Healthcare Informatics 100. Company profile: MediSolution, Inc. The Canadians are coming.
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Economic Competition↗
Biomedical subjects
J Manning
Publications and source records attributed to J Manning.
A multidisciplinary study investigating radiotherapy in Ewing's sarcoma: end results of POG #8346. Pediatric Oncology Group.
PURPOSE: To determine if involved field radiation (IF) is equivalent to standard whole bone radiation (SF) in local tumor control; to establish patterns of failure following treatment; and to determine response, event-free survival (EFS), and overall survival rates from multidisciplinary therapy in Ewing's sarcoma. METHODS AND MATERIALS: Between 1983 and 1988, 184 children with Ewing's sarcoma were enrolled onto Pediatric Oncology Group 8346 (POG 8346). A total of 178 (97%) met eligibility criteria; 6 had pathology other than Ewing's sarcoma. Induction chemotherapy of cyclophosphamide/doxorubicin (adriamycin )(C/A) x 12 weeks was followed by local treatment either surgery or radiation therapy and C/A, dactinomycin, and vincristine for 50 weeks. Resection was advised for patients with small primary tumors if accomplished without functional loss. Forty patients were randomized to receive SF, whole bone radiation to 39.6 Gy plus a 16.2 Gy boost (total 55.8 Gy) or IF to 55.8 Gy, and the remainder were assigned to IF radiation. RESULTS: Of 178 eligible patients, 141 (79%) had localized disease and 37 (21%) had metastases at presentation. Their 5-year EFS was 51% (SE 5%) and 23% (SE 7%) respectively. The response rate to induction chemotherapy was 88% (28% complete, 60% partial), but after radiotherapy the response rate increased to 98%. Thirty-seven of the localized patients underwent resection, of whom 16 (43%) required postoperative radiotherapy; the 5-year EFS of these surgical patients was 80% (SE 7%). The remaining 104 localized patients were eligible for randomization or assignment to receive radiotherapy; the 5-year EFS of these patients was 41% (SE 5%), with no significant difference in EFS between those randomized to SF vs. IF. Site of primary tumor correlated with 5-year EFS: distal extremity 65% (SE 8%), central 63% (SE 10%), proximal extremity 46% (SE 8%), and pelvic-sacral 24% (SE 10%) (p=0.004). Initial tumor size did not correlate significantly with EFS. Patterns of failure among the 141 localized patients revealed 23% of patients experienced a local failure, while 40% had a systemic failure. The 5-year local control rate for the surgical patients +/- postoperative radiotherapy was 88% (SE 6%), while for the patients undergoing radiotherapy alone it was 65% (SE 7%). There was no difference in local control between those randomized to SF vs. IF. The 5-year local control rate for the patients with pelvic-sacral tumors was 44% (SE 15%), significantly worse than the local control rates for those with central tumors 82% (SE 8%), distal extremity 80% (SE 8%), or proximal extremity 69% (SE 9%) (p=0.023). However, quality of radiotherapy correlated with outcome. Patients who had appropriate radiotherapy had a 5-year local control of 80% (SE 7%), while those with minor deviations had 5-year local control of 48% (SE 14%), and those with major deviations had a local control of only 16% (SE 15%) (p=0.005). The local failure was within an irradiated volume in 62% of patients, outside the irradiated volume in 24% of cases, while the precise location could not be determined in the remaining 14%. CONCLUSIONS: As most failures in Ewing's sarcoma are systemic, improved EFS requires more effective systemic chemotherapy. Adequate IF radiotherapy requires treatment to appropriate volumes as defined by MRI imaging and full radiation doses. Pretreatment review of radiologic images with a musculoskeletal radiologist to determine appropriate tumor volumes, as well as use of conformal radiotherapy techniques are important for improved outcome.
Adolescent↗
The clinical behavior of localized and multicentric Castleman disease.
