Showing papers by "Sunnybrook Health Sciences Centre published in 1996"
TL;DR: Overexpression of p59ILK disrupted epithelial cell architecture and inhibited adhesion to integrin substrates, while inducing anchorage-independent growth, and is proposed that ILK is a receptor-proximal protein kinase regulating integrin-mediated signal transduction.
Abstract: THE interaction of cells with the extracellular matrix regulates cell shape, motility, growth, survival, differentiation and gene expression, through integrin-mediated signal transduction1–3. We used a two-hybrid screen to isolate genes encoding proteins that interact with the β1-integrin cytoplasmic domain. The most frequently isolated complementary DNA encoded a new, 59K serine/threonine protein kinase, containing four ankyrin-like repeats. We report here that this integrin-linked kinase (ILK) phosphorylated a β1-integrin cytoplasmic domain peptide in vitro and coimmunoprecipitated with β1 in lysates of mammalian cells. Endogenous ILK kinase activity was reduced in response to fibronectin. Overexpression of p59ILK disrupted epithelial cell architecture and inhibited adhesion to integrin substrates, while inducing anchorage-independent growth. We propose that ILK is a receptor-proximal protein kinase regulating integrin-mediated signal transduction.
1,162 citations
TL;DR: Low-molecular-weight heparin was more effective than low-dose Heparin in preventing venous thromboembolism after major trauma and both interventions were safe.
Abstract: Background Patients who have had major trauma are at very high risk for venous thromboembolism if they do not receive thromboprophylaxis. We compared low-dose heparin and a low-molecular-weight heparin with regard to efficacy and safety in a randomized clinical trial in patients with trauma. Methods Consecutive adult patients admitted to a trauma center who had Injury Severity Scores of at least 9 and no intracranial bleeding were randomly assigned to heparin (5000 units) or enoxaparin (30 mg), each given subcutaneously every 12 hours in a double-blind manner, beginning within 36 hours after the injury. The primary outcome was deep-vein thrombosis as assessed by contrast venography performed on or before day 14 after randomization. Results Among 344 randomized patients, 136 who received low-dose heparin and 129 who received enoxaparin had venograms adequate for analysis. Sixty patients given heparin (44 percent) and 40 patients given enoxaparin (31 percent) had deep-vein thrombosis (P = 0.014). The rates ...
726 citations
TL;DR: The MENQOL (Menopause-Specific Quality of Life) questionnaire is a self-administered instrument which functions well in differentiating between women according to their quality of life and in measuring changes in theirquality of life.
633 citations
TL;DR: It is demonstrated that probable AD can be predicted with a high degree of accuracy and with a relatively brief battery of neuropsychological tests.
Abstract: We determined whether a battery of neuropsychological tests could predict who would develop Alzheimer's disease (AD) in a group of 123 memory-impaired nondemented patients. Patients were followed longitudinally for 2 years with a research battery of neuropsychological tests. After 2 years, 29 developed probable AD, and 94 did not develop dementia. We used logistic regression analyses to examine the classification accuracy of subjects' performance at entry to the study on the research battery. The logistic regression model was significant with an accuracy of 89%, sensitivity of 76%, and specificity of 94%. Two tests contributed significantly to this model: the delayed recall from the Rey Auditory Verbal Learning Test and the Mental Control subtest of the Wechsler Memory Scale. These two tests alone produced the same accuracy, sensitivity, and specificity as the larger model. These results demonstrate that probable AD can be predicted with a high degree of accuracy and with a relatively brief battery of neuropsychological tests.
582 citations
TL;DR: Future work will likely benefit by mimicking the varied and unpredictable nature of the events that often precipitate falls in daily life, in order to draw connections between the laboratory or clinic and "real-life" stability.
473 citations
TL;DR: The use of patients' perceptions in determining the content of a new measure, The Toronto Extremity Salvage Score (TESS), a reliable and valid measure that is able to detect change over time.
