Serum vitamins A and E,beta-carotene,and selenium in patients with breast cancer.

A total of 89 subjects including 30 breast cancer patients with distal metastases, 29 patients with benign breast disease, and 30 healthy subjects were studied. Serum samples from these subjects were obtained from the National Cancer Institute (NCI) Breast Cancer Serum Bank, Bethesda. Serum concentrations of vitamin A and its transport proteins (prealbumin and retinol-binding protein [RBP]), beta-carotene, vitamin E, and selenium were determined. For each of these parameters the mean for the breast cancer patients was lower than that of the healthy subjects. The differences between healthy subjects and patients with either breast cancer or benign breast disease were, however, statistically significant only in the case of RBP (p less than 0.05). In the case of vitamin A and its transport proteins these differences were reduced by comparing the cancer patients with the benign breast disease patients rather than with the healthy controls. This indicates that the low serum levels for those three parameters may be merely a consequence of disease in general rather than a feature of cancer per se.     

The effectiveness of interventions for optometric referrals into the hospital eye service: A review

Purpose

Ophthalmic services are currently under considerable stress; in the UK, ophthalmology departments have the highest number of outpatient appointments of any department within the National Health Service. Recognising the need for intervention, several approaches have been trialled to tackle the high numbers of false-positive referrals initiated in primary care and seen face to face within the hospital eye service (HES). In this mixed-methods narrative synthesis, we explored interventions based on their clinical impact, cost and acceptability to determine whether they are clinically effective, safe and sustainable. A systematic literature search of PubMed, MEDLINE and CINAHL, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), was used to identify appropriate studies published between December 2001 and December 2022.

Recent Findings

A total of 55 studies were reviewed. Four main interventions were assessed, where two studies covered more than one type: training and guidelines (n = 8), referral filtering schemes (n = 32), asynchronous teleophthalmology (n = 13) and synchronous teleophthalmology (n = 5). All four approaches demonstrated effectiveness for reducing false-positive referrals to the HES. There was sufficient evidence for stakeholder acceptance and cost-effectiveness of referral filtering schemes; however, cost comparisons involved assumptions. Referral filtering and asynchronous teleophthalmology reported moderate levels of false-negative cases (2%–20%), defined as discharged patients requiring HES monitoring.

Summary

The effectiveness of interventions varied depending on which outcome and stakeholder was considered. More studies are required to explore stakeholder opinions around all interventions. In order to maximise clinical safety, it may be appropriate to combine more than one approach, such as referral filtering schemes with virtual review of discharged patients to assess the rate of false-negative cases. The implementation of a successful intervention is more complex than a ‘one-size-fits-all’ approach and there is potential space for newer types of interventions, such as artificial intelligence clinical support systems within the referral pathway.     

Toxoplasma Infection in Schizophrenia Patients: A Comparative Study with Control Group

Background

Schizophrenia is a serious, chronic, and often debilitating neuropsychiatric disorder. Its causes are still poorly understood. Besides genetic and non-genetic (environmental) factors are thought to be important as the cause of the structural and functional deficits that characterize schizophrenia. This study aimed to compare Toxoplasma gondii infection between schizophrenia patients and non-schizophrenia individuals as control group.

Methods

A case-control study was designed in Tehran, Iran during 2009-2010. Sixty-two patients with schizophrenia and 62 non-schizophrenia volunteers were selected. To ascertain a possible relationship between T. gondii infection and schizophrenia, anti-Toxoplasma IgG antibodies were detected by indirect-ELISA. Data were statistically analyzed by chi- square at a confidence level of 99%.

Results

The sero-positivity rate among patients with schizophrenia (67.7%) was significantly higher than control group (37.1) (P <0. 01).

Conclusion

A significant correlation between Toxoplasma infection and schizophrenia might be expected.     

Immunoglobulin and secretory component regulation in the rat uterus at the time of decidualization

