically acceptable; (2) is the participation of health professionals ethically different and (3) is it wiser to permit and set criteria (being fully aware of some dangers that lurk in such a move) or to forbid (knowing that it will occur clandestinely and uncontrolled). This paper takes no definite stand although it is very troubled by useless suffering (not only pain) by many who would wish their life and with it their suffering ended.     

Immunization using autologous dendritic cells pulsed with the melanoma-associated antigen gp100-derived G280-9V peptide elicits CD8+ immunity.

PURPOSE: To determine the toxicity, maximal tolerated dose, and clinical and immunologic response to autologous dendritic cells pulsed with melanoma-associated antigen gp100-derived G280-9V peptide. PATIENTS AND METHODS: Twelve HLA-A*0201(+) patients with advanced melanoma were administered dendritic cells pulsed with G280-9V peptide. Cohorts of three patients were administered 5 x 10(6), 15 x 10(6), and 50 x 10(6) cells i.v. every 3 weeks for six doses according to a dose escalation scheme. Three additional patients were treated at the highest dose. No additional cytokines or therapies were coadministered. The immunogenicity of G280-9V-pulsed dendritic cells was measured by IFN-gamma ELISPOT assay, tetramer assay, and (51)Cr release assay comparing prevaccination to postvaccination blood samples. Response to treatment was assessed by Response Evaluation Criteria in Solid Tumors. RESULTS: CD8(+) immunity to the native G280 was observed in 8 (67%) patients as measured by ELISPOT and in 12 (100%) patients as measured by tetramer assay. Of the 9 patients tested, 9 (100%) had measurable high-avidity CTL activity as defined by lysis of allogeneic melanoma lines, which coexpress HLA-A*0201 and gp100. The median follow-up of the entire cohort is 43.8 months. Two (17%) partial responses were observed and 3 (25%) patients had stable disease. The median survival of the treated population was 37.6 months. At this time, three patients are alive, including one patient who continues to respond without additional treatment. CONCLUSION: The high rate of immunization as measured by three independent assays and the occurrence of clinical regression support continued investigation of G280-9V peptide as a candidate epitope in melanoma vaccine formulations.     

Inherited variation in circadian rhythm genes and risks of prostate cancer and three other cancer sites in combined cancer consortia

Circadian disruption has been linked to carcinogenesis in animal models, but the evidence in humans is inconclusive. Genetic variation in circadian rhythm genes provides a tool to investigate such associations. We examined associations of genetic variation in nine core circadian rhythm genes and six melatonin pathway genes with risk of colorectal, lung, ovarian and prostate cancers using data from the Genetic Associations and Mechanisms in Oncology (GAME‐ON) network. The major results for prostate cancer were replicated in the Prostate, Lung, Colorectal and Ovarian (PLCO) cancer screening trial, and for colorectal cancer in the Genetics and Epidemiology of Colorectal Cancer Consortium (GECCO). The total number of cancer cases and controls was 15,838/18,159 for colorectal, 14,818/14,227 for prostate, 12,537/17,285 for lung and 4,369/9,123 for ovary. For each cancer site, we conducted gene‐based and pathway‐based analyses by applying the summary‐based Adaptive Rank Truncated Product method (sARTP) on the summary association statistics for each SNP within the candidate gene regions. Aggregate genetic variation in circadian rhythm and melatonin pathways were significantly associated with the risk of prostate cancer in data combining GAME‐ON and PLCO, after Bonferroni correction (p_pathway < 0.00625). The two most significant genes were NPAS2 (p_gene = 0.0062) and AANAT (p_gene = 0.00078); the latter being significant after Bonferroni correction. For colorectal cancer, we observed a suggestive association with the circadian rhythm pathway in GAME‐ON (p_pathway = 0.021); this association was not confirmed in GECCO (p_pathway = 0.76) or the combined data (p_pathway = 0.17). No significant association was observed for ovarian and lung cancer. These findings support a potential role for circadian rhythm and melatonin pathways in prostate carcinogenesis. Further functional studies are needed to better understand the underlying biologic mechanisms.     

Prognostic impact of circulating tumor cells assessed with the CellSearch System? and AdnaTest Breast? in metastatic breast cancer patients: the DETECT study

Introduction

There is a multitude of assays for the detection of circulating tumor cells (CTCs) but a very limited number of studies comparing the clinical relevance of results obtained with different test methods. The DETECT trial for metastatic breast cancer patients was designed to directly compare the prognostic impact of two commercially available CTC assays that are prominent representatives of immunocytochemical and RT-PCR based technologies.

Methods

In total, 254 metastatic breast cancer patients were enrolled in this prospective multicenter trial. CTCs were assessed using both the AdnaTest Breast Cancer and the CellSearch system according to the manufacturers' instructions.