BACKGROUND: Castleman disease, an unusual condition of unknown cause consisting of a massive proliferation of lymphoid tissue, remains a clinicopathologic diagnosis. Three histologic variants (hyaline vascular, plasma-cell, and mixed) and two clinical types (localized and multicentric) of Castleman disease have been described. OBJECTIVE: To analyze the clinical features, management, and outcome of patients with Castleman disease. DESIGN: Case series. SETTING: University referral hospitals. PATIENTS: All patients with Castleman disease who were seen at Texas Medical Center, Houston, Texas, between 1977 and 1995. INTERVENTIONS: Surgical excision for localized disease; surgery, combination chemotherapy, or prednisone for multicentric disease. MEASUREMENTS: Patients were identified according to initial presentation as having localized or multicentric Castleman disease. Patients within each group were further subdivided according to whether they had hyaline vascular, plasma-cell, or mixed disease. RESULTS: Data from 15 patients were analyzed. All 7 patients with localized disease underwent surgical excision and remain free of disease. The 8 patients with multicentric disease were further subdivided according to initial treatment: Three patients who received combination chemotherapy are currently alive and free of disease; 2 patients treated with prednisone are alive but have needed intermittent maintenance therapy for disease reactivations; and 2 patients treated with surgery only have died, 1 of infectious complications and 1 of non-Hodgkin lymphoma. CONCLUSIONS: Localized and multicentric Castleman disease are different clinical disorders with overlapping histologic features. Localized disease can be cured with surgery, but complete remissions in patients with multicentric disease have been achieved only with chemotherapy or prednisone given at the time of diagnosis.
Adolescent↗
Developmental regulation of ENaC subunit mRNA levels in rat kidney.
To assess the role of distal nephron apical Na channel (ENaC) gene expression in Na wasting by the immature kidney, ENaC alpha-, beta-, and gamma-subunit mRNA levels were examined in the rat by RT-PCR. In microdissected nephron segments, all three ENaC subunit mRNAs were detected in the distal convoluted tubule, connecting tubule, cortical collecting duct, and outer medullary collecting duct. The inner medullary collecting duct and all other nephron segments were consistently negative. The mRNA levels were quantified in kidneys at different developmental stages by multiplex RT-PCR with "primer dropping," with endoplasmic reticulum-specific cyclophilin mRNA as an internal standard. All three ENaC mRNA levels were low or undetectable on gestational day 16 and only slightly higher 3 days before birth. A sharp rise was observed between 3 days before and 1-3 days after birth; the levels at postnatal days 1-3 were already similar to those of adult kidneys. The results suggest that ENaC subunit gene expression is not a limiting factor in the full-term newborn rat kidney, but low levels of expression may limit distal Na absorption in more immature kidneys, such as those of very premature human infants.
Animals↗
Optimization of environmental factors for the biological treatment of trinitrotoluene-contaminated soil.
In earlier studies (Boopathy et al. 1994a, 1994b), soil bacteria present in a TNT-contaminated site removed 2,4,6-trinitrotoluene (TNT). In this study the optimum conditions for the most efficient removal of TNT is discussed. The results suggest that the soil bacterial consortium has an optimal pH range of 6-7. Maximum growth was observed at pH 7. However, the TNT removal rate was higher at pH 6. Studies of the effects of temperature showed that the bacterial consortium had maximum metabolic activity at 20 to 22 degrees C (ambient temperature). At a higher temperature (37 degrees C) the TNT removal rate dropped significantly. The consortium could not use TNT as a nitrogen source but required the addition of ammonium. Optimal growth occurred with 0.25 g/L of ammonium chloride. Growing cells removed TNT significantly faster rates than resting cells or cell-free extract. The operation of soil slurry reactors with the optimal conditions suggested that TNT can be removed effectively from the contaminated sites. These environmental conditions established as optimal can be used to improve the efficiency of large-scale soil slurry reactors for the treatment of soil contaminated with TNT.
Biodegradation, Environmental↗
Use of trinitrobenzene as a nitrogen source by Pseudomonas vesicularis isolated from soil.
An aerobic Gram-negative bacterium identified as Pseudomonas vesicularis was isolated from soil contaminated with 2,4, 6-trinitrotoluene (TNT) and 1,3,5-trinitrobenzene (TNB). This bacterium used TNB as the sole source of nitrogen. The TNB was metabolized within 80 h of incubation. The major metabolites produced were dinitroaniline,dinitrobenzene (DNB), nitroaniline, nitrobenzene (NB), and ammonia. The concentrations of DNB and NB produced in the culture medium were nearly stoichiometric. The ammonia concentration in the culture medium increased during the course of incubation. The end product of TNB metabolism was NB,which did not undergo further degradation even after long incubation time. This bacterium could be used in a syntrophic culture system with other NB-degrading bacteria to remove TNB completely from soil and water at contaminated sites.
Biodegradation, Environmental↗
An outbreak of infection due to verocytotoxin-producing Escherichia coli O157 in four families: the influence of laboratory methods on the outcome of the investigation.
