The Effect of Presleep Focal Attention Load on Subsequent Sleep Patterns

The hypothesis that a load on focal attention prior to sleep results in subsequent changes in sleep patterns was investigated. Eight females and 2 males slept in the laboratory for 4 nights: 2 adaptation nights, 1 experimental night preceded by a focal attention load, and 1 control night preceded by relaxed activity. On the experimental night, time in bed, total sleep time, and stage REM sleep were significantly longer than on the control night. The results support the hypothesis and suggest that attention during REM sleep has a unique character.     

Moloney virus induction of T-cell lymphomas in a plasmacytomagenic strain of Eμ-V-ABL transgenic mice

Although the v-abl gene can provoke several types of lymphoid neoplasm, mice of a transgenic strain (Em?-v-abl 40) in which lymphocytes are targeted for expression of v-abl by a linked immunoglobulin enhancer (Em?) spontaneously develop only plasmacytomas. To determine whether other lymphocytes of this strain were susceptible to transformation, and to identify genes that can collaborate with v-abl in tumorigenesis, Em?-v-abl 40 mice were subjected to insertional mutagenesis by neonatal infection with Moloney murine leukemia virus. Tumorigenesis was accelerated moderately, but nearly all the tumors were T lymphomas. The altered tumor type may reflect both the T-cell tropism of Moloney virus and the higher level of Em?-v-abl 40 expression found in T lymphocytes than in B lymphocytes. Insertion near the c-myc, N-myc or pim-1 gene was observed in 42% of the induced tumors, indicating that each of these genes may collaborate with v-abl in lymphomagenesis. Most of the accelerated tumors had a surprisingly low level of transgene expression. Thus, high expression of v-abl may not be required for Moloney-induced T lymphomagenesis.     

Manipulation of the tumor suppressor p53 for potentiating cancer therapy

The tumor suppressor p53 is a linchpin in the regulation of appropriate cellular responses to various stress conditions. Inactivation of the functions of this critical participant can have diabolical consequences, in particular the development of malignant diseases. Elicitation of appropriate p53 functions is an attractive strategy for combating cancer. Triggering p53 responses, reconstituting p53 activities through gene therapy, coercing mutant p53 to perform normal functions, manipulating p53 regulators, and activating p53 effectors are all approaches that are currently being developed. Here, we will overview 'p53-based' strategies for fighting cancer, both those under clinical trial and recent innovative concepts.     

Ethnic disparities in emergency department utilization patterns in southern Israel: a population-based study

Approximately 520,000 residents (30?% Bedouins) inhabit the Negev region of southern Israel. Despite the geographical proximity, Bedouins differ from Jews demographically and socio-economically. To evaluate the ethnic disparities in emergency department (ED) utilization patterns in this population-based observational retrospective cohort study, individual data regarding 93,338 visits to the ED throughout 2007?C2009 (9?months) were obtained. Demographic data were obtained from the Central Bureau of Statistics. The age- and gender-adjusted annual rates of ED visits were: 31.1 and 23 per 100 residents for Bedouins and Jews, respectively (P?<?0.001). Significant differences in visiting patterns according to the weekday and time of day between these groups were observed. Bedouins were referred at a higher rate by a physician compared with Jews (81 vs. 61?%; P?<?0.001). Ethnic disparities in chief complaints including the following age-adjusted odds ratio values of Bedouins compared with Jews were found: respiratory [Adj OR 1.38 (95?% CI 1.31?C1.46)], fever [Adj OR 0.67 (95?% CI 0.64?C0.71)], and cardiovascular [Adj OR 1.23 (95?% CI 1.16?C1.32)] in Bedouins versus Jews, respectively (P?<?0.001 each). Multivariate analysis demonstrated a higher risk for in-hospital admission among Bedouins than Jews [Adj OR 1.52 (95?% CI 1.47?C1.58); P?<?0.001]. Utilization patterns of EDs of Bedouins and Jews differ. Potential etiologies are increased morbidity, reduced accessibility to primary care clinics, use of private often non-board-certified physicians, and decreased socio-economic status among Bedouins. This warrants further research and interventional programs dealing with causes of the disparities.     

Adherence to Guidelines of Pain Assessment and Intervention in Internal Medicine Wards

Proper management of pain reduces morbidity, assists in recovery, and increases patient satisfaction. The role of a nurse in an accurate pain evaluation is pivotal. It seems that pain evaluation guidelines are not fully adhered to by nurses. The aim of this study was to assess the performance of pain evaluation and management by nurses in patients admitted in internal medicine wards and to identify groups of patients in which pain evaluation was insufficient. In this cross-sectional study medical records of 59 randomly chosen patients were reviewed: age 64.5 ± 18.5 years, 55% women, and hopitalization length 3.9 ± 1.6 days. Data relating to pain evaluation and management were obtained for every patient–hospitalization day (total 213 patient-days) and compared with the guidelines. Pain was evaluated in 176 out of 213 encounters (66.2%): 84.3% upon admission and 72.7% daily routine evaluation in accordance with guidelines. In 23.7% of evaluations, pain level warranted alleviating treatment (visual analog scale ≥3). However, such treatment was administered in only 29.3% of these cases. Reevaluation after treatment and additional evaluations thereafter were performed in 33.3% and 22% of encounters, respectively. The independent factors associated with the reduced performance of pain evaluation were: widower (odds ratio [OR] 0.88, 95% confidence interval [CI] 0.78-0.98; p = .024), reduced level of consicousnness (OR 0.77, 95% CI 0.63-0.95; p = .013), mental disorders as a cause of hospitalization (OR 0.81, 95% CI 0.71-0.94; p = .004), and isolation (OR 0.87, 95% CI 0.76-0.99; p = .03). Pain assessment and management in internal medicine wards is insufficient, especially in the above subgroups. Specific education programs targeted to the latter subgroups and to the unique pain assessment tools are warranted.     