Abstract: Patients undergoing limb salvage surgery for bone and soft tissue sarcoma of the extremities experience significant physical disability as a result of life-preserving treatment The existing health status measures do not adequately evaluate physical function from the patient's perspective This paper presents the developmental studies item selection, of a new measure, The Toronto Extremity Salvage Score (TESS) Patients with bone and soft tissue sarcoma (76 upper and 83 lower extremity) were randomly selected and mailed the TESS Patients rated the severity and importance of physical disabilities; the response options included a ‘not applicable’; category and open-ended questions that allowed patients to suggest additional items for inclusion in the questionnaire Therefore, patient perceptions were used to determine item content Difficulty and importance frequencies were calculated and items rated “totally unimportant’ or ‘not applicable’ by 30% of the sample were eliminated Extra items identified 30% of the time were added to the questionnaire Internal consistency was evaluated by Cronbach's alpha Test-retest reliability and validity were evaluated on subsequent patient samples The intraclass correlation coefficient (ICC) was calculated for test-retest reliability and correlations with The Musculoskeletal Tumour Society Rating Scale (MSTS) were calculated for construct validity Standardized effect sizes were calculated as a measure of responsiveness Fifty upper extremity and sixty-six lower extremity patients responded to the mailed questionnaire No items were eliminated based on importance or not applicable ratings Sporting activities were identified as additional items in both the upper and lower extremity questionnaire High internal consistency was demonstrated: 094 for the lower and 092 for the upper extremity questionnaires respectively Test-retest reliability was evaluated at multiple time-points and the intraclass correlation coefficient was greater than 087 in all instances Construct validity was shown by a moderate correlation with the MSTS The effect sizes were large demonstrating responsiveness The use of patients' perceptions in determining the content of the TESS has resulted in a reliable and valid measure that is able to detect change over time
467 citations
TL;DR: New evidence suggests that, via interactions with focal adhesion kinase, the integrin cytoplasmic domains can coordinate actin cytoskeletal organization and responses to growth factors.
412 citations
TL;DR: Because of the complexity of injuries that most often result in acute pelvic fractures, they should be considered in the context of polytrauma management, rather than in isolation.
Abstract: Acute pelvic fractures are potentially lethal, even with modern techniques of poly-trauma care. The appropriate treatment of such fractures is dependent on a thorough understanding of the anatomic features of the pelvic region and the biomechanical basis of the various types of lesions. Although the anterior structures, the symphysis pubis and the pubic rami, contribute approximately 40% to the stiffness of the pelvis, clinical and biomechanical studies have shown that the posterior sacroiliac complex is more important to pelvic-ring stability. Therefore, the classification of pelvic fractures is based on the stability of the posterior lesion. In type A fractures, the pelvic ring is stable. The partially stable type B lesions, such as "open-book" and "bucket-handle" fractures, are caused by external- and internal-rotation forces, respectively. In type C injuries, there is complete disruption of the posterior sacroiliac complex. These unstable fractures are almost always caused by high-energy severe trauma associated with motor vehicle accidents, falls from a height, or crushing injuries. Type A and type B fractures make up 70% to 80% of all pelvic injuries. Because of the complexity of injuries that most often result in acute pelvic fractures, they should be considered in the context of polytrauma management, rather than in isolation. Any classification system must therefore be seen only as a general guide to treatment. The management of each patient requires careful, individualized decision making.
393 citations
TL;DR: Balance confidence assessed by the ABC and self-perceived need for personal assistance with outdoor ambulation were the only indicators significantly associated with the performance measures.