Three members of family A, who had diarrhoea on 20 October, lived on a small arable farm which had 10 cattle. Manure from the animals was used to fertilize the ground for growing potatoes which were then offered for retail sale, unwashed, directly from the farm. The mother from family B bought potatoes, which were covered with manure, from family A in early November and over the subsequent 10 days she became ill with diarrhoea and her daughter and son both became ill with bloody diarrhoea. The mother from family C visited family B while the daughter from the latter family was symptomatic; the mother developed diarrhoea several days later. The mother and two sons from family D visited family B while the son from the latter family was symptomatic; the first son developed bloody diarrhoea 6 days later which progressed to development of haemolytic-uraemic syndrome. Direct culture of faecal samples onto cefixime rhamnose sorbitol MacConkey agar failed to isolate E. coli O157 from any of the symptomatic patients, and direct culture onto cefixime tellurite sorbitol MacConkey agar isolated the organism from only one patient. In contrast, a combination of isolation of E. coli O157 by immunomagnetic separation and detection of E. coli O157-specific secretory IgA, suggested E. coli O157 infection in all eight symptomatic patients, but not in any of the family members who were not ill. Two children who excreted the organism for 60 and 89 days respectively were the only two patients who did not develop a secretory IgA response. E. coli O157 was not isolated from potatoes from the farm and faecal samples from the farm animals were not available for examination. The study illustrates the need to use the most sensitive methods available during the investigation and follow up of cases of E. coli O157 infection.
Animals↗
Selective cytotoxicity of lithium gamma-linolenic acid in human T cells chronically and productively infected with HIV.
We sought to extend observations of lithium gamma-linolenic acid (LiGLA)-associated selective cytotoxicity in different models of chronic HIV infection in vitro. In our initial experiments, 8E5, 8E5L and A3.01 cells were allowed to proliferate in the presence of 0-20 microg/ml LiGLA for 4 days. Similarly, OM-10.1 cells (with or without prior stimulation with tumour necrosis factor-alpha (TNF-alpha)) were grown with 0-5 microg/ml LiGLA for 10 days. Significant cytotoxicity was observed in productively infected 8E5 cells (100% cell death by day 2 at the highest concentration) as compared with latently infected 8E5L cells (50% cell death on days 2-4) and uninfected A3.01 cells. No drug-induced viral stimulation was observed in surviving cells. In fact, a mild direct antiviral effect may be present, independent of cytotoxicity. Maximum cytotoxicity to OM-10.1 cells was only observed when active viral replication was induced by TNF-alpha. Our preliminary results are encouraging and suggest that LiGLA should be retained as a candidate antiretroviral agent. Further work is underway to identify the specific mechanism underlying our observations.
Anti-HIV Agents↗
Modification of the glycosyl groups of collagen: effects on fibril assembly.
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Animals↗
Increased nailfold capillary dimensions in primary Raynaud's phenomenon and systemic sclerosis.
The aim of the study was to measure nailfold capillary dimensions and capillary density in patients with primary Raynaud's phenomenon (PRP) and systemic sclerosis (SSc) compared to control subjects. Ten controls, nine patients with PRP and 10 patients with SSc were studied. All dimensions other than distance between limbs were significantly increased in both the PRP and SSc groups compared to controls (P < 0.01), with the SSc group showing the most marked increases (SSc vs PRP, P < 0.05 for all dimensions). Capillary density was significantly reduced in the SSc group compared to controls (P = 0.004). These results suggest that structural vascular changes occur in PRP as well as in SSc, and that PRP may, therefore, not be entirely benign.
Capillaries↗
Australian registered nurse medical device education: a comparison of simple vs. complex devices.
As the primary users of medical devices in direct patient care, registered nurses must be competent both with simple and complex devices because any device improperly used can have serious consequences. Results of a cross-sectional survey of registered nurses (n = 238) working at a large South Australian tertiary care centre on units with high usage both of indwelling urethral (Foley) catheters and intravenous infusion pumps revealed that participants were significantly more likely to have learned to use the indwelling urethral (Foley) catheter in nursing school than they were to have learned how to use an intravenous infusion pump. Participants differed significantly on most (13 of 17) items about what they learned, with nurses being more likely to learn various factors about the indwelling urethral catheter than the infusion pump. Registered nurses were more likely to feel stressed when using an intravenous infusion pump than when using an indwelling urethral catheter, but were more likely to have used an indwelling urethral catheter that caused a patient harm than an intravenous infusion pump that caused a patient harm. The most frequently identified reasons for incidents of patient harm resulting from use of an intravenous infusion pump were user error and inadequate device education. The most frequently identified reasons for incidents of patient harm resulting from use of an indwelling urethral catheter were the patient's condition, particularly confusion, user error, equipment malfunction, and inadequate device education.
Adult↗
Extramedullary plasmacytoma mimicking primary colonic carcinoma in a patient with Crohn's disease. Case report and literature review.
