A Case-Control Study of Nitrate in Drinking Water and Non-Hodgkin's Lymphoma in Minnesota

Nitrate in drinking water has been implicated as a possible risk factor for non-Hodgkin's lymphoma. The authors examined the association between non-Hodgkin's lymphoma and waterborne nitrate through a population-based case-control study of white men in Minnesota. The authors, by linking residential histories with community water records, estimated average long-term exposure to nitrate in drinking water from 1947 to 1975 for 73 cases diagnosed between 1980 and 1982 and for 147 controls who used community water supplies. No association was found between nitrate levels in community water supplies and non-Hodgkin's lymphoma within the range of study exposures (median of highest exposure category = 2.4 mg nitrate/l [range = 0.1-7.2 mg/l]). The findings provide some safety assurance for those who use water systems that have nitrate levels that are less than 2.4 mg/l.     

Biopsy in a patient with PMP22 exon 2 mutation recapitulates pathology of Trembler-J mouse

We describe a patient with a longstanding history of hypertrophic neuropathy of Dejerine–Sottas type, ultimately diagnosed with CMT1E disease due to a new p.Leu18Arg missense mutation in the first transmembrane domain of the PMP22 gene. The patient never walked independently and was wheelchair bound by age 18 years. Her parents and son were unaffected. Her peroneal muscular atrophy syndrome presented with scoliosis, bilateral hearing loss, pes planus, distal sensory loss and generalized areflexia. A nerve biopsy at age 26 years showed nerve hypertrophy, myelin uncompaction, defects in mesaxon formation, Schwann cells with irregular outline, axons incompletely surrounded by Schwann cell processes and very short internodes interspersed with denuded axons. Large, mostly denervated, onion bulb formations were also prominent. These findings indicate that demyelination continues undeterred in the advanced stages of the disease and is followed by remyelination attempts that recapitulate the early defects in Schwann cell/axon interaction seen in the Trembler-J mouse, which carries a mutation in the same transmembrane domain.     

Intrahepatic cholangiocarcinoma: current management and emerging therapies

Introduction: Intrahepatic cholangiocarcinoma (iCCA) is a malignancy with an increasing incidence and a high-case fatality. While surgery offers the best hope at long-term survival, only one-third of tumors are amenable to surgical resection at the time of the diagnosis. Unfortunately, conventional chemotherapy offers limited survival benefit in the management of unresectable or metastatic disease. Recent advances in understanding the molecular pathogenesis of iCCA and the use of next-generation sequencing techniques have provided a chance to identify ‘target-able’ molecular aberrations. These novel molecular therapies offer the promise to personalize therapy for patients with iCCA and, in turn, improve the outcomes of patients.

Area covered: We herein review the current management options for iCCA with a focus on defining both established and emerging therapies.

Expert commentary: Surgical resection remains as an only hope for cure in iCCA patients. However, frequently the diagnosis is delayed till advanced stages when surgery cannot be offered; signifying the urge for specific diagnostic tumor biomarkers and targeted therapies. New advances in genomic profiling have contributed to a better understanding of the landscape of molecular alterations in iCCA and offer hope for the development of novel diagnostic biomarkers and targeted therapies.     

ADOLESCENT BEHAVIOR AND SEXUALLY TRANSMITTED DISEASES: THE DILEMMA OF HUMAN PAPILLOMAVIRUS

Adolescence is a period of physical, cognitive, psychosocial, and moral development that often results in risk-taking behavior. As a consequence, adolescents are at high risk for sexually transmitted disease (STD). Two of the most common STDs in the United States, chlamydia and human papillomavirus (HPV), affect millions of adolescent women. HPV, contrasted with chlamydia, poses a unique challenge to health care providers. In addition to causing genital warts, HPV has been shown to be the causative agent in the development of cervical cancer. Interventions that are effective in decreasing the transmission of chlamydia, such as increasing condom use, are less effective in prevention of HPV. Efforts to increase adolescent awareness of HPV, to increase age of first coitus, and to decrease numbers of sexual partners are more effective for HPV prevention. Early screening for HPV, smoking cessation, and health promotion may be effective in decreasing the incidence of cervical cancer in young women. Nurse practitioners and other primary health care providers need a more holistic approach to the prevention of HPV in adolescent women.     

‘Sick of AIDS’: life,literacy and South African youth

Young people are among those most vulnerable to HIV/AIDS in South Africa. To date, however, there has been a shortage of fictional narratives appropriate to their needs, and addressing issues of HIV/AIDS. Accessibility to literature is of concern for a variety of reasons, ranging from low levels of literacy among many Black students to the non‐availability of books in many schools. This paper aims to extend notions of the meanings of literacy within the context of HIV/AIDS prevention amongst South African youth. It examines the significance of such literacy both to life itself and to what counts as literature.     

The Australian First‐time Grandparents Study: Time spent with the grandchild and its predictors

Aim: This paper presents data on the amount of contact a large cohort of first‐time Australian grandparents have with their grandchild, and the amount of child care they provide. It compares these with grandparents' expectations and desired levels. Method: Prospective grandparents were assessed on multiple measures before the birth of their grandchild, and at 6, 12, 24 and 36 months thereafter. Results: At the 12‐month assessment, grandmothers had approximately 15 hours per week contact, and provided approximately 7.5 hours per week of child care. The corresponding figures for grandfathers were 9.5 hours and 5 hours respectively. Approximately 10% of grandparents reported no contact with their grandchild, and 30–40% reported undertaking no child care. Almost half the grandparents desired more contact than they were actually getting. Conclusion: Accurate quantification of contact and care is a prerequisite for investigation of the impact of the transition to grandparenthood on health and well‐being.