Results

With the CellSearch system, 116 of 221 (50%) evaluable patients were CTC-positive based on a cut-off level at 5 or more CTCs. The median overall survival (OS) was 18.1 months in CTC-positive patients. (95%-CI: 15.1-22.1 months) compared to 27 months in CTC-negative patients (23.5-30.7 months; p<0.001). This prognostic impact for OS was also significant in the subgroups of patients with triple negative, HER2-positive and hormone receptor-positive/HER2-negative primary tumors. The progression free survival (PFS) was not correlated with CTC status in our cohort receiving different types and lines of systemic treatment (p = 0.197). In multivariate analysis, the presence of CTCs was an independent predictor for OS (HR: 2.7, 95%-CI: 1.6-4.2). When the AdnaTest Breast was performed, 88 of 221 (40%) patients were CTC-positive. CTC-positivity assessed by the AdnaTest Breast had no association with PFS or OS.

Conclusions

The prognostic relevance of CTC detection in metastatic breast cancer patients depends on the test method. The present results indicate that the CellSearch system is superior to the AdnaTest Breast Cancer in predicting clinical outcome in advanced breast cancer.

Trial registration

Current Controlled Trials Registry number ISRCTN59722891.     

Recent Advances in Archaeological Science Techniques Special Feature: Dating the emergence of dairying by the first farmers of Central Europe using 14C analysis of fatty acids preserved in pottery vessels

Direct, accurate, and precise dating of archaeological pottery vessels is now achievable using a recently developed approach based on the radiocarbon dating of purified molecular components of food residues preserved in the walls of pottery vessels. The method targets fatty acids from animal fat residues, making it uniquely suited for directly dating the inception of new food commodities in prehistoric populations. Here, we report a large-scale application of the method by directly dating the introduction of dairying into Central Europe by the Linearbandkeramik (LBK) cultural group based on dairy fat residues. The radiocarbon dates (n = 27) from the 54th century BC from the western and eastern expansion of the LBK suggest dairy exploitation arrived with the first settlers in the respective regions and were not gradually adopted later. This is particularly significant, as contemporaneous LBK sites showed an uneven distribution of dairy exploitation. Significantly, our findings demonstrate the power of directly dating the introduction of new food commodities, hence removing taphonomic uncertainties when assessing this indirectly based on associated cultural materials or other remains.