To determine the effect of decidualization on uterine immunoglobulins (Igs), we measured the levels of IgG, IgA, and secretory component (SC) after induction of artificial decidual cell reactions (DCR) in hormonally primed ovariectomized rats. When progesterone-treated (2.5 mg/day, 3 days) rats received an intraluminal instillation of oil or a needle scratch stimulation in one uterine horn, the stimulated horn had an increase in wet weight and cytoplasmic protein relative to the contralateral horn. Under these conditions, IgG levels increased 10-fold in the lumen of the stimulated horn. This response was selective for IgG, because induction of DCR had no effect on accumulation of IgA or SC in the stimulated horn. The progesterone-induced accumulation of IgG after DCR was further enhanced by estradiol. The addition of a small amount of estradiol (0.2 microgram) on day 3 of a 4-day progesterone pretreatment resulted in further increases in both the wet weight of the stimulated horn and the concentration of IgG in the lumen. The amount of IgG in the lumen of the stimulated horn was 5-fold greater than that in the stimulated horn after progesterone alone. Levels of IgA and SC, however, remained unchanged with this treatment. These results indicate that movement of IgG into the uterine lumen occurs as a part of the DCR and that both an appropriate endocrine balance and physical stimulation are essential for maximal IgG accumulation. Further, they suggest that IgG may play a central role in early pregnancy, which results in the successful implantation of the blastocysts.     

Radioiodinated peanut lectin: clinical use as a tumour-imaging agent and potential use in assessing renal-tubular function

Peanut lectin (PNA) has been shown to have a high affinity for Thomsen-Friedenreich (T) antigen, which is associated with the membrane of many solid tumour cells. PNA labelled with 131I was used as a tumour-imaging substance in patients with known metastatic cancer. Serial gamma scintiscans were obtained in 17 patients following a single injection of 131I-labelled PNA. Only in 1 patient was this technique able to reveal a known metastasis at analogue imaging. In the remaining patients, no visible uptake of 131I-PNA could be demonstrated at sites of known metastases. PNA is rapidly excreted through the kidneys and localizes in the renal tubules. As a tumour-imaging agent, 131I-PNA appears to be without value, but its renal-excretory characteristics make it a potentially useful agent for the in vivo assessment of renal-tubular disorders.     

Extended phase I study of human beta-interferon in human cancer

Ten patients with advanced cancer were treated with weekly intravenous escalating doses of human beta-interferon (HuIFN beta) 4 days each week. The starting dose of HuIFN beta was 3.0 X 10(6) units/m2 and the dose was doubled each week until dose-limiting toxicity was observed. Subjective toxicity included mild fevers and chills, malaise and flu-like symptoms. The lowest dose which caused suppression of the platelet and/or white cell count was 64 X 10(6) units daily, and the maximum dose given was 320 X 10(6) units daily. Both subjective and objective toxicity were not dose-related, easily managed and reversible. Serum interferon levels and the duration of measurable interferon activity on natural killer cells was in general dose-dependent. Two patients had an objective partial response, and two others showed stable disease while receiving HuIFN beta.     

Liver: an alarm for the heart?

BACKGROUND/AIMS: Fatty liver (FL) and coronary artery disease (CAD) have several risk factors in common, which are usually considered to account for their frequent coexistence. The independent association between FL and angiographic CAD was assessed in this case-control study by considering the contribution of their shared risk factors. METHODS: Three hundred and seventeen adult patients who underwent elective coronary angiography (CAG) were recruited immediately after CAG and classified into either of the two groups A (normal or mildly abnormal CAG; n=85) or B (clinically relevant CAD; n=232). A liver sonography was performed on the same day as CAG. RESULTS: The groups were significantly different in terms of gender, fasting blood glucose, low-density lipoproteins, diabetes (DM), hypertension and FL. In binary logistic regression, FL was the strongest independent predictor of CAD [P<0.001, odds ratio (OR)=8.48%, 95% confidence interval (CI)=4.39-16.40], followed by DM (P=0.002, OR=2.94) and male gender (P=0.014, OR=2.31). This pattern of associations did not change after clinically significant variables (waist-to-hip ratio, body mass index, triglycerides and high-density lipoproteins) were added to analysis. CONCLUSION: Fatty liver seems to be a strong independent alarm for the presence of significant CAD.     

Low Pulse Pressure as a Predictor of Death in Patients with Mild to Advanced Heart Failure