Abstract: Background. This study compares several psychological indicators of balance confidence in relation to physical performance, past and current experience, gender bias, and other perceptions of daily functioning. Methods. Sixty community-dwelling ambulatory elders (aged 65-95) were administered the Falls Efficacy Scale (FES), the Activities-Specific Balance Confidence Scale (ABC), and three dichotomous questions on fear of falling, activity avoidance, and perceived need for personal assistance to ambulate outdoors. Performance measures on walking (average speed) and balance (static posturography) were obtained on a subsample of 21 subjects. Results. Balance confidence assessed by the ABC and self-perceived need for personal assistance with outdoor ambulation were the only indicators significantly associated with the performance measures. As expected, perceived balance capabilities were more strongly related to current behavior (frequency of doing specific activities) than to past experience (fall history). Gender differences in self-report emerged for the global fear-of-falling indicator but not for the two efficacy ratings. Conclusions. Psychological indicators of balance confidence are important to measure both in conjunction with balance test performance and as a legitimate focus of rehabilitation. Of the various indicators assessed here, the dichotomous fear-of-falling question appears to have the least utility. Perceived need for personal assistance to ambulate outdoors has merit as an initial clinical screening question for discriminating persons on the basis of both physical ability and confidence. The ABC scale appears to have the greatest utility as an evaluative index for older persons at a moderate to high level of functioning.
390 citations
TL;DR: Observations support the role of the Chronic Respiratory Questionnaire for measuring patient's symptoms, the validity of the approach for assessing the MID, and an estimate on the order of 0.5 as the threshold for this particular health status measure.
366 citations
TL;DR: The results implicate p27 as a regulator of drug resistance in solid tumors and suggest that tumor–targeted p27 antagonists may be useful chemosensitizers in conjunction with conventional anticancer therapy.
Abstract: A low proliferating fraction in solid tumors limits the effectiveness of cell cycle-dependent chemotherapeutic agents. To understand the molecular basis of such "kinetic" resistance we cultured tumor cells as multicellular spheroids and examined levels of p27Kip1, a cyclin-dependent kinase inhibitor known to be upregulated by intercellular contact in normal cells. When transferred from monolayer to three-dimensional culture, a consistent upregulation (up to 15-fold) of p27 protein was observed in a panel of mouse and human carcinoma cell lines. Antisense-oligonucleotide-mediated downregulation of p27 in EMT-6 mammary tumor cell spheroids reduced intercellular adhesion, increased cell proliferation, sensitized tumor cells to 4-hydroperoxycyclophosphamide, and restored drug- or radiation-induced cell-cycle perturbations repressed in spheroid culture. Our results implicate p27 as a regulator of drug resistance in solid tumors and suggest that tumor-targeted p27 antagonists may be useful chemosensitizers in conjunction with conventional anticancer therapy.
TL;DR: Brachial plexus injuries were more likely to be severe (Sunderland Grade 3 or 4), compared with infraclavicular injuries, which were neurapraxic in 50% of cases (P Language: en).
Abstract: OBJECTIVE: The purpose was to identify the prevalence, causative factors, injury types, and associated injury patterns in multitrauma patients who sustained brachial plexus injuries. METHODS: A retrospective review of a prospectively collected and computerized database and a chart review were performed. RESULTS: Brachial plexus injuries were identified in 54 of 4538 (1.2%) patients presenting to a regional trauma facility. Young male patients predominated. Motor vehicle accidents were the most frequent cause overall, but only 0.67% of such accidents resulted in plexus injuries. Conversely, 4.2% of motorcycle accident victims and 4.8% of snowmobile accident victims suffered brachial plexus injuries. Injuries were supraclavicular for 62% of patients and infraclavicular for 38%. Supraclavicular injuries were more likely to be severe (Sunderland Grade 3 or 4), compared with infraclavicular injuries, which were neurapraxic in 50% of cases (P Language: en
TL;DR: The Quebec Back Pain Disability Scale is a new measure of functional disability for patients with back pain that was developed in several stages, including a literature review, two studies seeking the opinions of patients and experts, pilot testing, and a large, longitudinal study of back pain patients.
TL;DR: Investigation of more quantitative, objective methods of analysing the film-screen mammogram found measures of the skewness of the image brightness histogram, and of image texture characterized by the fractal dimension strongly correlated with radiologists' subjective classifications of mammographic parenchyma.
