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Selecting initial therapy. Seminoma and nonseminoma.

About 80% of seminoma presents as low-stage disease. If clinical studies are negative, the usual initial therapy is "prophylactic" radiotherapy to the retroperitoneal zone. If clinical Stage II disease is evident, radiotherapy versus primary chemotherapy is being studied. Primary chemotherapy is treatment of choice for clinical Stage III disease. Postchemotherapy radiographic lesions are safe to follow without surgical extirpation as they are usually necrotic. Surveillance for clinical Stage I disease is another option. For nonseminoma, clinical Stage I disease has been managed with staging RPLND. But 70% of such cases will have negative nodes. Hence, primary surveillance studies are under way, with chemotherapy reserved for those who relapse clinically (estimated 95% survival). Sadly, surveillance has not been effective when applied on an ad hoc basis at the community level. Problems are compliance, delayed detection of relapse, nonreporting of failures. Clinical Stage II disease is managed with RPLND. Adjuvant, limited postoperative chemotherapy is an option versus no postoperative chemotherapy followed by full chemotherapy for those who relapse as Stage III disease later. Another option under study for Stage II disease is primary chemotherapy with RPLND surgery reserved for those who achieve only a partial remission.

Antineoplastic Agents↗

Late-life depression: the differences between early- and late-onset illness in a community-based sample.

BACKGROUND: Several studies have described etiological and clinical differences between elderly depressed patients with early onset of their illness compared to late onset. While most studies have been carried out in clinical samples it is unclear whether the findings can be generalized to the elderly population as a whole. The aim of this study was to compare early-onset (EOD) and late-onset (LOD) depressive illness in a community-based sample. METHODS: Large (n = 3107) representative sample of older persons (55-85 years) in the Netherlands. Two-stage screen procedure to identify elderly with MDD. The Center for Epidemiologic Studies Depression scale (CES-D) was used as a screen and the Diagnostic Interview Schedule (DIS) to diagnose MDD. Data on 90 older persons with early-onset depression and 39 with late-onset depression were available. RESULTS: Those with LOD were older, and more often widowed. Family psychiatric history, vascular pathology, and stressful early and late life events did not differ between groups. EOD subjects had more often double depression and more anxiety. CONCLUSIONS: In a community-based sample we did not detect clear differences in etiology and phenomenology between EOD and LOD. This discrepancy with reports from clinical samples could be due to selection bias in clinical studies. Consequently, all patients with late-life depression deserve a diagnostic work-up of both psychosocial and somatic risk factors and treatment interventions should be focused accordingly.

Age Distribution↗

Screening for unknown synthetic steroids in human urine by liquid chromatography-tandem mass spectrometry.

Chemically modified steroids (designer steroids), including tetrahydrogestrinone and norbolethone, pose a threat to the integrity of the sport community. These compounds have recently been detected in urine specimens from athletes, resulting in temporary or permanent suspension from amateur and/or professional competition. Triple quadrupole mass spectrometers enable doping control laboratories to screen for unknown, anabolic, androgenic steroids utilizing precursor ion scans. On the basis of common dissociation patterns of steroids with common structural features, characteristic product ions were selected to serve as diagnostic markers for previously unidentified drugs or drug metabolites in human urine samples. An assay was established to complement standard screening procedures. Urine specimens were enzymically hydrolyzed, partitioned into ether, concentrated, and analyzed by precursor ion scanning. Spectra from samples fortified with eight standard compounds (methyltestosterone, ethyltestosterone, 1-testosterone, gestrinone, dihydrogestrinone, tetrahydrogestrinone, norbolethone, and propyltrenbolone) and one deuterium-labeled analog (d(4)-tetrahydrogestrinone) at 50 ng/ml of urine, had precursor ion peaks other than those from common endogenous steroids. Subsequent product ion scan experiments on precursor ions of peaks of unknown origin provided structural identification of the unknown compounds.

Chromatography, Liquid↗

Using administrative health data to monitor potential adverse health effects in environmental studies.

