Health beliefs and parenting attitudes influence breastfeeding patterns among low-income African-American women.

OBJECTIVE: To describe breastfeeding initiation among 210 urban African-American mothers with inadequate prenatal care. METHODS: This study is a case-control study of postpartum mothers recruited from four large urban hospitals. RESULTS: Mothers who chose to breastfeed were more educated, employed before birth, married, and using contraception postnatally. Regression model analysis controlling for demographic differences revealed that breastfeeding was significantly associated with a higher perception of severity of illness and higher confidence in the ability of health care to prevent illness. Breastfeeding mothers were less likely to reverse parent-child roles and had a lower perception of hassle from their infant's behavior. When comparing mothers who breastfed longer than 8 weeks to those who did not breastfeed, breastfeeding mothers had high scores related to empathy toward infants on the Adult-Adolescent Parenting Inventory as well as a low perception of hassle on the Parenting Daily Hassle. The perception of existing formal or informal social support did not influence breastfeeding behavior. CONCLUSION: Personal attributes of low-income urban mothers such as health beliefs and parental attitudes may play a role in the initiation and duration of breastfeeding. Low-income African-American mothers may be influenced in their choice to breastfeed by supportive messages from physicians and nurses delivering care to mothers and their newborns. Emphasis should be placed on the role breastfeeding can play in preventing childhood illnesses.     

Lymphocytic and collagenous colitis: the emerging entity of microscopic colitis. An update on pathophysiology, diagnosis and management.

Microscopic colitis (MC) encompasses the two morphologically distinct entities of collagenous colitis (CC) and lymphocytic colitis (LC). MC was first described less than 30 years ago but is presently recognized as a relatively common cause of chronic diarrhea in the adult population. Remarkably, up to 10% of adults who have a colonoscopy for the investigation of chronic diarrhea, and have endoscopically normal appearing mucosa, may have MC. Patients with MC generally present with chronic diarrhea, which can be associated with cramping and bloating. Endoscopic and radiological examinations are usually normal. Histological assessment reveals inflammation consisting predominantly of lymphocytic infiltration, and a thickened subepithelial collagen band is diagnostic of CC. Both LC and CC can be associated with autoimmune diseases such as celiac disease, diabetes, arthritis and thyroiditis, yet the mechanisms involved in the pathogenesis remain unclear. Emerging studies suggest that a stepwise approach be taken in the medical management of MC. This approach includes antidiarrheal agents and stopping of any offending agents; budesonide or bismuth subsalicylate; and cholestyramine or 5-acetylsalicylic acid agents. In resistant cases, oral corticosteroids and other immune modulatory therapy have been used.     

Evaluation of osteopontin as biomarker for pancreatic adenocarcinoma.

OBJECTIVES: Pancreatic adenocarcinoma is a deadly disease with an overall 5-year patient survival of less than 5%. This dismal prognosis of pancreatic cancer is largely due to the advanced stage of the disease at presentation. If pancreatic cancer could be diagnosed more readily and accurately using serum markers, patient survival could theoretically be improved by enabling more patients to avail of surgical resection. One candidate tumor marker recently identified by global gene expression analysis of pancreatic cancer is the secreted glycophosphoprotein osteopontin (OPN). In this study, we evaluate OPN as a serum marker of pancreatic adenocarcinoma. METHODS: In situ hybridization for OPN was performed on a pancreatic adenocarcinoma tissue microarray. Serum OPN levels were determined in preoperative sera from 50 patients with pancreatic cancer and 22 healthy control individuals by competitive ELISA. RESULTS: In situ hybridization for OPN performed on a tissue microarray revealed strong OPN mRNA signal in tumor-infiltrating macrophages in 8 of 14 pancreatic adenocarcinomas. In contrast, OPN expression was not seen in the pancreatic cancer cells themselves, nor was it seen in normal pancreatic tissue or in the macrophages distant from the infiltrating cancer. Serum OPN levels, as measured by ELISA, were elevated in the sera of 50 patients with resectable pancreatic adenocarcinoma compared to 22 healthy control individuals (mean +/- SD for OPN was 482 +/- 170 ng/ml and 204 +/- 65 ng/ml, respectively; P < 0.001). Using a cutoff level of 2 SD above the mean for healthy individuals, elevated OPN had sensitivity of 80% and specificity of 97% for pancreatic cancer. In contrast, only 62% of these patients with resectable pancreatic cancer had elevated CA19-9. CONCLUSIONS: Serum OPN may have utility as a diagnostic marker in patients with pancreatic cancer.     

