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PubMed2006

Racial differences in doctors' information-giving and patients' participation.

BACKGROUND: Whether doctor-patient communication differs by race was investigated in patients with pulmonary nodules or lung cancer. METHODS: Eligible patients (n = 137) had pulmonary nodules or lung cancer and were seen in thoracic surgery or oncology clinics for initial treatment recommendations at a large southern Veterans Affairs Medical Center from 2001-2004. Doctor-patient consultations were audiotaped. Audiotapes were transcribed, unitized into utterances, and utterances were coded as doctors' information-giving or patients' and companions' active participation (asking questions, expressing concerns, and making assertions). Data were compared by patient race and doctor-patient racial concordance using t-tests or chi-square tests as appropriate. Mixed linear regression was used to determine the independent predictors of doctor's information-giving after controlling for clustering of patients by doctor. RESULTS: Patient age, gender, marital status, clinical site, and health status were similar by race (P > .20), but black patients were somewhat less likely to have education beyond high school and to bring a companion to the visit (P = .06) than white patients. Black patients and their companions received significantly less information from doctors (49.3 vs. 87.3 mean utterances; P < .001) and produced significantly fewer active participation utterances (21.4 vs. 37.2; P < .001) than white patients. In mixed regression analyses, after adjusting for patients' and companions' participation, clustering by doctor, and other factors, race no longer predicted information-giving (P = .54). Patients in racially discordant interactions received significantly less information and were significantly less active participants (P < .001) when compared with patients in racially concordant interactions, and after controlling for patients' participation and other factors using mixed regression, racial discordance did not predict information-giving. CONCLUSIONS: The results indicate a pattern of communication that may perpetuate patient passivity and limited information exchange where black patients and patients in discordant interactions do less to prompt doctors for information and doctors in turn provide less information to these patients.

Black or African American↗
PubMed2005

B7-H3 promotes acute and chronic allograft rejection.

The B7 homolog B7-H3 is important for the regulation of immune responses though its functions in vivo are controversial. We report the first clinical and experimental data concerning expression and function of B7-H3 in alloresponses. Immunohistological and molecular analyses showed B7-H3 expression by cells mediating rejection of human and mouse allografts. To analyze the significance of B7-H3 in rejecting allografts, we generated B7-H3-/- mice and showed that targeting of B7-H3 was synergistic with other forms of immune modulation; e.g. a regimen of rapamycin gave 12-14 days of survival in wild-type controls but led to permanent cardiac and islet allograft survival in B7-H3-/- mice. Cardiac allografts in treated B7-H3-/- mice showed markedly decreased production of key cytokine, chemokine and chemokine receptor mRNA transcripts as compared to wild-type controls. The incidence of chronic rejection in two different cardiac allograft models was also inhibited in B7-H3-/- as compared to wild-type recipients. Lastly, in addition to the expected antigen-presenting cell expression of B7-H3, CD4 and CD8 T cells showed B7-H3 induction upon cell activation, and both dendritic cell- and T cell-expressed B7-H3 each enhanced T cell proliferation in vitro and in vivo. We conclude that B7-H3 promotes T cell-mediated immune responses and the development of acute and chronic allograft rejection.

Acute Disease↗
PubMed1992

Do bilineal pedigrees represent a problem for linkage analysis? Basic principles and simulation results for single-gene diseases with no heterogeneity.