Following episodes of environmental contamination, health professionals are limited in their ability to detect adverse health effects in surrounding communities due to lack of relevant baseline health data, resources, and appropriate control populations. The objective of this study was to ascertain the feasibility of using administrative health data for these purposes. The Manitoba Health Services Commission's (MHSC) database is comprehensive since universal health care is free in Canada. As part of an evaluation of two proposed hazardous waste treatment sites, the feasibility of using MHSC's data was tested by (a) defining the two study and control sites through use of MHSC's population registry and (b) determining baseline morbidity rates through analysis of MHSC's physician visit payment files; diagnoses were coded using ICD-9-CM. The results indicated that there were some differences between the groups studied in the age- and sex-standardized morbidity rates of diagnoses potentially influenced by exposures to chemicals. Use of administrative data provided by a national health service is an inexpensive and efficient way to create and follow potentially exposed cohorts residing in defined communities. Despite limitations related to small populations in exposed communities and lack of standardized diagnostic criteria by physicians, this method should be explored further in environmental studies.

Adolescent↗

Chlamydia trachomatis: serological diagnosis.

Satisfactory methods for the serodiagnosis of Chlamydia trachomatis have been widely discussed in recent years. Until a decade ago, the complement-fixation test measuring group-specific antibody was the most widely applied technique. However, despite showing relatively high diagnostic sensitivity in systemic chlamydial infections, it is of little value in the serodiagnosis of localized chlamydial oculo-genital infections or of trachoma. The more recently developed microimmunofluorescence (micro-IF) test is not only a very sensitive technique, but can also reach a high degree of serodiagnostic specificity in certain chlamydial infections. Unlike the complement-fixation test, it measures type-specific antibody which may be directed against one or more C trachomatis serotypes. By nature, chlamydia infections often lead to high background rates of antibody in affected populations. Interpretation of serological results may therefore be difficult, particularly when only single-serum samples are available. However, in seroepidemiological work, in the study of transmission patterns and in the detection of predominant serotypes in a community, the micro-IF test is especially valuable, and if results are interpreted with care, the test may also serve as an indicator of chlamydial infection. The predictability, sensitivity and specificity of serological tests for C. trachomatis will be discussed.

Antibodies, Bacterial↗

Mass screening for colorectal cancer.

A voluntary community colorectal cancer screening project to detect occult blood in the stool of asymptomatic individuals was undertaken; 49,353 Hemoccult II kits were distributed. A total of 23,674 completed kits were returned to a central repository and processed (compliance rate, 48 percent); 851 participants had positive results (3.6 percent). Of the 640 who underwent further medical evaluation, 299 participants (46.7 percent) who had adequate follow-up had no evidence of disease. Diverse disease entities were detected in 341 participants, which was 1.4 percent of those enrolled. Forty-one patients (0.17 percent) showed significant findings that included 29 cancers (0.12 percent) and 12 (0.05 percent) noninvasive malignant polyps. Of the cancers, there were 27 colorectal, one non-Hodgkin's lymphoma, and one carcinoma of the vocal cord. In addition, 107 patients (0.45 percent) had benign polyps and 193 patients (0.82 percent) had various diseases of the gastrointestinal tract and other medical conditions. The cost of the program was modest and the results conformed to those found in previous screening surveys. The heightened public awareness of testing for colorectal disease and the detection of early lesions justifies the guaiac test screening program for mass survey.

Adult↗

Autecological properties of 3-chlorobenzoate-degrading bacteria and their population dynamics when introduced into sediments.