Abstract: Information derived from mammographic parenchymal patterns provides one of the strongest indicators of the risk of developing breast cancer. To address several limitations of subjective classification of mammographic parenchyma into coarse density categories, we have been investigating more quantitative, objective methods of analysing the film-screen mammogram. These include measures of the skewness of the image brightness histogram, and of image texture characterized by the fractal dimension. Both measures were found to be strongly correlated with radiologists' subjective classifications of mammographic parenchyma (Spearman correlation coefficients, Rs = -0.88 and -0.76 for skewness and fractal dimension measurements, respectively). Further, neither measure was strongly dependent on simulated changes in mammographic technique. Correlation with subjective classification of mammographic density was better when both the skewness and fractal measures were used in combination than when either was used alone. This suggests that each feature provides some independent information.
TL;DR: In this article, a retrospective review of patients undergoing delayed treatment for a closed injury of the lower extremity, where fasciotomy should be performed, is presented, where the authors determine the end result of patients who underwent delayed FASCIotomy, i.e., more than 35 hours for an established lower limb compartment syndrome.
Abstract: Objective To determine the end result of patients who underwent delayed fasciotomy, i.e., more than 35 hours for an established lower limb compartment syndrome.Design A retrospective review of patients undergoing delayed treatment for a closed injury of the lower extremity, where fasciotomy should i
TL;DR: The results suggest that leaning should be monitored or controlled during balance assessment, particularly when dealing with individuals who may be anxious or afraid of falling, and highlight the need to account for the potentially confounding influence of arousal when studying attentional effects.
Abstract: Healthy young adults (n = 39) were asked to perform four different secondary cognitive tasks during quiet unperturbed stance, in order to investigate the influence of physiological arousal and attention distraction on the control of spontaneous postural sway. During each task, postural activity was quantified in terms of center-of-pressure displacement, leg-muscle activation, and ankle and hip rotation. Arousal was monitored via skin conductance, and questionnaires were used to assess state anxiety. Respiratory trunk movements were also recorded, to assess potential arousal-related destabilizing effects, but failed to show a strong association with the postural measures. The nature of the secondary task affected the postural responses in that subjects tended to lean slightly forward, and exhibited higher levels of activation in tibialis anterior, when performing a mental-arithmetic task. Although this task affected both attention and arousal, the leaning effect was limited to subjects who reported higher levels of anxiety-related autonomic or somatic symptoms during testing, and the degree of leaning was correlated with the level of physiological arousal. A secondary task that diverted attention but did not affect physiological arousal (listening to a spoken-word recording) failed to elicit changes in postural response. These findings suggest that the changes in leaning were associated with task-related changes in physiological arousal, and highlight the need to account for the potentially confounding influence of arousal when studying attentional effects. Given the potential influence on stability, the results also suggest that leaning should be monitored or controlled during balance assessment, particularly when dealing with individuals who may be anxious or afraid of falling.
TL;DR: A general framework for development of new techniques to measure T2 decay accurately in vivo is illustrated by Monte Carlo simulations performed to determine whether the multicomponent T2 distribution of tissue can be estimated accurately from T1 decay data acquired in vivo.
Abstract: Monte Carlo simulations were performed to determine whether the multicomponent T2 distribution of tissue can be estimated accurately from T2 decay data acquired in vivo. Simulated data were generated for white matter, fast twitch muscle, and breast tissue. The signal-to-noise ratio, number of data samples, and minimum echo time were varied from the experimental conditions currently achievable with MRI to those achievable for in vitro experiments. Data were fitted by a distribution of T2 values using the T2NNLS algorithm, and statistics characterizing the estimated T2 components were determined. Current MRI techniques were found to provide conditions insufficient for accurate multicomponent T2 analysis on a pixel-by-pixel basis. However, volume localization methods that measure T2 decay from a large volume of interest have potential for this analysis. These results illustrate a general framework for development of new techniques to measure T2 decay accurately in vivo.
TL;DR: A conical screw profile increases insertion torque, although insertional torque is not a reliable predictor of pull‐out strength in cadaveric bone.