Some investigators have expressed concern--especially for psychiatric disorders--that bilineal pedigrees should not be included in linkage studies. This study compares the "informativeness" of bilineal and unilineal families for a homogeneous single-gene disorder. Three approaches were used: (1) simulation studies of three-generation pedigrees, (2) calculation of expected lod scores (ELODs) in nuclear families, and (3) calculation of Fisher's information number I(theta) in nuclear families. The simulation studies in (1) permitted a realistic comparison between bilineal datasets and purely unilineal ones. The calculations in nuclear families in (2) and (3) then made it possible to analyze the sources of information loss in bilineal families. Overall, in datasets of five three-generation pedigrees each, the drop in mean maximum lod score was approximately 50% from purely unilineal datasets to extremely bilineal ones. In less-extreme bilineal datasets, which are closer to most real data than the extremely bilineal ones, the drops in lod score were very small--less than 10% in some, and practically zero in others. The details will vary, depending on size and structure of the pedigree, genetic model, true value of the recombination fraction, and informativeness of the marker. However, these results imply that the information loss due to bilineality is not necessarily very great. The nuclear-family calculations showed that for phase-known matings there is relatively little information loss in bilineal families, but for phase-unknown matings there the loss is much greater. In conclusion, for single-gene disorders with no genetic heterogeneity, whereas bilineal families can be less informative than comparable unilineal families, they are not so much less informative that they should automatically be discarded from linkage datasets. The implications of bilineal pedigrees for linkage studies of heterogeneous disorders are also discussed.

Computer Simulation↗
PubMedDate not supplied

Dermatofibrosarcoma protuberans.

The consultants agreed that dermatofibrosarcoma protuberans is characterized by its persistent growth and locally aggressive behavior. However, they did not all agree on the mode of treatment. Drs. Schuller and Snyderman favored surgical resection of the involved areas including the right cheek, lower eyelid, and any necessary portions of the nasal ala and upper lip. They encouraged the use of Moh's chemosurgery to detect microscopic disease. They were also in agreement regarding reconstruction, suggesting a cervical-facial or bi-lobed flap for the cheek. A full-thickness skin graft was recommended for the lower eyelid with primary closure planned for the lip defect. They disagreed on the use of postoperative radiation therapy. Dr. Schuller elected not to irradiate; Dr. Snyderman favored 60 to 65 Gy post-operatively. Dr. Quivey expressed concern regarding the morbidity from such a large resection and extensive reconstruction and suggested primary radiation therapy with external beam. All three consultants felt that good follow-up would include thorough head and neck examinations with MRI and/or CT scans if there were any concern about tumor recurrence.

Adult↗
PubMed1998

Activation of mitogen-activated protein kinases/extracellular signal-regulated kinases in human hepatocellular carcinoma.

Mitogen-activated protein kinase/extracellular signal-regulated protein kinase (MAPK/ERK) is a key molecule in intracellular signal transducing pathways that transport extracellular stimuli from cell surface to nuclei. MAPK/ERK has been revealed to be involved in the physiological proliferation of mammalian cells and also to potentiate them to transform. However, its role in the outgrowth of human hepatocellular carcinoma (HCC) has yet to be clarified. Therefore, in this study, we investigated the activation of MAPK/ERK and its associated gene expression in HCC. MAPK/ERK was activated in 15 of 26 cases of HCC we examined (58%), and its activity level was significantly higher in HCC than in the adjacent non-cancerous lesions. Besides, MAPK/ERK activation in HCC was positively correlated with protein expression of transcription factor c-Fos. Furthermore, in 25 of 26 cases of HCC which genomic DNA was available, 22 cases without genomic DNA amplification exhibited positive correlation, not only between protein expression of c-Fos and cyclin D1, but also between MAPK/ERK activation and cyclin D1 expression. Concerning the relationship between MAPK/ERK activation and the clinicohistopathological features of HCC, the tumor (HCC) versus non-tumor (non-cancerous counterpart) ratio (T/N) of MAPK/ERK activity was positively correlated with tumor size, but neither with the stage of HCC nor the degree of differentiation of HCC. In conclusion, these findings suggest that MAPK/ERK activation in human HCC may play an important role in multistep hepatocarcinogenesis, especially in the progression of HCC; at least in part, through cyclin D1 up-regulation primarily induced by MAPK/ERK via c-Fos.

Aged↗
PubMed2000

Timing of surgery for enterovesical fistula in Crohn's disease: decision analysis using a time-dependent compartment model.

