Epilepsy, intellectual disability, and living environment: a critical review

Epilepsy occurs at a higher incidence and is more prevalent in people with an intellectual disability than in the general population. Nonetheless, we have insufficient knowledge of the extra needs of people with epilepsy and intellectual disability, of their families, and of the living environment. The lack of information about specific needs of the living environment may, in particular, be important. A Medline search revealed that scant attention has been paid to the specific needs for patients with epilepsy and intellectual disability, and only a few studies have focused specifically on this topic. The majority of studies have been focused on medical treatment issues and the organization and availability of health and social services. There is an indication that people with epilepsy and intellectual disability lack skills training appropriate to their intellectual potential. And although several reviews have emphasized the need for information on living environment and quality of life, we did not find such studies in our search.     

Aneuploidy and proliferation in keratinocytic intraepidermal neoplasias

Cutaneous squamous (pre)malignancies can be classified according to the keratinocytic intraepidermal neoplasia (KIN) classification. Aneuploidy can be seen as the result of chromosomal aberrations leading to altered DNA content and has been strongly associated with malignancy. Hyperproliferation is also strongly associated with tumorigenesis. The aim of the study was to analyse the presence and the amount of aneuploidy and proliferation in the progression from intraepithelial neoplasm to microinvasive carcinoma (miSCC). For this purpose, nuclei were isolated from 116 formalin-fixed KIN lesions from 68 patients in which DNA content was measured by flow cytometry. Proliferation was assessed by immunohistochemical staining for Ki67 as well as by flow cytometry. Aneuploidy was increasingly found in higher KIN lesions, but not in normal skin. However, in miSCC aneuploidy was relatively less frequently found. DNA indices (mean +/- SE) of KIN III-lesions (1.57 +/- 0.05) were significantly lower compared with KIN I/II lesions (1.71 +/- 0.05). Ki67 expression was strongly positively correlated with KIN grade, and proved to be a good adjunct in the classification of KINs. Thus, aneuploidy occurred more frequently in higher KIN lesions, indicating cumulative damage during KIN progression. The lower frequency of aneuploidy in miSCC compared with KIN III may point at alternative routes towards invasive carcinoma besides serial progression through all three KIN stages. Ki67 expression appears a valuable marker in the classification of KINs.     

Primary and locally recurrent retroperitoneal soft-tissue sarcoma: Local control and survival

Aim

To evaluate local control for long-term prognosis in retroperitoneal soft-tissue sarcoma (primary tumors (PT) and local recurrence (LR)).

Methods

A total of 110 patients underwent surgery between 1988 and 2002. Prospectively gathered clinicopathological data were analyzed. Kaplan–Meier estimations and Cox regression analyses were performed.

Results

Resectability was 90%, being comparable for PT (n = 71) and LR (n = 39). Morbidity, mortality, blood loss, and operation time did not differ for PT or LR (24% vs. 31%, p = 0.41; 7.0% vs. 5.1%, p = 1.0; 1000 ml vs. 1500 ml, p = 0.17; 240 min vs. 255 min, p = 0.13). Hospitalization was comparable in both groups (median, 12 days (PT) and 13 days (LR)). Follow-up was 89 months (median, IQR 37–112 months). Local 3- and 5-year control rates after complete resection of PT were 66% and 59% (19% and 9% for LR, p < 0.001). The mean number of operations were 1.4 for PT and 2.4 for LR (p = 0.0047). The 5-year survival rates after complete resection were 51% for PT and 43% for LR (p = 0.39). The 5-year survival rates were 65%, 4%, and 0% for complete resection, incomplete resection, and exploration, respectively (p < 0.001). Multivariate analysis showed high-grade and blood loss with a poor prognosis.

Conclusions

Comparable resectability rates and perioperative outcome were observed for surgery of PT and LR. Consequent reoperation leads to respectable long-term survival rates after resection of LR. The prognosis in retroperitoneal sarcomas varies significantly according to resectability, grade and blood loss.     

Size and concentration measurement of an industrial aerosol

Several real-time particle sizing instruments were evaluated for measuring the size distribution and concentration of the aerosol produced during the high speed grinding of gray iron castings. Aerosol was sampled in the airstream entrained by the motion of a spinning grinding wheel in a pilot grinding operation. Measurement methods based on differing physical principles were selected for evaluation and compared: particle inertia (aerodynamic particle sizer and quartz crystal microbalance cascade impactor); light scattering (laser aerosol spectrometer); and projected-area microscopy (scanning electron microscope). Inferences of aerodynamic diameter based on measurements by the laser aerosol spectrometer consistently undersized that determined by the aerodynamic particle sizer by a factor of 1.5. Estimates of aerodynamic diameters from projected area diameters determined by scanning electron microscopy differed from those obtained by the aerodynamic particle sizer by a factor of 2. Differences appeared to be a non-linear function of particle diameter. Estimates of respirable mass determined from mass-weighted particle size spectra varied by a factor of 6 between the largest estimate (scanning electron microscope) and the smallest estimate (laser aerosol spectrometer).     

