The effect of anaerobic exercise on salivary cortisol,testosterone and immunoglobulin (A) in boys aged 15–16 years

This study investigated the effect of repeated bouts of short-term, high-intensity cycling exercise on the salivary cortisol, testosterone and immunoglobulin (A) concentrations of 15–16 year old boys. Seventeen apparently healthy schoolchildren (aged 15.5 ± 0.4 years) participated in this study. All participants completed 6 × 8 s sprints, interspersed with 30 s recovery intervals on a cycle ergometer. Using the passive drool method, salivary samples were taken before, and 5 min after, exercise. The group mean for peak power output was 723.1 ± 180.3 s. There were significant changes (p ≤ 0.05) in both SalT and SalC, 5 min after completing 6 × 8 s cycle sprints. No significant differences (p > 0.05) were recorded for SIg(A). The increases in SalT and SalC reported in this study confirm that repeated bouts of short-term, high-intensity exercise produces significant physiological hormonal responses in adolescent boys, but does not affect mucosal immune function.     

Azygos lobe associated with esophageal atresia: a trap for the unwary

Presence of an associated azygos lobe may cause problems during thoracotomy on the right side for esophageal atresia. Awareness of the anomaly allows its recognition and appropriate management.     

Developing and validating a tool for measuring the educational environment in clinical anesthesia

Purpose

We aimed to develop a contemporary measure for anesthesia teaching and learning in the operating theatre that was applicable to a variety of training jurisdictions, the Measure for the Anaesthesia Theatre Educational Environment (MATE).

Methods

A systematic review of the literature and modified Delphi approach was used to identify items for content validity. Reliability and exploratory factor analyses were conducted after a pilot survey of trainees to show construct validity, with removal of redundant items. Item domains were identified through a global assessment of factor structure accuracy and relation to real-world constructs.

Results

Literature review generated an initial 73-item list. A modified Delphi approach with 24 experts identified 44 relevant items. The pilot survey generated 390 responses. Reliability analysis, exploratory factor analysis, and global assessment refined the measure to 33 items. Four domains were identified according to factor structure: teaching preparation and practice, assessment and feedback, procedures and responsibility, and overall atmosphere. The educational environment was rated by trainees at 74.6 ± 15.6% with excellent internal consistency (Cronbach’s α = 0.975).

Conclusion

The MATE survey tool generated valid and reliable scores when measuring the educational environment in the operating theatre. Further research is required to investigate possible differences between the training countries and age of junior doctors and the associated underlying factors. Other researchers are invited to administer the survey and share results within a central database.

     

Aromatase inhibitors in breast cancer

Estrogens play important roles in breast cancer development and progression. In postmenopausal women, traditional endocrine therapies such as tamoxifen have sought to inhibit estrogen action by targeting the estrogen receptor itself. However, newer treatments are evolving that target estrogen production in postmenopausal tissues through inhibition of the aromatase enzyme. Clinical data demonstrate that these aromatase inhibitors are superior to tamoxifen as adjuvant therapy for breast cancer and have now replaced tamoxifen as first line therapy in a number of treatment regimens for postmenopausal breast cancer patients.     

Interferon-gamma protects against the development of structural damage in experimental arthritis by regulating polymorphonuclear neutrophil influx into diseased joints

OBJECTIVE: Local interaction between soluble mediators within the inflamed synovium is a key factor that governs the pathologic outcome of inflammatory arthritides. Our aim was to investigate the interplay between the Th1 lymphokine interferon-gamma (IFNgamma) and pivotal cytokines that drive rheumatoid arthritis (RA) pathology (interleukin-1beta [IL-1beta] and tumor necrosis factor alpha [TNFalpha]) in modulating inflammation and arthritis in vitro and in vivo. METHODS: Monarticular antigen-induced arthritis (AIA) was initiated in IFNgamma-deficient (IFNgamma(-/-)) mice and age-matched wild-type (IFNgamma(+/+)) mice. Joint swelling was measured and histologic analysis was performed in order to assess changes in both inflammatory and degenerative parameters in vivo. In vitro, the influence of IFNgamma in regulating IL-1beta- and TNFalpha-driven CXCL8 and CCL2 production was quantified by enzyme-linked immunosorbent assay. RESULTS: In murine AIA, both inflammatory and degenerative arthritis parameters were significantly exacerbated in the absence of IFNgamma. IFNgamma appeared to be a crucial factor in regulating CXCR2+ neutrophil influx in the joint. In in vitro studies using RA fibroblast-like synoviocytes, IFNgamma modulated both IL-1beta- and TNFalpha-driven chemokine synthesis, resulting in the down-regulation of CXCL8 production. CONCLUSION: IFNgamma exerts antiinflammatory, chondroprotective, and antiosteoclastogenic effects in murine AIA through a mechanism that involves the regulation of chemokine synthesis and local neutrophil recruitment. These studies suggest a potential therapeutic role of modulating IFNgamma signaling in the treatment of inflammatory arthritides.     

Managing persistent hiccups in advanced cancer 2: treatment

This is the second in a two-part unit on persistent hiccups in advanced cancer. Part 1 explored the incidence, causes, physiology and adverse effects of hiccups. This part examines both their non-pharmacological and pharmacological management.     

CAMHS dependency scoring: clarity and clinical relevance of the CAMHS-AID

AIM: A dependency measure (the CAMHS-AID) was developed in Birmingham and Manchester to support more accurate decisions about whether a young person can be accommodated on a child and adolescent mental health services (CAMHS) inpatient unit. This study aimed to test the content and face validity of the scale. METHOD: Eighty-six nursing staff were provided with booklets of the randomly ordered CAMHS-AID items and asked to rate the clarity of the items and how well they reflected clinical practice on a 5-point scale. RESULTS: The majority of the items were given a score of four or five, indicating that the majority of the CAMHS nurses felt that the CAMHS-AID items were very clear and understandable and accurately reflected clinical practice. There was greater variance when rating the clinical relevance of the items; the higher the grade of nurse the more likely they were to rate the items a 5 for clinical relevance. CONCLUSION: The CAMHS-AID has good content and face validity. We are continuing to investigate other aspects of validity and reliability of this context specific dependency scoring tool.