OBJECTIVES: Previous decision analyses of inflam matory bowel diseases (IBD) have used decision trees and Markov chains. Occasionally IBD patients present with medical problems that are difficult or even impossible to phrase in terms of such established decision tools. This article aims to introduce modeling by a time-dependent compartment mode and demonstrate its feasibility for decision analysis in IBD METHODS: A Crohn's disease patient presented with a pelvic abscess and an enterovesical fistula. Being hesitant to operate in an acutely inflamed area, the surgeon recommended that the patient continue antibiotic therapy until the abscess had re solved. The gastroenterologist argued that the patient had already been treated with antibiotics for a prolonged time period and expressed concern that the patient's overall diminished health status would deteriorate by further delay of surgery. The occurrence of fistula, abscess, urinary tract infection, antibiotic therapy, surgical operation, and health-related quality of life were modeled as separate compartments, with time-dependent relationships among them. The simulation was carried out on an Excel spreadsheet. RESULTS: In the model, the surgeon's predictions were associated with rapid resolution of the pelvic abscess under antibiotic therapy and improvement of the patient's health status. The gastroenterologist's predictions resulted in a smaller decline in abscess size and further deterioration of the patient's health while waiting for a definitive treatment. The disagreement between surgery and gastroenterology arose from predicting different time courses for the individual disease events, in essence, from assigning different time constants to the time-dependent influences of the disease model. CONCLUSIONS: The compartment model provides a simple and generally applicable method to assess time dependent-changes of a complex disease. The present analysis also serves to illustrate the usefulness of such models in simulating disease behavior.

Abdominal Abscess↗
PubMed1996

Biology of colorectal and gastric cancer cell lines.

Cell lines established from the human colorectal and gastric cancers may provide very useful tools to the study of the disease and to develop and test new therapeutic approaches, and a large bank of well-characterized cell lines should reflect the diversity of tumor phenotypes and provide adequate models for the study of tumor heterogeneity. Colorectal lines are relatively easy to establish, while gastric cancer cell lines remain extremely difficult to propagate in long-term culture, and the number of cell lines is very limited. In this paper, we describe the up-to-date results of the characteristics of our nine colorectal cancer cell lines and four gastric cancer cell lines. Based on culture, xenograft, and ultrastructural morphologies, these cell lines could be subtyped into well-differentiated, moderately differentiated, poorly differentiated, and mucinous carcinomas. Basic properties concerning expression and secretion of antigens, neuroendocrine features, receptor binding of various gastrointestinal hormones and neurotransmitters, cytogenetic studies, gene amplification and expression, and chemosensitivity profiles are described. In particular, a greater number of receptors for hormones and neurotransmitters are expressed on human colorectal cancer cell lines compared to gastric cancer cell lines, raising the possibility that gastrointestinal hormones may have a greater autocrine effect on colon cancer cell growth. Despite major differences in the biology of colorectal cancer and gastric cancer as indicated by clinical studies, the multiple properties that we examined reveals marked similarities between the colorectal and gastric cancer cell lines. However, in vitro chemosensitivity patterns to cytotoxic drugs are very different in colorectal and gastric cell lines. Some of these observations may be due to the relatively low expression of the multidrug-resistance-associated (MDR1) gene in gastric cancer cell lines. In addition, colorectal cancer cell lines express receptors for peptide hormones more frequently.

Adenocarcinoma↗
PubMed2005

Callahan fails to meet the burden of proof for Thought Field Therapy claims.

Callahan's response evades the key issues raised by merely restating and elaborating upon what has already been said, providing citations that are out of context and irrelevant to the issues at hand, and misrepresenting what was actually said by his critics and me and the authors of articles he cites. He spends paragraphs refuting "straw men." He provides additional anecdotes, which offer no convincing evidence for his claims. His critics have expressed concern that Callahan and Thought Field Therapy (TFT) proponents will cite his response article, as published in the Journal of Clinical Psychology, to promote TFT, as TFT proponents have repeatedly done for the non-peer-reviewed earlier issue devoted to TFT. Callahan has been given an unprecedented opportunity to present his work in a reputable journal without prior peer review and has failed to meet the burden of proof for his claims, thus undermining his own claim, that his work has been rejected solely as a result of bias against innovation.