Short-term inter-visit variability of erg amplitudes in normal subjects and patients with retinitis pigmentosa

PURPOSE: To evaluate the short-term test/retest variability in visually normal subjects and patients with retinitis pigmentosa (RP), and to assess the effect of stimulus intensity and baseline amplitude on electroretinogram (ERG) variability. METHODS: Eighteen patients with RP and nine visually normal subjects had a series of three unilateral ERGs, with an inter-visit interval of no less than 2 days and no more than 2 weeks. Responses to dark-adapted and both light-adapted single flash and 32 Hz flicker stimuli were recorded from a dilated eye over a range of stimulus intensities. B-wave amplitudes were compared to baseline amplitudes recorded at initial visit, and the resulting inter-visit percent difference was compared between stimulus intensities. Inter-visit variability was determined by one-way repeated measures analysis of variance using a 95% confidence interval to calculate threshold criteria for significant change. Analysis of variance followed by Bonferroni test for pairwise comparison was used to test for differences in inter-visit variability between two RP patient subgroups (higher versus lower baseline amplitudes) and visually normal subjects. The effect of stimulus intensity on amplitude reproducibility was also assessed. RESULTS: Threshold for significant increase or decrease in inter-visit ERG amplitudes at a 95% confidence level for patients with RP and visually normal subjects was often at or above 25% and not infrequently at or above 40% for certain stimuli and test conditions. While no statistical difference in inter-visit variability was demonstrated between visually normal subjects and patients with RP who were arbitrarily categorized as having relatively higher baseline amplitudes, there was a difference between each of these two groups and a smaller group of patients with RP categorized as having lower baseline amplitudes. Although the authors could not demonstrate that percent inter-visit differences varied with stimulus intensity in either controls or patients with RP, the 32 Hz flicker stimulus generally produced less amplitude variability than either dark- or light-adapted single flash stimuli in patients with RP. CONCLUSIONS: When using ERG amplitude for monitoring either the natural history of functional loss in retinal disease or as an outcome measure during a therapeutic trial, it becomes vital to define inter-visit variability of ERG amplitudes. These findings suggest that a percentage of patients with RP with appreciably lower baseline ERG amplitudes may manifest greater inter-visit ERG amplitude variability than patients with RP with higher baseline amplitudes or controls. Stimulus intensity had no clinically significant effect on inter-visit amplitude variability.     

Role of p53 in the progression of gastric cancer

Intestinal metaplasia (IM) is a premalignant lesion associated with gastric cancer (GC) but is poorly described in terms of molecular changes. Here, we explored the role of TP53, a commonly mutated gene in GC, to determine if p53 protein expression and/or the presence of somatic mutations in TP53 can be used as a predictive marker for patients at risk of progressing to GC from IM. Immunohistochemistry and high resolution melting were used to determine p53 protein expression and TP53 mutation status respectively in normal gastric mucosa, IM without concurrent GC (IM-GC), IM with concurrent GC (IM+GC) and GC. This comparative study revealed an incremental increase in p53 expression levels with progression of disease from normal mucosa, via an IM intermediate to GC. TP53 mutations however, were not detected in IM but occurred frequently in GC. Further, we identified increased protein expression of Mdm2/x, both powerful regulators of p53, in 100% of the IM+GC cohort with these samples also exhibiting high levels of wild-type p53 protein. Our data suggests that TP53 mutations occur late in gastric carcinogenesis contributing to the final transition to cancer. We also demonstrated involvement of Mdmx in GC.     

Healthcare-service utilization and direct costs throughout ten years following acute myocardial infarction: Soroka Acute Myocardial Infarction II (SAMI II) project

Objective: Acute myocardial infarction (AMI) is associated with significant risk for long-term morbidity and healthcare expenditure. We investigated healthcare utilization and direct costs throughout 10 years following AMI.

Methods: A retrospective study included AMI patients hospitalized in a tertiary medical center throughout 2002–2012. Data was obtained from computerized medical records. Hospitalizations, emergency department (ED), primary care and outpatient consulting clinic visits and other ambulatory services, following the AMI and their costs, were compared with the year preceding the AMI.

Results: Overall 9548 patients were analyzed (age 66.6?±?13.9 years, 67.8% men, 48.1% ST-elevation AMI). A significant increase in the utilization of all the evaluated services was observed in the first year following the AMI compared with the preceding year (p?<?.001 for each) and followed by a decline thereafter (p-for trend <?.001 for each) except increased number of ED visits (p-for trend?=?.014). Annual per-patient costs throughout the first year following AMI (5592€) were significantly greater compared with the preceding year (3120€) and declined subsequently to 3216€ and 2760€ for years 2–5 and 6–10, respectively. Multivariate analysis showed that throughout the first half of the follow-up total costs were slightly higher and in the second half similar to the year preceding the AMI. Analysis of the relative costs showed that ambulatory services make up most of the expenditure.

Conclusions: Healthcare utilization and economic expenditure peak throughout the first year and decline afterwards. For several services it remains higher for up to 10 years compared with the year preceding the AMI.