The six questions of pathogen reduction technology: An overview of current opinions

The current measures to ensure blood safety include: donor selection, conventional serology testing for infectious markers by ELISA and NAT, leukoreduction, UV/Gamma irradiation and pathogen reduction technologies (PRT). These measures offer some conceptual assurance on continual improvement in blood safety, but with respect to PRT, there are at least six unresolved questions [6 Qs] that still need to be addressed to make them universally acceptable. The current status of PRT for plasma, platelets and red blood cells is explored through comparative analyses, in tabulated format, to help in answering the questions posed by the authors of this overview.     

Psychiatric Disorders and Participation in Pre- and Postoperative Counselling Groups in Bariatric Surgery Patients

Background  

Psychological and behavioural factors seem to influence the results of bariatric surgery and the ability to achieve sustained weight loss and subjective wellbeing after the operation. Adequate pre- and postoperative psychological counselling are suggested to improve the results of surgery. However, some patients are reluctant to participate in pre- and postoperative counselling. The aim of the present study was to investigate the possible influence of psychiatric disorders on willingness to participate in group counselling in patients accepted for bariatric surgery.     

Overall survival after resection for colon cancer in a national cohort study was adversely affected by TNM stage, lymph node ratio, gender, and old age

Background

A national surveillance program of colon cancer treatment was introduced in 2007. We examined prognostic factors for colon cancer operated in 2000 with an aim of improving survival in the new program and a special focus on the merit of lymph node yield.

Methods

A cohort of 269 patients, 152 women (56.5%), with a mean age of 71?years, was operated for colon cancer in 2000 at three teaching hospitals and followed up for 7?years.

Results

Overall 5-year survival was 58.0%, and overall hospital mortality was 5.2%, with 4.5% in elective cases and 12.5% after urgent surgery. In only 41.1% of the specimens were 12 or more lymph nodes retrieved, but this did not affect survival in the combined cohort, although one of the hospitals achieved a significantly better result with a harvest of 12 or more lymph nodes. In a multivariate analysis, old age, gender, a high lymph node ratio (LNR) at stage III, and tumor?Cnode?Cmetastasis stage were adverse factors for survival.

Conclusions

The operative mortality was high and should be reassessed. The lymph node count did not have a significant impact on outcome overall, whereas the LNR proved significant for stage III. A prospective protocol using overall lymph node yield as a surrogate measure for more radical surgery, nevertheless, seems warranted to improve the lymph node harvest according to international recommendations.     

Low levels of cellular omega-3 increase the risk of ventricular fibrillation during the acute ischaemic phase of a myocardial infarction

AIM OF THE STUDY: Animal studies have demonstrated evidence of an anti-arrhythmic effect of marine n-3 fatty acids (FAs). In humans the same mechanism may explain the observed reduction in sudden cardiac death (SCD) associated with intake of fish. Whether high levels of n-3 FAs could protect against ventricular fibrillation (VF) during the acute ischaemic phase of a myocardial infarction (MI) is, however, not known. MATERIALS AND METHODS: We measured red blood cell content of eicosapentaenoic acid (EPA)+docosahexaenoic acid (DHA) expressed as a percentage of total FAs (the omega-3 index) at admission in 460 patients hospitalised with an acute coronary syndrome. Out of 265 patients suffering their first MI, 10 (cases) experienced an episode of VF during the initial 6h of symptom onset. The omega-3 index of these patients was compared to that of 185 first-MI patients (controls) free of VF for at least 30 days post-admission. RESULTS: The median value of the omega-3 index in the VF cases was 4.88% as compared to 6.08% in the controls (p=0.013). After adjustment for age, sex, ejection fraction, high-sensitivity C-reactive protein, use of beta-blocker, differences of infarct characteristics and previous angina pectoris, a 1% increase of the omega-3 index was associated with a 48% reduction in risk of VF (odds ratio (OR) 0.52, 95% confidence interval (CI) 0.28-0.96; p=0.037). CONCLUSION: Our study supports an anti-arrhythmic effect of n-3 FAs through their incorporation into myocardial cell membranes, reducing the risk of VF during ischaemia.     

A pilot study of key nursing aspects with different cooling methods and devices in the ICU

INTRODUCTION: Therapeutic hypothermia (TH) has become an integrated part of neurointensive care. Still, little data exists on the actual experience with cooling patients in the ICU from the intensive care nurse (ICN) perspective. The purpose of this survey was to evaluate important nursing aspects with different cooling methods and devices in ICU use. MATERIALS AND METHODS: The ICNs used a four-point rating scale (1=worst, 4=best possible) to evaluate (a) ease of application, (b) visual patient monitoring, (c) work load, (d) hygiene and (e) noise level with four cooling methods used in our ICU. Our simple, initial method of towels soaked in iced water spread over the torso was compared to three commercial cooling methods used; (1) Coolgard 3000 (Alsius, Irvine, USA), (2) Thermowrap (MTRE, Yavne, Israel) and (3) Artic Sun (Medivance, Louisville, USA). RESULT: There were significant differences in how the ICNs rated the nursing aspects of the different cooling methods. Ice-water soaked towels over the torso scored high with respect to ease of application and noise level. For work-load, all the three commercial devices scored significantly better than ice-water soaked towels (P<0.05). Only the Coolgard 3000 system scored significantly better than ice-water soaked towels for visual patient monitoring (P<0.001). For hygienic aspects, Artic Sun and Coolgard scored significantly higher than the others (P<0.05). Overall, the ICNs involved felt they had a general good understanding of TH but were only partly prepared in terms of training and knowledge of protocols and complications when TH was introduced in our ICU. The majority felt the new cooling protocol was acceptable. CONCLUSION: We identified significant differences in the rating of key nursing aspects of the different cooling methods. More studies on implementation of new cooling methods and devices seem warranted.     