Abstract: Study Design. Insertion torque and pull-out strenghts of conical and cylindrical pedicle screws were compared in human cadaveric vertebral bodies. Objectives. To compare the performance of the conical design with the cylindrical design, and to determine whether insertional torque correlates with pull-out strenght. Summary of Background Data. A tapered pedicle screw design may lessen the likelihood of implant failure. Its effect on thread purchase is not known. Previous studies of cylindrical designs on the relation between insertion torque and pull-out strenght have been conducted in bovine and synthetic bone. Methods. Seventy-eight pedicles were assigned randomly to one of the following pedicle screw: Texas Scottish Rite Hospital (Sofamor-Danek, Memphis, TN), Steffee VSP (Acromed, Cleveland, OH), Diapason (Dimso, Paris, France), AO Schanz (Synthes, Paoli, PA), or Synthes USS (Synthes, Paoli, PA). Pedicle screws were inserted with a torque screwdriver. Each screw was extracted axially from the pedicle at a rate of 1.0 mm/sec until failure using an MTS machine (Bionix 858, Minneapolis, MN). Force data were recorded. Results. The conical design had the highest insertion torque. There were no significant differences in pull-out between any of the screw types. Correlation between insertional torque and pull-out strenght was statistically significant only with the Texas Scottish Rite Hospital and Steffee VSP in L4 and AO Schanz in L5. Conclusions. A conical screw profile increases insertion torque, although insertional torque is not a reliable predictor of pull-out strenght in cadaveric bone. Screw profile (with similar dimensions) has little effect on straight axial pull-out strenghts in cadaveric bone.
TL;DR: The Geriatric Depression Scale short form appears to be a useful, valid screening instrument in this population of geriatric affective disorders patients.
Abstract: The validity of the Geriatric Depression Scale (GDS) short form was assessed in a geriatric affective disorders outpatient clinic (N = 116). The GDS was highly correlated with the Montgomery Asberg Depression Rating Scale (MADRS), and with optimal cutoff scores of 5/6, demonstrated a sensitivity of 85% and a specificity of 74.0%. The GDS appears to be a useful, valid screening instrument in this population.
TL;DR: Dermatologists need to be aware of the serious adverse reactions that can develop after minocycline use and suggest that antinuclear antibody and hepatic transaminase levels be determined at baseline.
Abstract: Background: Minocycline has been reported to cause serious, albeit rare, adverse events, including serum sickness—like reaction, hypersensitivity syndrome reaction, and drug-induced lupus. A retrospective review of patients seen in our Adverse Drug Reaction Clinic as well as information obtained from the Health Protection Branch was done to identify patients with minocycline-induced reactions. In addition, the literature concerning serious reactions to minocycline was reviewed. Observations: Six patients with a hypersensitivity syndrome reaction, 6 patients with a serum sickness—like reaction, and 1 patient who had symptoms consistent with drug-induced lupus were identified. A review of the literature identified 11 cases of hypersensitivity syndrome reaction, 1 case of serum sickness—like reaction, and 24 cases of drug-induced lupus. Serum sickness—like reactions occur sooner than hypersensitivity syndrome reactions (15.6 vs 23.7 days,P=.04). Drug-induced lupus occurs on average 2 years after the start of minocycline therapy. Conclusions: Dermatologists need to be aware of the serious adverse reactions that can develop after minocycline use. In patients who may require long-term therapy with minocycline (>1 year), we suggest that antinuclear antibody and hepatic transaminase levels be determined at baseline. Rechallenge with minocycline or other tetracyclines is currently not recommended for patients who develop these serious reactions. Arch Dermatol. 1996;132:934-939
TL;DR: The data suggest that chronic cocaine use is associated with modestly reduced levels of striatal DA and the DA transporter in some subjects and that these changes might contribute to the neurological and psychiatric effects of the drug.
Abstract: Depletion of striatal dopamine (DA) has been hypothesized to explain some of the neurological and psychiatric complications of chronic use of cocaine, including increased risk for neuroleptic-precipitated movement disorders. We measured levels of DA, as well as two DA nerve terminal indices, namely, the DA transporter (DAT) and the vesicular monoamine transporter (VMAT2) in autopsied brain of 12 chronic cocaine users. Mean DA levels were normal in the putamen, the motor component of the striatum; however 4 of the 12 subjects had DA values below the lower limit of the control range. DA concentrations were significantly reduced in the caudate head (head, -33%; tail, -39%) with a trend for reduction in nucleus accumbens (-27%). Striatal DAT protein (-25 to -46%) and VMAT2 (-17 to -22%) were reduced, whereas DAT determined by [3H]WIN 35,428 binding was normal. In conclusion, our data suggest that chronic cocaine use is associated with modestly reduced levels of striatal DA and the DA transporter in some subjects and that these changes might contribute to the neurological and psychiatric effects of the drug.