Ecologically significant properties of wild-type and genetically engineered bacteria capable of degrading 3-chlorobenzoate (3-CB) were compared in the laboratory, and isolates were introduced into streambed sediments in microcosms to observe their population dynamics. 3-CB metabolism, growth on algal extract, temperature optima, and ingestion by protozoa were ecological properties considered relevant to the persistence of these bacteria if introduced into nature. Cell-specific Vmax for 3-CB metabolism and cell-specific mineralization rates each spanned approximately 2 orders of magnitude, but isolates did not rank consistently. The Ks for 3-CB metabolism for Alcaligenes sp. BR60 was approximately 40-fold lower than the mean value for the other isolates, which differed only approximately 4-fold among themselves. All isolates grew on an algal extract nearly as well as on tryptone-yeast extract, implying potential for survival on natural metabolic substrates in situ. Most isolates had temperature optima that were 3-15 degrees C higher than maximum stream water temperature (22 degrees C). Ciliates preferentially ingested P. acidovorans M3GY, and either P. putida RC-4(pSI30) or its parent strain were least preferred, but microflagellates did not exhibit consistent preferences. Fluorescent antibodies were prepared against isolates to permit detection of target cells in natural communities. In three different microcosm experiments the cell densities of introduced isolates declined over a period of days. In one experiment, 3-CB additions (100 mg/L) led to increases of P. alcaligenes C-0 and P. acidovorans M3GY cell densities within 1 day, although P. putida RC-4(pSI30) took 4 days. In a second experiment, the persistence of P. putida RC-4(pSI30) and its parent strain P. putida RC-4 were compared and rates of initial population decline were not statistically different. 3-CB addition stimulated the growth of other organisms while densities of the P. putida strains further declined. In a third experiment exposure to 100 mg 3-CB/L slowed the rate of decline of P. acidovorans M3GY densities compared to a 10 mg/L concentration or unamended control. Competition with the native flora was a significant factor affecting the persistence of introduced 3-CB degraders.

Alcaligenes↗

Community structure of bacteria associated with sheaths of freshwater and brackish thioploca species.

Bacterial communities associated with sheaths of Thioploca spp. from two freshwater lakes (Lake Biwa, Japan, and Lake Constance, Germany) and one brackish lake (Lake Ogawara, Japan) were analyzed with denaturing gradient gel electrophoresis (DGGE) of 16S rRNA gene fragments. The comparison between the DGGE band patterns of bulk sediment and Thioploca filaments of Lake Biwa suggested the presence of specific bacterial communities associated with Thioploca sheaths. As members of sheath-associated communities, bacteria belonging to Bacteroidetes were detected from the samples of both freshwater lakes. A DGGE band from Thioploca of Lake Biwa, belonging to candidate division OP8, was quite closely related to another DGGE band detected from that of Lake Constance. In contrast to the case of freshwater lakes, no bacterium of Bacteroidetes or OP8 was detected from Thioploca of Lake Ogawara. However, two DGGE bands from Lake Ogawara, belonging to Chloroflexi, were quite closely related to a DGGE band from Lake Constance. Two DGGE bands obtained from Lake Biwa were closely related to phylogenetically distant dissimilatory Fe(III)-reducing bacteria. Cloning analyses for a dissimilatory sulfite reductase gene were performed on the same samples used for DGGE analysis. The results of the analyses suggest that sheaths of freshwater/brackish Thioploca have little ecological significance for the majority of sulfate reducers.

Animals↗

Methodologies for the characterization of microbes in industrial environments: a review.

There is growing interest in research and development to develop novel tools to study, detect, and characterize microbes and their communities in industrial environments. However, knowledge about their validity in practical industrial use is still scarce. This review describes the advantages and limitations of traditional and molecular methods used for biofilm and/or planktonic cell studies, especially those performed with Listeria monocytogenes, Bacillus cereus, and/or Clostridium perfringens. In addition, the review addresses the importance of isolating the microorganisms from the industrial environment and the possibilities and future prospects for exploiting the described methods in the industrial environment.

Biofilms↗

Renal disease in patients with HIV.

As survival continues to improve in the era of highly active antiretroviral therapy, kidney, liver, and cardiac disease have become increasingly important sources of mortality and morbidity in patients with HIV. The incidence of end-stage renal disease in patients with HIV is projected to increase, and the incidence of earlier chronic kidney disease, acute renal failure, and electrolyte abnormalities is likely to be much higher than appreciated. Both acute and chronic kidney disease are more common in the setting of advanced HIV, hepatitis coinfection or liver disease, and medication toxicity. Close collaboration between nephrologists and infectious disease specialists is important to facilitate the identification, diagnosis, and management of acute and chronic kidney disease in patients with HIV. Recently published guidelines highlight the increased awareness of kidney disease in the infectious disease community and provide guidelines for the detection and management of chronic kidney disease in patients with HIV.