We present the case of a 45-year-old man who underwent segmental resection for what was considered clinically to be a primary colonic carcinoma. Histopathologic evaluation revealed the tumor to be a malignant plasmacytoma of the colon. Additionally, the entire segment of distal ileum and colon was involved by an inflammatory process with the features of Crohn's disease, accompanied by focal glandular dyplasia of the colonic mucosa. This case reemphasizes that plasmacytoma of the colon can closely mimic carcinoma of the colon in its presentation. The association between plasmacytoma of the colon and Crohn's disease has not, to our knowledge, been described previously.
Carcinoma↗
Health across the life span: raising nursing student awareness in Australia.
Quality nursing practice depends on knowledgeable and sensitive professional nurses. Nursing students, and ultimately the public they serve, benefit from learning experiences that enhance understanding of the physical and psychoemotional effects of aging and health dysfunctions across the life span. The Friends of the School of Nursing Program at The University of South Australia, City Campus, is a coalition between students and volunteers that provides students with the opportunity to participate in a variety of learning situations involving people of all ages and representing different health, social, and cultural backgrounds.
Adult↗
Single-dose and steady-state pharmacokinetics of fosinopril and fosinoprilat in patients with hepatic impairment.
The single-dose and steady-state pharmacokinetics of the angiotensin-converting enzyme (ACE) inhibitor fosinopril and its active diacid, fosinoprilat, were evaluated in 6 healthy volunteers and 12 patients with alcoholic cirrhosis. Fosinopril was administered at a dosage of 10 mg once daily for 14 days. Results in the two groups were similar, with no evidence of accumulation of fosinoprilat in hepatically impaired patients. Mean (+/- SD) maximum observed plasma concentrations of fosinoprilat in the healthy subjects were 112.0 +/- 67.2 ng/mL after the first dose and 144.1 +/- 61.7 ng/mL at steady-state. Corresponding values for the hepatically impaired patients were 111.4 +/- 40.1 ng/mL and 140.2 +/- 50.9 ng/mL. The area under the serum concentration versus time curve for healthy volunteers was 790.7 +/- 431.0 ng.hr/mL after the first dose and 940.3 +/- 400.4 ng.hr/mL at steady-state. Similar values were noted in hepatically impaired patients: 926.0 +/- 293.9 ng.hr/mL and 1,255.4 +/- 434.0 ng.hr/mL for first dose and steady-state, respectively. No statistically significant differences were detected in fosinoprilat pharmacokinetic values between healthy and hepatically impaired subjects. Absence of accumulation can be attributed to the dual route of elimination of fosinoprilat reported in previous studies. Renal excretion of fosinoprilat in hepatically impaired patients prevents increased accumulation. The present findings suggest that the starting dose of fosinopril used in hypertensive patients with normal renal and hepatic function can also be used in patients with hepatic impairment secondary to cirrhosis.
Antihypertensive Agents↗
Sustained-release transdermal glyceryl trinitrate patches as a treatment for primary and secondary Raynaud's phenomenon.
A randomized, double-blind, placebo controlled, cross-over study was conducted to determine the clinical efficacy of and patient tolerance to sustained-release glyceryl trinitrate (GTN) patches in the treatment of Raynaud's phenomenon. The patients studied were those with primary Raynaud's disease (n = 21) and patients with Raynaud's phenomenon secondary to systemic sclerosis (n = 21). GTN patches (0.2 mg/h) were found to be effective in reducing the number (P < 0.05) and severity of Raynaud's attacks (P < 0.05) in both groups of patients. Objective assessments by infrared thermography did not show any significant improvement when the patients were on GTN patches (P > 0.05). Headaches, refractory to treatment, led to the withdrawal of eight patients from the study and occurred in approximately 80% of the remaining patients. Thus, in spite of the subjective efficacy, the frequent headaches will limit the use of GTN patches in Raynaud's phenomenon. Elucidating the mechanism of action of the beneficial and adverse effects of GTN at the molecular level may shed light on the pathogenesis of Raynaud's phenomenon and its treatment.
Administration, Cutaneous↗
Reality based scenarios facilitate knowledge network development.
The challenge in nursing education is to create a learning environment that enables students to learn new knowledge, access previously acquired information from a variety of disciplines, and apply this newly constructed knowledge to the complex and constantly changing world of practice. Faculty at the University of South Australia, School of Nursing, City Campus describe the use of reality based scenarios to acquire domain-specific knowledge and develop well connected associative knowledge networks, both of which facilitate theory based practice and the student's transition to the role of registered nurse.
Clinical Competence↗
Accidental ingestion of methadone by children in Merseyside.
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Accidents↗