The associations between age and the development of laboratory abnormalities and treatment discontinuation for reasons other than virological failure in the first year of highly active antiretroviral therapy

Objective

The aim of this study was to describe the relationship between age and the time to treatment discontinuation in the absence of virological failure as well as the development of specific laboratory abnormalities, in patients starting highly active antiretroviral therapy (HAART) for the first time.

Methods

Analyses included 8708 antiretroviral‐naïve patients from the UK Collaborative HIV Cohort (CHIC) study who started HAART from 1998 onwards. We considered time to the first discontinuation of any drug in the initial HAART regimen for reasons other than virological failure; the association between this and age at the start of HAART was determined using proportional hazards regression after adjustment for potential confounders. The incidence of specific laboratory abnormalities in the first year after starting HAART was compared in those of different ages using multiple logistic regression.

Results

A total of 2650 patients discontinued at least one drug in their HAART regimen in the first year for reasons other than virological failure; after controlling for confounders, those aged < 30 years at the time of starting HAART were more likely to discontinue than those aged 30–39 years [relative hazard (RH) 1.12; 95% confidence interval (CI) 1.01, 1.24] as were those aged 50 years (RH 1.14; 95% CI 1.00, 1.31). There were strong associations between greater age and raised total cholesterol, decreased haemoglobin and raised triglycerides over the first year, although the latter disappeared after adjustment for pre‐HAART levels, suggesting that this finding reflected higher pre‐HAART triglyceride levels in older individuals.

Conclusions

Continued attempts to improve the tolerability of HAART regimens may help to sustain the good outcomes in all age groups over the longer term.     

Conjugated linoleic acid (CLA), body fat, and apoptosis

OBJECTIVE: The objective of the study was to determine if consumption of conjugated linoleic acid (CLA) by mice could induce apoptosis in adipose tissue. Other objectives were to determine the influence of feeding mice CLA for < or =2 weeks on body fat, energy expenditure, and feed intake. RESEARCH METHODS AND PROCEDURES: A mixture of CLA isomers (predominantly c9,t11 and t10,c12) was included in the AIN-93G diet at 0, 1, and 2%, and fed to mice for 12 days (Trial 1), or was included at 2% and fed to mice for 0, 5, and 14 days (Trial 2). Feed intake was measured daily and energy expenditure was determined by direct calorimetry on day 9 in Trial 1. Retroperitoneal fat pads were analyzed for apoptosis by determination of DNA fragmentation. RESULTS: Dietary CLA reduced feed intake by 10% to 12% (p < 0.01), but either did not influence or did not increase energy expenditure as indicated by heat loss. Body weight was not influenced by consumption of CLA in Trial 1 but was increased (p < 0.01) by CLA in Trial 2. Weights of retroperitoneal, epididymal, and brown adipose tissues were lower (p < 0.01) in animals fed CLA, although liver weight was increased (p < 0.10; Trial 1) or not changed (Trial 2). Analysis of retroperitoneal fat pad DNA from both trials indicated that apoptosis was increased (p < 0.01) by CLA consumption. DISCUSSION: These results are interpreted to indicate that CLA consumption causes apoptosis in white adipose tissue. This effect occurs within 5 days of consuming a diet that contains CLA.     

DSA及动脉栓塞在骨与软组织肿瘤中的临床应用

目的:研究介入治疗在骨科肿瘤术前的临床应用价值。方法:对9例骨科肿瘤做介入治疗患者均行DSA造影,并用明胶海绵条做供养动脉栓塞。结果:肿瘤均有不同程度的坏死、液化和囊变,术中易剥离,出血少,术野清楚,缩短手术时间。结论:骨科肿瘤术前栓塞能够有效地减少术中失血,提高手术治疗成功率,是一种有价值的术前辅助性治疗方法。     

Towards an understanding of salient neighborhood boundaries: adolescent reports of an easy walking distance and convenient driving distance

Numerous studies have examined the association between the surrounding neighborhood environment and physical activity levels in adolescents. Many of these studies use a road network buffer or Euclidean distance buffer around an adolescent's home to represent the appropriate geographic area for study (i.e., neighborhood). However, little empirical research has examined the appropriate buffer size to use when defining this area and there is little consistency across published research as to the buffer size used. In this study, 909 12^th grade adolescent girls of diverse racial and geographic backgrounds were asked to report their perceptions of an easy walking distance and a convenient driving distance. These two criterions are often used as the basis for defining one's neighborhood.     

Diagnosis of subsegmental pulmonary emboli: a multi-center study using a porcine model

We measured sensitivity, positive predictive value, and free-response receiver operating characteristic (FROC) of 20 radiologists detecting subsegmental-sized pulmonary emboli in a porcine model using either contrast-enhanced computed tomography (CT) or digital subtraction (DS) pulmonary angiography. Colored methacrylate beads (4.2 and 3.8 mm diameter) were injected into 9 anesthetized juvenile pigs. CT and DS pulmonary angiography images were obtained before and after a pulmonary infiltrate was introduced into the lower lobes. Following imaging, the pigs were euthanized, and the pulmonary arterial tree was cast using clear methacrylate allowing direct visualization of emboli. The 20 radiologists used a custom-made computer application to display the images on their personal computer and record their diagnoses. The results were mailed electronically to the coordinating center for comparison with the cast of the pulmonary vasculature. Twenty-three emboli were included in the statistical analysis. Overall sensitivity for spiral CT and angiography, respectively, was: 60 +/- 18% and 72 +/- 11% (P = 0.06). Positive predictive value for spiral CT and angiography, respectively, was: 49 +/- 24% and 58 +/- 23% (P = 0.25). There was a large variation in both sensitivity and positive predicted values between Readers. There was no difference in sensitivity or positive predictive value between radiologists from community or academic centers (P > 0.27). FROC analysis showed no significant difference between CT or DS (P = 0.27). In conclusion, in this porcine model, there is no overall diagnostic advantage to using DS pulmonary angiography rather than contrast-enhanced spiral CT for the diagnosis of PE when images are interpreted by radiologists located in either academic or community hospital settings.     