TL;DR: Evaluating the reliability of interactive anthropometric landmark localization based on digitized three-dimensional facial images and identifying sources of error associated with the technique has direct implications for the clinical adaptation of this diagnostic tool for quantitative evaluation of facial surface anatomy.
Abstract: Three-dimensional measurement and characterization of facial surface anatomy are fundamental to the objective analysis of facial deformity. However, existing clinical tools are inadequate. Recent innovations in laser scanning technology provide a potentially useful technique for accurate three-dimensional documentation of the face. The purpose of this study is to evaluate the reliability of interactive anthropometric landmark localization based on digitized three-dimensional facial images and to identify sources of error associated with the technique. Three-dimensional surface data were acquired using a commercially available laser scanning device (Cyberware 3030RGB digitizer), and all subsequent anthropometric analyses were performed interactively on the computer monitor. Four experimental conditions were studied, with 10 observations for each condition. A stable anthropomorphic model with prelabeled anatomic landmarks was scanned repeatedly under varying conditions of head inclination and position within the scanning gantry to determine the effect of these variables on the reliability of the technique. The scanning protocol was then repeated with the labels removed to evaluate the reliability of interactive localization of anthropometric landmarks on a digitized three-dimensional image. Optimal results were obtained with the head positioned in the center of the scanning gantry and with the Frankfort plane elevated 10 degrees from the horizontal. Under these circumstances, all 22 labeled landmarks were visualized and the variance in landmark localization was less than 0.6 mm in the x (horizontal), y (vertical), and z (depth) dimensions. Varying head position or inclination caused significant degradation of the digitized image. The variance of interactive landmark localization was analyzed in three dimensions. The reliability and the spatial orientation of variability were determined for each anthropometric point. These findings have direct implications for the clinical adaptation of this diagnostic tool for quantitative evaluation of facial surface anatomy.
TL;DR: EAS is a rapid and accurate indicator of the need for urgent laparotomy in the hypotensive blunt trauma victim and a negative EAS can hasten the search for other causes of hypotension.
Abstract: Objective : Trauma victims with hypotension require a rapid and reliable localization of bleeding and expedient surgical tri-age. Our hypothesis is that emergent abdominal sonography (EAS) is a rapid and accurate test of the need for urgent laparotomy in blunt trauma victims with hypotension. Methods : Among 400 blunt trauma victims entered in a prospective blind study of EAS, a subgroup of 69 (17%) patients had a systolic blood pressure ≤90 mm Hg during their initial assessment. Although the EAS results [(+) = fluid, (-) = no fluid] were not used in clinical decision making, the potential contribution of EAS to patient care was examined. Results : The mean Injury Severity Score was 32. Twenty-two (32%) patients were EAS (+), of which 19 required an acute laparotomy. No laparotomies were performed in the 47 EAS (-) patients. The EASs required 19 ± 5 seconds in the EAS (+) group and 154 ± 13 seconds in the EAS (-) group. Twenty of the 22 positive EASs had free fluid in Morison's pouch. All 13 patients with an ultrasound score ≥3 had a laparotomy. The primary etiology of hypotension was blood loss in 42 patients, hemoperitoneum in 18, and retroperitoneal hemorrhage in 12. Conclusion : EAS is a rapid and accurate indicator of the need for urgent laparotomy in the hypotensive blunt trauma victim. Further, a negative EAS can hasten the search for other causes of hypotension. Diagnostic peritoneal lavage may become obsolete in centers with EAS capabilities.
TL;DR: It was found that ApoE genotype was a reliable prognostic indicator of who developed AD in this group only when memory test performance was included in the predictive model.