Journal Article↗

Detection of feigned head injury symptoms on the MMPI-2 in head injured patients and community controls.

MMPI-2 results from 39 moderately to severely head injured (HI) and 44 community volunteer (CV) participants given instructions to feign symptoms or answer honestly during an analog forensic neuropsychological examination were compared. No significant effects for HI or the interaction between the HI and instruction set (IS) factors were noted on either clinical or selected validity scales (F, Fb, Fp, Ds2, FBS). However, the main effect of IS was significant for both clinical and validity scales (median Cohen's d=1.34 and 1.39, respectively). Most validity scales were characterized by perfect specificity rates but low to modest sensitivity, whereas FBS had both moderate sensitivity and specificity. Logistic regressions showed that the F and Ds2 scales made a significant contribution independent of motivational tests to the identification of feigning during neuropsychological examination.

Adult↗

Detection and localization of occult lesions using breast magnetic resonance imaging: initial experience in a community hospital.

RATIONALE AND OBJECTIVES: To evaluate the outcome of diagnostic breast MR imaging followed by MR guided needle localization for mammographically and sonographically occult breast lesions in a community-based hospital. MATERIALS AND METHODS: Records of the initial 50 consecutive patients who underwent MR guided needle localizations at our institution from November 2001 to January 2003 were reviewed. Sixty-two lesions were localized by MR and were mammographically and sonographically occult. Pathology following excision was reviewed and correlated with the MR findings. RESULTS: Cancer was present in 15 % (9/62) of lesions or 18 % (9/50) of the women localized. Five of the lesions (56%) were invasive carcinoma and four (44%) were ductal carcinoma in situ (DCIS). High-risk lesions, including atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH), were found in 6.5 % (4/62) of the lesions, while 3 % (2/62) of the lesions contained lobular carcinoma in situ (LCIS). Cancer plus high risk lesions were found in 15/62 (24%) lesions or 14/50 (28%) of women who underwent biopsy. CONCLUSION: The data in this study supports findings from other studies conducted by large research institutions. In this regard, it is important that community-based hospitals, such as the one operating this breast MR program, can achieve the same positive predictive values as those found in data emanating from academic institutions.

Adult↗

A 2-year follow-up study of alcohol consumption and risk of dementia.

BACKGROUND: This report focused on investigating the relationship between alcohol consumption and dementia in elderly people through prospective studies. METHODS: We conducted a 2-year follow-up study of elderly people from six communities in Chongqing, China. Dementia was detected using the Mini-Mental State Examination (MMSE) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). The relationship between alcohol consumption and dementia was investigated using multiple logistic regression models, adjusting for the potential confounders age, sex, educational level and cigarette smoking. RESULTS: Light-to-moderate drinking was associated with a significantly lower risk of dementia compared with non-drinking. Excessive drinking was related to a higher risk of dementia. The effect of light-to-moderate drinking seemed most prominent among vascular dementia, 0.63 (0.55-0.72) for Alzheimer's disease, 0.31 (0.19-0.51) for vascular dementia and 0.45 (0.12-1.69) for other dementia. In a model adjusting for confounding variables, a light-to-moderate intake of beer was associated with a significantly higher risk of dementia than a non-drinker of beer. For wine, a significantly lower risk of dementia existed for a light-to-moderate drinker. CONCLUSIONS: Light-to-moderate drinking was associated with a significantly lower risk of dementia compared with a non-drinker.

Aged↗

Direct amplification of rhizobial nodC sequences from soil total DNA and comparison to nodC diversity of root nodule isolates.