The contribution of humoral immunity to the control of avian reoviral infection in chickens after vaccination with live reovirus vaccine (strain 2177) at an early age

The presence of maternal immunity in broilers does not preclude the successful protective immunization with an attenuated live reovirus vaccine at 1-day-old. This was recently demonstrated in a reovirus challenge model based on reovirus isolation from different organs (van Loon et al., 2002). Discrimination between challenge and vaccine virus was made by specific monoclonal antibody. Notably, at the day of challenge the levels of circulating reovirus-specific antibodies proved to be minimal or undetectable. This suggested an antibody-independent vaccination-induced immunity under the chosen conditions. In the present study we assessed the contribution of specific humoral responses in the same experimental model, by evaluating the control of a virulent challenge infection in the complete absence of B cells as a result of cyclophosphamide treatment. These experiments were performed in both SPF white leghorn chickens and commercially available broilers with passively acquired maternal antibodies. Our data demonstrate that the virus is controlled in the absence of actively produced antibodies, and is independent of B lymphocytes. This suggests that cellular immunity is sufficient for protection of broilers with maternal antibodies against reovirus infection following early age vaccination with live reoviral vaccine.     

An investigation of dust generation by free falling powders.

To identify the dust generation processes, aluminum oxide powder was dropped as a free falling slug in a test chamber. The effect of the slug's mass, diameter, and drop height upon the aerosol concentration and size distribution was measured with an aerodynamic particle sizer. To differentiate between aerosol generated during the free fall and at the end of the fall, the slug was dropped either onto a flat surface or into a container of water that suppressed dust generation associated with the impact at the end of the fall. Aerosol generation occurred during the slug's free fall as well as at the end of the fall. The falling solid induced an airflow that followed the falling solid to the end of the fall. This induced airflow contained the aerosol generated during the free fall. At the end of the free fall, the induced airflow, combined with air jets created on impact, dispersed the aerosol throughout the test chamber. Additional measurements were made by using "neutral buoyancy" helium-filled bubbles to visualize the airflow in the test chamber. The airflow and ensuing turbulence were sufficient to keep large, inspirable particles suspended throughout the test chamber for periods greater than 10 min. During experimental work, the effect of drop height, mass, and slug diameter upon aerosol generation by a single slug of powder was studied. The results indicated that the manner in which a powder is handled may be as important as material dustiness as measured by a dustiness tester. Aerosol generation can be reduced by minimizing the contact between the falling powder and the air.     

Adjuvant treatment of in-transit melanoma: Narrowing the knowledge gap left by clinical trials

Few clinical trials address efficacy of adjuvant systemic treatment in patients with in-transit melanoma (ITM). This study describes adjuvant systemic therapy of ITM patients beyond clinical trials. In this study, we included stage III adjuvant-treated melanoma patients registered in the nationwide Dutch Melanoma Treatment Registry between July 2018 and December 2020. Patients were divided into three groups: nodal disease only, ITM only and ITM and nodal disease. Recurrence patterns, recurrence-free survival (RFS) and overall survival (OS) at 12-months were analyzed. In our study population of 1037 patients, 66.8% had nodal disease only, 16.7% had ITM only and 16.2% had ITM with nodal disease. RFS at 12-months was comparable in the nodal only and ITM only group (72.2% vs70.1%, P = .97) but lower in ITM and nodal disease patients (57.8%; P = .01, P < .01). Locoregional metastases occurred as first recurrence in 38.9% nodal disease only, 71.9% of ITM-only and 44.0% of ITM and nodal disease patients. Distant recurrences occurred in 42.3%, 18.8% and 36.0%, respectively (P = .02). 12-months OS was not significantly different for nodal disease only patients compared with ITM-only (94.4% vs 97.6%, P = .06) but was significantly higher for ITM-only compared with ITM and nodal disease patients (97.6% vs 91.0%, P < .01). In conclusion, we showed that in the adjuvant setting, RFS rates in ITM-only patients are similar to non-ITM, though better than in ITM and nodal disease patients. Adjuvant-treated ITM-only patients less often experience distant recurrences and have a superior OS compared with ITM and nodal disease patients.     

Exploring the impact of social network change: Experiences of older adults ageing in place

Social networks are sources of support and contribute to the well‐being of older adults who are ageing in place. As social networks change, especially when accompanied by health decline, older adults’ sources of support change and their well‐being is challenged. Previous studies predominantly used quantitative measures to examine how older adults’ social networks change. Alternatively, this study explores the impact of changing social networks on older adults’ lives by examining their personal experiences. We held four focus groups, two with a total of 14 older adults who are ageing in place and receiving home care and two with a total of 20 home‐care nurses from different regions and organisations in the Netherlands. Subsequently, an expert team of home‐care professionals and managers discussed and verified the results. Procedures for grounded theory building were used for analysis. We revealed four themes of high‐impact experiences: (a) struggling with illness/death of the spouse; (b) working out a changing relationship with (grand)children; (c) regretting the loss of people they have known for so long and (d) feeling dependent and stressed when helpers enter the network. Also, network dynamics were found to follow three consecutive stages: (a) awareness of social network change; (b) surprise when social network change actually occurs and (c) acceptance and adjusting to new circumstances. Together, the four themes of experiences and three stages of network change form an integrative model of the role of social network dynamics for older adults’ lives when ageing in place.