Abstract: Given the relationship between the presence of ApoE epsilon 4 and Alzheimer's disease (AD), were studied whether knowledge of epsilon 4 status would predict which memory-impaired patients would develop AD over time. One hundred seven patients who presented with memory impairment but not dementia were referred to the study by their family physicians. These patients were followed prospectively over a 2-year period. Twenty-nine patients developed AD, while 78 did not develop dementia. We found that ApoE genotype was a reliable prognostic indicator of who developed AD in this group only when memory test performance was included in the predictive model. These findings indicate that limitations of ApoE genotyping in isolation as a prognostic indicator of AD. Because this study included prospectively selected patients who were followed longitudinally, our findings are likely to have more relevance in the clinical setting than those obtained from currently available retrospective studies.
TL;DR: The results clearly demonstrate that compensatory stepping responses to non-sagittal perturbations are strongly influenced by biomechanical constraints and affordances that do not affect the forward and backward stepping behaviour that has been studied traditionally.
TL;DR: Investigating the relationships between uncertainty, symptom distress, and discharge information needs in individuals after a colon resection for cancer found that increased attention to information needs at discharge may decrease an individual's level of uncertainty and facilitate the transition from hospital to home.
Abstract: The purpose of this study was to determine the relationships between uncertainty, symptom distress, and discharge information needs in individuals after a colon resection for cancer. The theoretical framework for the study was derived from Lazarus and Folkman's stress, appraisal, and coping model, and Mishel's theory of uncertainty in illness. Uncertainty was measured by the Mishel Uncertainty Illness Scale (MUIS); symptom distress of pain, fatigue, constipation, diarrhea and loss of appetite by visual analogue scales; and discharge information needs by the Patient Learning Need Scale (PLNS). Forty individuals with a first diagnosis of cancer were interviewed after surgical resection of colon cancer. The study results indicated that they had moderate levels of uncertainty, low levels of symptom distress, and a moderate number of discharge information needs. Information related to treatment, complications, and activities of living were identified as highly important. An increase in uncertainty was significantly associated with an increase in discharge information needs. Increased attention to information needs at discharge may decrease an individual's level of uncertainty and facilitate the transition from hospital to home.
TL;DR: Factors affecting homeostasis in the skin and oral mucosa include a delicate balance between cytokines/cytokine-receptors and their antagonists, which can influence the development of cutaneous and oral diseases and some neoplastic processes.
Abstract: Cytokines are polypeptide growth factors produced by most nucleated cells in the body, including epithelial cells, keratinocytes, and Langerhans cells in the skin. Cytokines can be classified into interleukins, tumor necrosis factors, chemokines, colony-stimulating factor, interferons, and growth factors. Like classic hormones, cytokines bind to specific recep- tors to transmit their messages to target cells. Cytokine receptors can be divided into three cytokine receptor superfamilies: the immunoglobulin superfamily, the hematopoietin family, and the tumor necrosis factor family. Following cytokine/cytokine- receptor binding (first messenger), a signal transduction pathway is initiated. Factors affecting homeostasis in the skin and oral mucosa include a delicate balance between cytokines/cytokine-receptors and their antagonists. An imbalance in these variables can influence the development of cutaneous and oral diseases—such as lichen planus, autoimmune disorders, and some neoplastic processes—and can affect wound healing. Potential uses of cytokines include cancer and antiviral therapy.
TL;DR: Upregulation of bcl-2 protein was identified in dysplastic epithelium adjacent to invasive tumour and in many cases there was reduced bax immunostaining, suggesting that alterations of b cl-2 and bax may play a role in the development of squamous cell carcinoma.