Heart Rate↗
PubMedDate not supplied

Determination of sample time for T1 measurement.

In spin-lattice relaxation time measurements, the relaxation time T1 is estimated from measuring the longitudinal magnetization during its return to thermal equilibrium from an initial (nonequilibrium) state. T1 estimation error depends on a number of factors, including the sample spacing, number of sample points, target T1 range, etc. We describe here a sample-time determination method based on the principles of optimal experimental design. A two-parameter model and a more general three-parameter model of the general T1 measurement experiment are used in this study. Both linear and power-law sample spacing strategies are evaluated. The proposed method formulates the sample-time determination problem in closed form expressions that allow for easy calculation of optimum sample times, if a prior T1 estimate or a probable T1 distribution over the target range is given. Valuable insights can be gained from evaluation of these expressions concerning the relationship of T1 estimation error and the sample spacing, number of sample points, target T1 range, etc.

Humans↗
PubMed1993

Psychologic and cosmetic self-assessments of breast conserving therapy compared with mastectomy and immediate breast reconstruction.

Cosmetic and psychologic morbidity was evaluated by patients' self-assessment in 42 patients who underwent breast conserving therapy (BCT) and 48 patients who underwent mastectomy with immediate breast reconstruction (MIBR). Although sexual adjustment and fear of cancer recurrence were not significantly different between the two groups, body image was rated as significantly better in the BCT group. Additionally, in the MIBR group, nine patients expressed concern about abdominal or back scars and 15 related abdominal or back pain. Eighty-three percent of the BCT group indicated BCT as a future choice of treatment, whereas only 38% of the MIBR group indicated MIBR as a future choice of treatment. Therefore, body image and patients' satisfaction were thought to have been improved by BCT, but psychologic morbidity was the same in both groups.

Adult↗
PubMed1977

Social and ethical implications of claims for cancer hazards.

Current data show that about 80% of human cancers can be traced to environmental causes. The majority of human cancers are associated with two main etiologic factors: smoking of cigarettes and diet, which account for most of the cancers in the respiratory tract, in the digestive tract, and in the endocrine sensitive and reproductive organs. The evidence for these multifactorial causes is both ipidemiologic and experimental. In recent years a number of lay and professional groups have expressed concern that the microcontaminants in our environment are responsible for cancer in man. Agitation, press releases, and statements before legislative and excutive government departments have made claims for cancer hazards which do not appear to rest on sound epidemiologic or experimental bases, yet these claims hav alarmed and indeed scared the public. Government agencies and industry have spent funds to investigate such claims. It appears that such actions not only divert valuable research funds and efforts into lines which do not seem to be fruitful in leading to a reduction in cancer risk for the main human cancers, but by falsely alarming the public, dilute serious efforts of cancer prevention with respect to the experimentally and epidemiologically established cancer risk.

Amaranth Dye↗
PubMed2005

Role of afterload reduction in the prevention of late anthracycline cardiomyopathy.

Afterload reduction is useful for treating and preventing adult congestive heart failure outside the realm of anthracycline toxicity. Afterload reducers are commonly used as treatment for acute heart failure associated with anthracyclines. However, the use of afterload reduction for the prevention of anthracycline associated late cardiomyopathy remains a controversial area, with strong opinions expressed concerning the potential risks and benefits of such an approach. This article will define "afterload" and the tools utilized to measure afterload. The study will then describe the theory for the use of afterload reduction in patients with anthracycline exposure who show signs of anthracycline cardiotoxicity, and will present data from the ACE-Inhibitor After Anthracyclines (AAA) Trial to help answer the question, "Should an afterload reducer be used to aid in preventing late anthracycline cardiotoxicity?" Finally, recommendations for future research will be presented.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2002

Variability in abciximab (ReoPro) prescribing: evidence based or budget driven?