The prognostic value of pulse pressure has been investigated in heart-failure patients. Low pulse pressure in advanced heart failure and high pulse pressure in mild heart failure have been separately linked to increased mortality rates. We prospectively investigated an association between pulse pressure and 2-year cardiovascular death in an entire heart-failure population.We prospectively enrolled 225 heart-failure patients (New York Heart Association [NYHA] functional class, I–IV; mean age, 56.5 ± 12.3 yr; 188 men). The patients'' blood pressures were measured in accordance with recommended guidelines. Pulse pressures were calculated as the difference between systolic and diastolic blood pressure values. The patients were monitored for a mean period of 670 ± 42 days for the occurrence of cardiovascular death.All patients were divided into quartiles according to their pulse pressures (<35, 35–45, 46–55, and >55 mmHg). Pulse pressure decreased as NYHA class worsened (P <0.001). Patients in the <35-mmHg quartile had the lowest plasma sodium concentrations, left ventricular ejection fractions, and systolic myocardial velocities upon echocardiography; and the highest left ventricular dimensions, early diastolic/late diastolic filling velocity ratios, and peak early/peak late diastolic myocardial velocity ratios. Pulse pressure independently predicted death in the patients with advanced heart failure and in the entire population. Upon receiver operating characteristic analysis, a 30-mmHg cutoff value for pulse pressure predicted death with 83.7% sensitivity and 79.7% specificity.Pulse pressure is easily calculated and enables the prediction of cardiovascular death in patients with mild to advanced heart failure. Pulse pressure can be used reliably as a prognostic marker in clinical practice.Key words: Blood pressure/physiology, cardiovascular diseases/mortality/physiopathology, epidemiologic methods, heart failure/epidemiology/etiology/physiopathology, multivariate analysis, predictive value of tests, prospective studies, pulse/physiology, reference values, risk factorsPulse pressure (PP) is the difference between systolic and diastolic blood pressure (BP) values. Pulse pressure markedly rises after the 5th decade of life, due to arterial stiffening with increasing age.^1,2 Several studies have shown a close relationship between high PP and the occurrence of cardiovascular (CV) death.^3-5 Furthermore, high PP is a risk factor for the development of coronary heart disease, myocardial infarction, and heart failure in normotensive and hypertensive persons.^6-10Data regarding the prognostic value of PP in patients with heart failure are limited and controversial. The importance of PP was investigated in 2 large studies. The SAVE¹¹ (Survival and Ventricular Enlargement) trial revealed a worse prognosis in patients with high PP and symptomatic or asymptomatic left ventricular (LV) systolic dysfunction. The SOLVD¹² (Studies of Left Ventricular Dysfunction) trial found that high PP independently predicted total and CV death in mild heart failure. However, in both studies, patients in New York Heart Association (NYHA) functional classes I and II constituted most of the population, and few patients had advanced heart failure (NYHA classes III and IV). In other studies involving patients with advanced heart failure, low PP was associated with high CV mortality rates.^13-16 We believed that further study was warranted in order to elucidate the prognostic value of PP in an entire heart-failure population. Accordingly, we investigated the association between PP and 2-year CV death in patients in whom the severity of heart failure ranged from mild to advanced.     

Video-Assisted Versus Conventional Tracheal Intubation in Morbidly Obese Patients

Background  We compared tracheal intubation characteristics and arterial oxygenation quality during airway management of morbidly obese patients whose trachea was intubated under video assistance with the LMA CTrach™ (SEBAC, Pantin, France) or the Airtraq™ laryngoscope (VYGON, écouen, France) with that of the conventional Macintosh laryngoscope. Methods  After standardized induction of anesthesia, 318 morbidly obese patients scheduled for elective morbid obesity surgery received tracheal intubation with the LMA CTrach™, the Airtraq™ laryngoscope, or the conventional Macintosh laryngoscope. Duration of apnea, time to tracheal intubation, and oxygenation quality during airway management were compared between the LMA CTrach™ and the laryngoscope groups. Results  Patients’ characteristics were similar in the three groups. The success rate for tracheal intubation was 100% with the LMA CTrach™ and the Airtraq™ laryngoscope. One patient of the Macintosh laryngoscope group received LMA CTrach™ intubation because of early arterial oxygen desaturation associated with unstable facemask ventilation. The duration of apnea was shorter with the LMA CTrach™ than that of the Airtraq™ laryngoscope and the Macintosh laryngoscope. The duration tracheal intubation was shorter with the Airtraq™ laryngoscope than with the Macintosh laryngoscopes and the LMA CTrach™. During airway management, arterial oxygenation was of better quality with the LMA CTrach™ and the Airtraq™ laryngoscope than that of the Macintosh laryngoscope. Conclusion  Because LMA CTrach™ promoted short apnea time and the Airtraq™ laryngoscope allowed early definitive airway, both video-assisted tracheal intubation devices prevented most serious arterial oxygenation desaturation evidenced during tracheal intubation of morbidly obese patients with the conventional Macintosh laryngoscope. Support was provided solely from department sources. LMA and PRODOL Companies promoted material support for the airways.