Abstract: The bcl-2 oncogene is a member of a family of genes encoding for proteins which regulate apoptosis (programmed cell death). Recent evidence suggests that the bcl-2 protein is regulated by a homologous protein bax which counteracts its effects and promotes apoptosis. Overexpression of bcl-2 has been reported in a number of human cancers, although correlations with tumour differentiation and clinical outcome are conflicting and depend on tumour type and site. We studied bcl-2 and bax protein expression in adjacent serial sections of 30 squamous cell carcinomas of the oral cavity and correlated this with tumour differentiation. Examination of normal epithelium showed bcl-2 expression confined to basal keratinocytes and dendritic cells. The bax immunostaining was seen throughout the thickness of the epithelium but was most intense in the suprabasal cells. Overall, moderate or marked immunostaining for bcl-2 was identified in 18/30 (60%) carcinomas and for bax in 19/30 (63%) tumours. The bcl-2 immunoreactivity was strongest in the poorly differentiated carcinomas where 6/7 (86%) showed strong staining. By contrast, bax immunoreactivity was strongest in the well-differentiated carcinomas with 8/11 (72%) staining strongly. In the well-differentiated tumour islands, there was inverse topographic distribution of bcl-2 and bax, with both proteins showing a pattern that recapitulated normal epithelium. Upregulation of bcl-2 protein was identified in dysplastic epithelium adjacent to invasive tumour and in many cases there was reduced bax immunostaining. These results suggest that alterations of bcl-2 and bax may play a role in the development of squamous cell carcinoma. Furthermore, disturbances of protein expression in dysplastic epithelium suggest a role in the early stages of epithelial carcinogenesis.
TL;DR: Many of the preoperative airway tests have only moderate inter-observer reliability, which may provide some insight into why previous research has failed to show that the tests accurately predict difficult trachéal intubation.
Abstract: To determine inter-observer reliability of ten preoperative airway assessment tests used for predicting difficult tracheal intubation. We prospectively assessed 59 patients undergoing elective surgery requiring tracheal intubation at a large metropolitan teaching hospital. Two experienced observers independently conducted the airway assessment tests on the same group of patients. Inter-observer reliability was examined using Kappa (K) and intraclass correlation coefficient (ICC). Two tests — mouth opening (ICC = 0.93) and chin protrusion (ICC = 0.89) — had excellent inter-observer reliability. Seven tests — thyromental distance (ICC =0.74), subluxation (K = 0.66), atlanto-occipital extension distance (ICC = 0.67) and angle (K = 0.66), profile classification (K = 0.58), ramus length (ICC = 0.53), oropharyngeal best view (K = 0.49) — were moderately reliable. One test — Mallampati technique of assessing oropharyngeal view (K = 0.31) — had poor reliability. Many of the preoperative airway tests have only moderate inter-observer reliability. This may provide some insight into why previous research has failed to show that the tests accurately predict difficult tracheal intubation.
TL;DR: There is a strong association between certain O groups and the eaeA gene, that serotype and type of verotoxin produced in a collection of 432 verotoxigenic Escherichia coli obtained from the faeces of healthy cows and calves are implicated in human and cattle disease, and that VT1 is more frequently associated witheaeA-positive than with eaeB-negative serogroups.
Abstract: This study determined the prevalence of the eaeA gene and its relationship to serotype and type of verotoxin produced in a collection of 432 verotoxigenic Escherichia coli (VTEC) obtained from the faeces of healthy cows and calves in a systematic random survey involving 80 dairy farms in Southwest Ontario. A PCR amplification procedure involving primer pairs which target the conserved central region of the O157:H7 eaeA gene showed that 151 (35.2%) strains were positive for the eaeA gene. All isolates (9-21 for each O group) of O groups 5, 26, 69, 84, 103, 111, 145 and 157 were positive, whereas all isolates (7-34 for each O group) of O groups 113, 132, and 153 and serotype O156:NM (38 isolates) were negative for eaeA. Seventy-three percent of 130 isolates of eaeA-positive serotypes produced VT1 only compared with 20% of 253 isolates of eaeA-negative serotypes. We conclude that there is a strong association between certain O groups and the eaeA gene, that serotypes of eaeA-positive and eaeA-negative VTEC implicated in human and cattle disease are present at high frequency in the faeces of healthy cattle, that VT1 is more frequently associated with eaeA-positive than with eaeA-negative serogroups, and that the eaeA gene is more frequently found in VTEC from calves compared with VTEC from adult cattle.