The introduction of new food commodities into the human diet at the very beginnings of plant and animal domestication is one of the most critical questions in the Neolithization process, having far reaching consequences for human evolution and environmental change. Of major importance is milk exploitation, as it relates to animal domestication but also the ability of adult humans to digest lactose (1, 2). Clearly, identifying the beginnings of the exploitation of domesticated animals for their secondary products (i.e., those obtained during the life of animals, such as milk, wool, or blood) as opposed to primary products (i.e., those obtained by the death of the animal such as meat, skin, teeth, or horn) makes it extremely important to establish when and how dairying began (3, 4). Directly dating the introduction of a new food commodity is nonetheless challenging.Evidence for dairy exploitation in prehistory can be interpreted from iconography, diagnostic ceramics, or domesticated animal slaughter patterns based on sex and ages (3, 4). Additionally, direct evidence for dairy exploitation can be derived from lipid analyses of food residues preserved in pottery vessels. By determining the stable carbon isotope values of the two fatty acids (FAs) (C_16:0 and C_18:0) characteristic of degraded animal fats, dairy products can be distinguished from carcass products (5). Recent combined lipid residue analyses of pottery vessels and animal management assessments based on faunal remains (stable isotopes, butchery practices, kill-off patterns, and calving patterns) have provided invaluable knowledge of early dairying practices at archaeological sites. Currently, the earliest evidence for milk use from lipid residues and faunal assemblages recovered during the Neolithic was found in Anatolia during the 7th millennium BC (6), from several regions in the Balkans, eastern Europe, and the Mediterranean during the 6th millennium BC (7–12), in Saharan Africa (Libya and Algeria) during the 5th millennium BC (13–15), from the beginning of the Neolithic in Britain, Ireland, and Scandinavia during the 4th millennium BC (5, 16–19), and in the Baltic countries during the 3rd millennium BC (16). The dates of the introduction of dairying in these regions have been established largely indirectly based on associated materials (e.g., animal bone collagen, charcoal, charred seeds, etc.) recovered from the same archaeological contexts as the pottery yielding milk fat residues. However, uncertainties exist with indirect dating due to possible intrusion or residuality of datable materials, resulting from the disturbance of archaeological layers and the requirement for the datable materials to be short-lived and truly contemporaneous in date with the pottery vessels containing the dairy residues.Thus, the application of recently developed methods for the direct dating of lipids from pottery food residues offers a unique approach to obtain accurate and precise dates for the introduction of new food commodities. The direct ¹⁴C dating of dairy fat residues avoids all the aforementioned uncertainties, offering an unprecedented opportunity to accurately date the start of dairying practices. At the University of Bristol, United Kingdom, we recently reported a method for radiocarbon dating pottery vessels from their absorbed food residues. Our compound-specific radiocarbon analysis (CSRA) approach is based on the isolation of the C_16:0 and C_18:0 FAs from the clay matrix and freeing them from exogenous organic contaminants (20, 21). We have successfully applied this approach to a small number of dairy residues from the Libyan Sahara and Central Europe, with one of the oldest dated dairy residues coming from the 6th millennium in the Balkans (11, 22). Hence, this dating method offers the opportunity to directly date residues identified as dairy fats based on the compound-specific δ¹³C values of the C_16:0 and C_18:0 FAs, avoiding taphonomic uncertainties arising from dating-associated materials.In this paper, we focus on the Linearbandkeramik (LBK) culture, the first farming society in Central Europe, which emerged and expanded over much of northern Europe in the middle of the 6th millennium BC (23). This culture has been divided into five main phases: Earliest (I), Early (II), Middle (III), Late (IV), and Final (V) LBK, known as the Meier-Arendt chronology, whose timing and evolution differed in the different regions of the LBK (24). Hence, the ceramic phases discussed in the remainder of this paper use the regional and site classifications for the chronology of earliest, early, middle, and Late LBK, which are not necessarily contemporaneous. For example, phase I in Poland and phase I in Cuiry-lès-Chaudardes refer to the Earliest and Late LBK phases, respectively, in the Meier-Arendt chronology.Dairy residues were identified in varying quantities at LBK sites across Central Europe. Some sites show only a weak dairy signal (1 to 2 potsherds only), while others display much higher recovery, with over 20% of the residues displaying dairy fat molecular and carbon isotope characteristics. These results emphasize the spatial disparity in the exploitation of cattle and caprines for their milk in this period. We do not exclude the possibility that the use of organic containers other than clay vessels for dairy products at some sites may affect the overall dairy lipid recovery observed. Diachronic studies in certain regions also revealed dairy practices evolving from being nonexistent or at very low levels at LBK sites but becoming much more abundant in the following Middle Neolithic cultures [e.g., the Rössen culture in Lower Alsace, France (22) or Funnel Beaker culture at the site of Kopydłowo, Poland (25)]. Dating of dairy residues recovered from the earliest phases of the sites would provide calendar ages for the emergence of dairying between LBK regions based directly on the commodity itself rather than on associated materials. Critically, some sites cannot be dated by conventional materials due to their poor preservation, while at other sites where dairy evidence is scarce, the possibility exists for false-positive signal arising due to stratigraphic perturbations. In reporting here the application of our recently developed CSRA method to a wide range of potsherds, we begin to resolve the timing of appearance of dairying practices by LBK farmers during the Neolithic in the diverse regions of the settlements.     

Distal femoral extension osteotomy and patellar tendon advancement or shortening in ambulatory children with cerebral palsy: A modified Delphi consensus study and literature review

Purpose:In children with cerebral palsy, flexion deformities of the knee can be treated with a distal femoral extension osteotomy combined with either patellar tendon advancement or patellar tendon shortening. The purpose of this study was to establish a consensus through expert orthopedic opinion, using a modified Delphi process to describe the surgical indications for distal femoral extension osteotomy and patellar tendon advancement/patellar tendon shortening. A literature review was also conducted to summarize the recent literature on distal femoral extension osteotomy and patellar tendon shortening/patellar tendon advancement.Method:A group of 16 pediatric orthopedic surgeons, with more than 10 years of experience in the surgical management of children with cerebral palsy, was established. The group used a 5-level Likert-type scale to record agreement or disagreement with statements regarding distal femoral extension osteotomy and patellar tendon advancement/patellar tendon shortening. Consensus for the surgical indications for distal femoral extension osteotomy and patellar tendon advancement/patellar tendon shortening was achieved through a modified Delphi process. The literature review, summarized studies of clinical outcomes of distal femoral extension osteotomy/patellar tendon shortening/patellar tendon advancement, published between 2008 and 2022.Results:There was a high level of agreement with consensus for 31 out of 44 (70%) statements on distal femoral extension osteotomy. Agreement was lower for patellar tendon advancement/patellar tendon shortening with consensus reached for 8 of 21 (38%) of statements. The literature review included 25 studies which revealed variation in operative technique for distal femoral extension osteotomy, patellar tendon advancement, and patellar tendon shortening. Distal femoral extension osteotomy and patellar tendon advancement/patellar tendon shortening were generally effective in correcting knee flexion deformities and extensor lag, but there was marked variation in outcomes and complication rates.Conclusion:The results from this study will provide guidelines for surgeons who care for children with cerebral palsy and point to unresolved questions for further research.Level of evidence:level V.