Additive viability-loss following hsp70/hsc70 double interference and Hsp90 inhibition in two breast cancer cell lines

Hsp70 is an anti-apoptotic protein over-expressed in breast, lung, rectum, endometrial and bladder cancers. In this study, we investigated the impact of Hsp70 protein expression, and its close family member, Hsc70, on breast cancer cell viability and on the activity of the Hsp90/Hsp70 chaperone complex, a complex whose activity is important for the survival of cancer cells and tumours. The simultaneous blockade of Hsp70, Hsc70 and Hsp90 was most efficient in reducing breast cancer cell viability, as compared to their respective separate blockades. However, while the Hsp90 inhibition alone correlates with lost cell viability and reduced Hsp90/Hsp70 chaperone complex activity, the single or mixed reduction in Hsp70 and Hsc70 expression displayed no ability to reduce the activity of the Hsp90/Hsp70 chaperone complex. The results suggest that targeting both the Hsp70 family, as well as the Hsp90 protein will have an additive negative effect on cancer cell survival, even though their pathways of action are separate.     

The impact of preoperative counseling on postoperative treatment adherence in bariatric surgery patients: a randomized controlled trial

Objective

To assess if attendance to a preoperative counseling program improved weight loss or adherence to treatment guidelines in patients who underwent bariatric surgery.

Methods

One-hundred-forty-one patients were included in the study. Sixty-nine percent chose to participate in the counseling groups. They were randomized to a Treatment group and a Control group. Thirty-one percent chose not to participate in the counseling. However, they gave their consent to assessment before and after surgery (Reference group).

Results

One year after bariatric surgery, 88% had a weight loss of ≥50% EWL, 37% reported more than 30 min of physical activity daily, 74% had 5–7 meals daily, and 87% took recommended vitamins. There were no differences in weight loss, eating habits, or physical exercise between the Treatment group, the Control group and the Reference group one year after surgery.

Conclusion

Preoperative group counseling did not increase treatment adherence to recommended life-style changes.

Practice implications

In accordance with findings in the present study, it is not reasonable to offer a preoperative counseling program for all patients undergoing bariatric surgery. Further research should focus on developing and evaluating programs for postsurgical follow-up, and identifying patients that are in need for more comprehensive treatment programs.     

Population-based evidence of increased survival in human papillomavirus-related head and neck cancer

BackgroundEvidence from clinical, population-based and molecular studies has shown that human papillomavirus (HPV) infection can be a causal risk factor for a subset of head and neck squamous cell carcinomas (HNSCC). It is proposed that HPV-associated oropharyngeal cancer is a new disease entity that requires treatment and prevention strategies distinct from present recommendations.MethodsIn our population-based study we estimated incidence and survival trends in 8270 patients with HPV-related HNSCC (HPV⁺HNSCC) and HPV-unrelated HNSCC (HPV^–HNSCC) in Norway over the past three decades.ResultsIn the period 1981–1995, patients with HPV⁺HNSCC had poorer survival than HPV^–HNSCC (adjusted hazard ratio (HR) 1.3, 95% confidence interval (CI): 1.14–1.44). By 1996–2007, survival had increased in both groups, but the increase was significantly greater among HPV⁺HNSCC patients (HR 0.57, 95% CI: 0.48–0.67). During the same period, incidence also increased, but only for HPV⁺HNSCCs. From 1981–1995 to 1996–2007, median age at diagnosis for HPV⁺HNSCC decreased from 63.2 to 59.8 years, while for HPV^–HNSCC median age at diagnosis of 66.6 years remained unchanged.ConclusionsWe demonstrate a population level improvement in survival among patients with oropharyngeal squamous cell cancers commonly related to infection with HPV. In contrast, patients with HNSCC not related to HPV only showed a modest improvement in survival in the period 1981–2007. A concomitant increase in incidence and survival was observed for HPV-related cancers only. This trend cannot be explained by changes in treatment, cancer registration nor screening, but is most likely due to an increased prevalence of HPV-positive tumours.     

Optimization and Application of the Head Space Liver S9 Equilibration Technique for Metabolic Studies of Organic Solvents

Abstract: A head space liver S9 vial equilibration technique for qualitative and quantitative metabolism of volatile organic solvents in vitro is described and investigated for optimal experimental conditions with toluene and n-hexane as model substrates. The method was also used for studying the metabolic interaction between acetone and styrene. NADP⁺ was a critical cofaclor in the system as concentrations above 2.5 mM resulted in inhibition of metabolism. Induction of cytochrome P450 by phenobarbital did not alter the observed cofactor dependency, and addition of vehicles such as rat blood did not enhance metabolism. Acetone-induced liver S9 increased the primary oxidation of styrene and also the formation of styrene oxide, but not significantly that of mandelic acid. Acetone as such had no effect on the metabolic elimination of styrene, indicating that the interaction is mainly on the level of enzyme induction occurring after long-term exposure to acetone. As earlier reports on styrene metabolism in vivo has not been able to detect styrene oxide in toxicokinetic studies with a sufficient degree of accuracy, the head space liver S9 vial equilibration technique may offer a fast and sensitive tool for screening of metabolic interactions between organic solvents when optimized for metabolic activity.