Flexural Performance of Encased Pultruded GFRP I-Beam with High Strength Concrete under Static Loading

There is an interesting potential for the use of GFRP-pultruded profiles in hybrid GFRP-concrete structural elements, either for new constructions or for the rehabilitation of existing structures. This paper provides experimental and numerical investigations on the flexural performance of reinforced concrete (RC) specimens composite with encased pultruded GFRP I-sections. Five simply supported composite beams were tested in this experimental program to investigate the static flexural behavior of encased GFRP beams with high-strength concrete. Besides, the effect of using shear studs to improve the composite interaction between the GFRP beam and concrete as well as the effect of web stiffeners of GFRP were explored. Encasing the GFRP beam with concrete enhanced the peak load by 58.3%. Using shear connectors, web stiffeners, and both improved the peak loads by 100.6%, 97.3%, and 130.8%, respectively. The GFRP beams improved ductility by 21.6% relative to the reference one without the GFRP beam. Moreover, the shear connectors, web stiffeners, and both improved ductility by 185.5%, 119.8%, and 128.4%, respectively, relative to the encased reference beam. Furthermore, a non-linear Finite Element (FE) model was developed and validated by the experimental results to conduct a parametric study to investigate the effect of the concrete compressive strength and tensile strength of the GFRP beam. The developed FE model provided good agreement with the experimental results regarding deformations and damaged patterns.     

Potential impact of PET/CT on the initial staging of lymphoma

Purpose

The aim of this study was to investigate the potential impact of PET/CT on the initial staging of lymphoma with comparison to each of the PET and CT components alone.

Materials and methods

PET/CTs from 37 patients with lymphoma undergoing initial staging were studied. Review of PET, CT and PET/CT images were done and staging of each patient by each modality was assigned and compared together. Clinical follow-up, additional imaging and histology served as the standard of reference.

Results

PET/CT correctly diagnosed 83 nodal regions as positive for lymphomatous involvement versus 61 and 57 detected by PET and CT respectively. The respective sensitivities, specificities, and accuracies for the detection of nodal involvement were: PET: 88.4%, 65%, 94%, CT 89.1%, 60.1%, 96.1%, PET/CT 96.3%, 88.3%, 98.2%. PET/CT also correctly identified more extra-nodal lesions (n = 24) than CT (n = 16) and PET (n = 15). Correct staging was more accurate at PET/CT (n = 31) in comparison to PET alone (n = 23) and CT alone (n = 21).

Conclusions

PET/CT was superior to PET and CT in the initial staging of lymphoma with significant better performance compared to PET and CT to clarify nodal and extra-nodal involved sites. The application of PET/CT rather than CT or PET is likely to be more beneficial.     

Cemented bipolar hemiarthroplasty with a cerclage cable technique for unstable intertrochanteric hip fractures in elderly patients

Aim

The purpose of this study is to evaluate the clinical and radiological outcomes of cemented bipolar arthroplasty as a primary treatment for unstable intertrochanteric fracture in the elderly patients.

Methods

Twenty hips with unstable intertrochanteric fractures were followed for more than 2 years after cemented bipolar hemiarthroplasty. The mean age was 69 years, and the mean follow-up period was 30.5 months. We evaluated the results by Harris hip score, complications, and radiologic findings.

Results

At the last follow-up, the mean Harris hip score was 83.3 points. Radiologically, there was no case of osteolysis. All stems were stable without significant changes in alignment or progressive subsidence.

Conclusions

Bipolar hemiarthroplasty with calcar reconstruction is a good option for unstable intertrochanteric fractures in elderly patients with severe osteoporosis with strict indication selection. Longer-term studies with larger numbers of patients are required to address the issues of late complications.