PURPOSE: Abciximab improves outcomes in patients undergoing percutaneous transluminal coronary intervention (PTCA). Clinicians, however, have expressed concerns that they do not have enough budget to administer abciximab to all eligible patients. We studied the patterns of prescribing of abciximab and identified factors that correlate with the level of usage. METHODS: In each of all 13 Dutch PTCA centres one opinion-leading cardiologist was approached to provide data on the abciximab prescribing in their centre and to co-operate in an interview on this topic. We performed linear regression analysis in which the level of abciximab prescribing was the dependent variable. Potential determinants investigated were the number of PTCAs performed, the criteria for abciximab prescribing, funding and possible financial restrictions, participation in clinical trials in the past, percentage stenting, and desired level of abciximab prescribing. RESULTS: All 13 PTCA centres in the Netherlands participated in our study. The level of abciximab prescribing varied from 2 to 36% of all PTCAs. The criteria for patient selection significantly differed between centres. Together budget, investigatorship, size, and type of the institution were highly predictive for the level of abciximab prescribing (R2 = 0.93, p < 0.001). The more patients doctors had included in clinical trials in the past, the higher was the likelihood that they had prescribed abciximab. CONCLUSIONS: Shortly after its introduction, patterns of abciximab prescribing varied widely between PTCA centres. There was no agreement on which patients to select for this preventive treatment. Budget and involvement in clinical trials in the past were important predictors of the level of prescribing in each centre.

Abciximab↗
PubMed2006

Does it hurt to know the worst?--psychological morbidity, information preferences and understanding of prognosis in patients with advanced cancer.

BACKGROUND AND METHOD: Many doctors, while offering open discussion of diagnosis and treatment to cancer patients, still express concern about the psychological impact of discussing a poor prognosis. In this study, 106 advanced cancer patients were interviewed at home. The interview included open discussion and structured questionnaires: the Hospital Anxiety Depression Scale and Rotterdam Symptom Checklist. Participants were asked about information preferences, worries and unanswered questions. The interviewer (M.B.) rated "Understanding of diagnosis and of prognosis". RESULTS: A majority of participants (78%) demonstrated a good understanding of their diagnosis and were consistent with their information preference. On prognosis, 54% of those desiring information (49% of overall group) were fully aware; a further 22% were aware but unrealistic about time-scale. Although most were satisfied with their level of knowledge, 28% had further questions, particularly concerning "mode of disease progression" (n=25), "mode of death" (n=13) and prognosis (n=18). When understanding of prognosis was compared with psychological distress, a significant difference was observed between those with realistic versus unrealistic time-scales. However, this could be explained by increasing physical symptoms. CONCLUSIONS: Patients with advanced cancer have a good understanding of their diagnosis but many do not fully understand their prognosis. Although patients with deteriorating health are more likely to be psychologically distressed, awareness of prognosis does not itself cause depression. Doctors should be aware of patients' ongoing but often unvoiced concerns and prepared to explore these with them.

Adult↗
PubMed2000

Etiology of body dissatisfaction and weight concerns among 5-year-old girls.

Among adolescent girls and women, higher weight status is associated with greater body dissatisfaction and weight concerns. This study investigated the etiology of body dissatisfaction and weight concerns among 5-year-old girls by assessing associations among girls' and parents' weight status, body dissatisfaction, and weight concerns. Weight status, body dissatisfaction, and weight concerns were assessed for 197 5-year-old girls and their parents, and relationships among these variables were investigated using multiple regression in the form of path analysis. For girls and parents, higher weight status was associated with greater body dissatisfaction, which in turn was associated with higher weight concerns. No direct relationship was found between girls' weight status and girls' weight concerns. Girls' body dissatisfaction and mothers' weight concerns, however, were independently and positively associated with higher weight concerns among girls. In conclusion, relationships among weight status, body dissatisfaction, and weight concerns for 5-year-old girls parallel those reported among adults. In addition, results suggest that the etiology of weight concerns in young girls may be linked to girls' subjective evaluations of their weight status (body dissatisfaction) in combination with weight concerns expressed by their mothers.

