Instability of microsatellites in radiation-associated thyroid tumours with short latency periods

PURPOSE: To determine the instability of microsatellite sequences in post-Chernobyl thyroid tumours from children and young adults, and to ascertain whether they correlated with the age of the patient at the time of the accident and the tumour latency period. MATERIALS AND METHODS: The stability of 26 microsatellite markers was investigated in 122 radiation-associated thyroid tumours (96 children, 26 adults) from Belarus and 39 spontaneous thyroid tumours (adults) from Munich without radiation history. RESULTS: A significant correlation between patient age at the time of the accident and the instability of microsatellite sequences was established. Also, a high instability of microsatellite sequences was found in 28 early thyroid tumours from Belarus with latency periods of 6-8 years, in contrast to a low instability of microsatellites in 94 tumours emerging 9-11 years after the accident. Microsatellite instability in the reference group from Munich proved similar to the early thyroid tumours from Belarus. CONCLUSION: Early, fast-growing and aggressive post-Chernobyl thyroid tumours are characterized by an increase in microsatellite instability.     

Die Übereinstimmung von Wohnbedürfnissen und Wohnbedingungen und ihr Einfluss auf die erlebte Stadtteilverbundenheit

Based on the "complementary-congruence model" of person-environment (p-e) fit, this study focuses on housing in old age as an interaction between housing needs and housing conditions in urban settings. The research aims are: (1) To establish a set of housing-related p-e fit indices based on the relationship between environmental needs and existing conditions in different physical and social domains, and to describe housing among elders aged 51-80 years and in different urban districts with these indices. The study distinguishes between basic, higher-order and social needs relating to housing; (2) To explain outdoor place attachment as an indicator for quality of life in different urban districts with a set of predictors including these person-environment fit indices. Data were drawn from telephone-based interviews with 365 older adults (51-80 years) who were questioned about individual housing needs and housing conditions. Results revealed higher p-e fit scores in the domains of higher-order and social housing needs and conditions in the districts which were considered to be more pleasant but had poor access to the city and to public transportation. In contrast, age was more important in explaining differences in the domain of basic housing needs and conditions with higher p-e fit scores among older participants in all settings. In explaining outdoor place attachment, the fit between basic and social housing needs and conditions was important, but the higher-order fit did not play a role.     

Abnormalities of the auditory brainstem response in post-meningitic infants and children

The auditory brainstem response (ABR) was recorded in 86 infants and children from 1 month to 14 years of age following episodes of bacterial or viral meningitis. Thirty-two demonstrated some degree of cochlear impairment There was a high incidence of neurological sequellae in these children. Eight children exhibited abnormal changes suggestive of brainstem dysfunction Six of these eight children also had abnormal neurologic examination. Recovery, or at least improvement in the ABR, occurred in six infants who were assessed upon discharge from the hospital, and then again several months post-hospitalization. In each case improvement was attributed to a resolving conductive component.The ABR was found to be effective for identifying hearing impairment and brainstem dysfunction in pediatric patients following central nervous system infection. Objective information, not available from other methods of assessment was obtained.     

RET rearrangements in post-Chernobyl papillary thyroid carcinomas with a short latency analysed by interphase FISH

Tissue samples from 13 post-Chernobyl childhood thyroid tumours that occurred within a short period of time (4-8 years) after the Chernobyl accident have been investigated by interphase FISH analysis for rearrangements of RET. In all, 77% of cases showed RET/PTC rearrangements and a distinct intratumoural genetic heterogeneity. The data were compared to findings on 32 post-Chernobyl PTCs that occurred after a longer period of time (9-12 years) after the accident. In none of the cases from either group were 100% of cells positive for RET rearrangement. In addition, the pattern of RET-positive cells was different in the two groups (short vs longer latency). A significant clustering of aberrant cells could be detected in the long-latency subgroup, whereas the aberrant cells were more homogeneously distributed among the short-latency tumours. The findings suggest that oligoclonal tumour development occurs in post-Chernobyl PTCs. This pattern of different clones within the tumour appears to become more discrete in cases with longer latencies, suggesting either outgrowth of individual clones or development of later subclones with time.     

Active treatments for aprosodia secondary to right hemisphere stroke

This study investigates the effects of two mechanism-based treatments for expressive aprosodia. Three participants, two women and one man, had a right hemisphere cerebral infarction resulting in affective aprosodia with greater expressive than receptive deficits. Trained raters determined presence of aprosodia by judging participants' performance on two emotional communication batteries. A single-subject design with replication across three participants was employed. Sentence production with the use of treated and nontreated emotions was measured during baseline and treatment phases. Sentences were scored for accuracy by a trained rater blind to time of testing and analyzed visually and statistically. Effect sizes calculated on the resulting data for each participant and treatment confirmed modest to substantial treatment effects for both treatments in all three participants. Because of a relative paucity of treatment studies investigating expressive aprosodia, these data are among the first to suggest that aprosodia may be amenable to behavioral treatments.     

Rebound in ventilator-associated pneumonia rates during a prevention checklist washout period

OBJECTIVE To describe the washout effect after stopping a prevention checklist for ventilator-associated pneumonia (VAP). METHODS VAP rates were prospectively monitored for special cause variation over 42 months in a paediatric intensive care unit. A VAP prevention bundle was implemented, consisting of head of bed elevation, oral care, suctioning device management, ventilator tubing care, and standard infection control precautions. Key practices of the bundle were implemented with a checklist and subsequently incorporated into the nursing and respiratory care bedside flow sheets to achieve long-term sustainability. Compliance with the VAP bundle was monitored throughout. The timeline for the project was retrospectively categorised into the benchmark phase, the checklist phase (implementation), the checklist washout phase, and the flowsheet phase (cues in the flowsheet). RESULTS During the checklist phase (12 months), VAP bundle compliance rose from <50% to >75% and the VAP rate fell from 4.2 to 0.7 infections per 1000 ventilator days (p<0.059). Unsolicited qualitative feedback from frontline staff described overburdensome documentation requirements, form fatigue, and checklist burnout. During the checklist washout phase (4 months), VAP rates rose to 4.8 infections per 1000 ventilator days (p<0.042). In the flowsheet phase, the VAP rate dropped to 0.8 infections per 1000 ventilator days (p<0.047). CONCLUSIONS Salient cues to drive provider behaviour towards best practice are helpful to sustain process improvement, and cessation of such cues should be approached warily. Initial education, year-long habit formation, and effective early implementation demonstrated no appreciable effect on the VAP rate during the checklist washout period.