Green tea polyphenol epigallocatechin gallate inhibits adipogenesis and induces apoptosis in 3T3-L1 adipocytes

OBJECTIVE: Green tea catechins have been shown to promote loss of body fat and to inhibit growth of many cancer cell types by inducing apoptosis. The objective of this study was to determine whether epigallocatechin gallate (EGCG), the primary green tea catechin, could act directly on adipocytes to inhibit adipogenesis and induce apoptosis. RESEARCH METHODS AND PROCEDURES: Mouse 3T3-L1 preadipocytes and mature adipocytes were used. To test the effect of EGCG on viability, cells were incubated for 3, 6, 12, or 24 hours with 0, 50, 100, or 200 microM EGCG. Viability was quantitated by MTS assay. To determine the effect of EGCG on apoptosis, adipocytes were incubated for 24 hours with 0 to 200 microM EGCG, then stained with annexin V and propidium iodide and analyzed by laser scanning cytometry. Both preadipocytes and adipocytes were also analyzed for apoptosis by terminal deoxynucleotidyl transferase dUTP nick-end labeling assay. To determine the effect of EGCG on adipogenesis, maturing preadipocytes were incubated during the 6-day induction period with 0 to 200 microM EGCG, then stained with Oil-Red-O and analyzed for lipid content. RESULTS: EGCG had no effect on either viability or apoptosis of preconfluent preadipocytes. EGCG also did not affect viability of mature adipocytes; however, EGCG increased apoptosis in mature adipocytes, as demonstrated by both laser scanning cytometry and terminal deoxynucleotidyl transferase dUTP nick-end labeling assays. Furthermore, EGCG dose-dependently inhibited lipid accumulation in maturing preadipocytes. DISCUSSION: These results demonstrate that EGCG can act directly to inhibit differentiation of preadipocytes and to induce apoptosis of mature adipocytes and, thus, could be an important adjunct in the treatment of obesity.     

Is there a cost to poor communication in cancer care?: a critical review of the literature

In this paper, the authors engage in a critical analysis of the existing empirical literature which addresses the impact of ineffective communication between cancer patients and clinicians. It is increasingly accepted that communication plays a significant role in many aspects of the care experience, and that poor communication can have a significantly negative influence on the patient's psychosocial experience, symptom management, treatment decisions, and quality of life. However, scant attention has been given to the idea that poor communication may also have an economic impact worthy of attention. This area has not been the focus of systematic inquiry or substantive critical consideration. On the basis of critical analysis of the limited empirical evidence that exists across a wide range of studies in related areas, the authors propose that the existential and material costs associated with poor communication in cancer care may well be considerable, and conclude with a call to mobilize a heightened enthusiasm for addressing the research challenges in this field.     

Approaching difficult communication tasks in oncology

Effective communication skills enable physicians to improve patients' understanding of their illnesses, improve patient adherence to treatment regimens, use time efficiently, avoid burnout, and increase professional fulfillment. Common communication pitfalls include blocking, lecturing, depending on a routine, collusion, and premature reassurance. Fundamental communication skills include "ask-tell-ask," "tell me more," and responding empathetically. Key communication tasks that are linked to the illness trajectory include: the first visit, giving bad news, making anticancer treatment decisions, offering clinical trials, completing anticancer therapy, and discontinuing palliative chemotherapy. While enhancing or acquiring new skills ultimately requires practice and feedback over time, this article provides a cognitive map for important communication skills that physicians need over the course of caring for a person with cancer.     

FDG-PET is able to detect pancreatic carcinoma in chronic pancreatitis

Purpose 2-(¹⁸F)-Fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) is an imaging technique which enables detection of malignancies. FDG-PET has been established as a tool for the diagnosis of pancreatic carcinoma (CA). Early detection is mandatory as cure can only be achieved in non-advanced disease. This is, however, very difficult with conventional radiological techniques. Patients with chronic pancreatitis (CP) are at risk of developing CA. A simple, reliable screening method for malignant degeneration is highly desirable. We set out to investigate whether FDG-PET is able to detect CA in the setting of CP and can fulfil a potential role in the early detection of CA in CP.Methods FDG-PET was performed in 77 CP patients and in six patients with CP complicated by CA (CP + CA). We included 26 CA patients as a positive control. A positive scan was defined as focal FDG accumulation in the pancreas region.Results In 67 of the 77 CP (87%) patients, pancreatic FDG accumulation was absent. Six patients had significant accumulation. In CA, 24/26 patients had a positive PET. Five out of the six patients with CP + CA had focal uptake, while minor uptake was seen in one patient. FDG-PET was positive in almost all CA patients and CP + CA patients. FDG-PET was negative in the large majority (87%) of CP patients, which suggests that a positive PET scan in CP patients must lead to efforts to exclude a malignancy.Conclusion These data suggest that FDG-PET has a potential role as a diagnostic tool for detecting CA in longstanding CP.