Body Image↗
PubMed2001

The mammalian safety of Bacillus thuringiensis-based insecticides.

The United States Environmental Protection Agency between the years 1961 and 1995 registered 177 products containing viable Bacillus thuringiensis (Bt). Numerous laboratory studies have demonstrated that Bt and Bt products are noninfectious and are toxic to mammals only at a dose > or =10(8) colony forming units (cfu) per mouse (a human equivalent based on the weight of >10(11) cfu). In contrast, as few as three vegetative cells of Bacillus anthracis can kill mice (a human equivalent of >10(3) cfu). There are only two literature reports of Bt infection in man between the year 1997 and the present, and all infected individuals had experienced either extensive burns or a blast injury, which predisposed them to infection. Two epidemiology studies conducted during large-scale aerial Bt serovar kurstaki spray campaigns reported no increased incidence of illness. Some recent papers have expressed concern about the production of Bacillus cereus enterotoxins by Bt isolates. Laboratory studies found no evidence of illness in rats and sheep fed Bt products, nor have epidemiology studies found increased incidence of diarrhea during Bt aerial spray campaigns. Increases in human antibody levels following exposure to Bt products have been reported but there was no increased incidence in asthma or other illness. Based on laboratory studies and field experience, Bt insecticides have an excellent safety record.

Animals↗
PubMed1995

Psychological response to cervical screening.

BACKGROUND: Few studies have examined the psychological costs of cervical screening, despite expressed concern over possible negative sequelae. METHODS: Seventy-five women with mild or moderately dyskaryotic smears, under cytological surveillance, 75 women referred for colposcopy after a first-ever abnormal smear showing severe dyskaryosis, and 75 controls with recent negative cytology were interviewed at home, and their psychological adjustment was assessed. RESULTS: Levels of distress were higher among women with an abnormal smear than among controls with a recent negative smear. Anxiety (Hospital Anxiety and Depression Scale range 0-21, "normal" range 0-7) was highest among those referred for colposcopy (mean 8.12, controls 5.88, P < 0.001); afterward, distress fell (mean 6.61, P < 0.001) but more problems of social adjustment were evident (surveillance vs controls, P < 0.01). High anxiety was associated with social maladjustment (colposcopy, P < 0.001; surveillance, P < 0.01) and negative feelings about the self (P < 0.05). Current anxiety was unrelated to knowledge about abnormal smears, but in the surveillance group was related to satisfaction with the explanation provided (P < 0.05). CONCLUSION: A positive cervical smear may by psychologically traumatic for a significant minority of women, irrespective of management strategy.

Adaptation, Psychological↗
PubMed1999

Polychlorinated biphenyls, polybrominated biphenyls, and dioxin reduction during processing/cooking food.

This chapter presents information on the levels of environmental contaminants found in recent market basket surveys as well as the effect of processing and cooking on the reduction of these contaminants. Although consumers have expressed concern over the level of environmental contaminants in the food supply, market basket surveys involving over 8,000 analyses of foods ready-to-eat, found measurable amounts (ppb levels) of PCBs in only 24 foods. Processing/cooking has been shown to reduce PCBs by 20-100%. Although PBBs got into the food chain as the result of one incredible accident and thus are not expected to be found in foods today, cooking/processing was also effective in reducing PBBs. Dioxins are the result of combustion processes and chemical manufacturing processes. TCDD levels found in Great Lakes fish were in the low part per trillion level. Again, cooking and processing resulted in substantially less TCDD in fish as eaten.

Animals↗