A group-specific primer set was developed using nodC as a target gene for the amplification of rhizobial sequence diversity from nodule isolates and total soil DNA preparations. The primer set was tested on 209 nodule isolates, recovered from six different trap plant species which were grown in two soil samples collected from a chickpea and a wheat field site in India. We also amplified and cloned PCR products from total DNA isolated from the same soil samples. The total diversity within the resulting clone libraries (Sigma 218 clones) was higher than that recovered from trap plants, but differed depending on the PCR protocols and primers used. However, some plant-selected genotypes could not be obtained using the community approach, probably due to variable detection limits and limited clone library sizes.

Bacterial Proteins↗

Molecular epidemiology of human astrovirus infections in Kolkata, India.

UNLABELLED: The study is aimed to determine the seasonal distribution and clinical characteristics of astroviruses associated with acute watery diarrhoea among children in Kolkata and characterize them at the molecular level. METHOD OF STUDY: Faecal specimens of acute watery diarrhoea cases (n=857) and non-diarrhoeic samples (n=211) from the hospitals and a nearby field community were screened with IDEIA Astrovirus detection kit; astrovirus co-infections with rotavirus and/or picobirnavirus were detected by RNA-PAGE and silver staining. Further RT-PCR was carried out using specific primers, viz. Mon340 (+) and Mon348 (-) targeting a highly conserved domain of ORF1a (289 bp) of human astroviruses. RESULTS: Astrovirus infection was detected in 50 cases (50/857); astroviruses were detected mostly in children aged 6-12 months (50%); all non-diarrhoeic samples (n=211) were negative for astrovirus. In 52% of astrovirus positive cases, the virus was detected as the sole agent; mixed infections were also detected with other diarrhoeic pathogens such as rotavirus (32%), picobirnavirus (2%), rotavirus and picobirnavirus (2%), picobirnavirus and Enterotoxigenic E. coli (ETEC) (2%), rotavirus and ETEC (2%), rotavirus and Enteroaggregative E. coli (EAEC) (2%), Enteropathogenic E. coli (EPEC) (2%), Shigella flexneri type 3a (2%) and Ascaris (2%). RT-PCR and sequencing of amplicons of astroviruses from Kolkata, with specific primers targeted to the conserved domain of ORF1a (289 bp) of the astrovirus genome, showed maximum homology to the astrovirus strain ("5-158") from Seoul (98%). RESULTS AND CONCLUSIONS: Clinical characteristics of the diarrhoeic children in Kolkata indicated that astrovirus infections were detected throughout the year and were associated with varying degree of dehydration and acute watery diarrhoea. In-depth molecular epidemiological surveillance of astroviruses in Kolkata is essential for better understanding of their overall genetic nature.

Adult↗

Future perspectives and potential implications of cardiac myocyte apoptosis.

Recent advances in the understanding of the molecular mechanisms of apoptosis has gained increasing interest in the cardiovascular research community. Apoptotic myocyte loss has been detected in different cardiac disease states such as ischemic heart disease and congestive heart failure. In addition, some evidence for the molecular mechanisms in cardiac myocyte apoptosis has been evolving, although at present the implications thereof for clinical cardiac disease are not known in most of the cases. Based on these new insights, it is the intention of this article to highlight some topics in apoptosis research that might be of particular interest to define the future role and potentials of new therapeutic approaches aimed at preventing myocyte apoptosis.

Animals↗

Extent of antibiotic use in Taiwan shown by antimicrobial activity in urine.

Taiwan has high prevalence of antibiotic resistant, community-acquired respiratory pathogens. We investigated whether there was a high frequency of antibiotic use in the community. Antimicrobial activity in urine was detected in 55.2% of 1182 patients on arrival at an emergency department, 25.1% of 203 internal medicine out-patients, 7.6% of 471 high school students, and 7.4% of 202 people at a centre for senior citizens.

Adolescent↗

Coping resources of maltreated children in the family: a salutogenic approach.

OBJECTIVE: Most research in child maltreatment within family focuses mainly on the pathological damage caused to the battered child. This study, based on a salutogenic approach, focuses on the resources that may help maltreated children to cope with their state and stay well. METHOD: Resilience was measured by two variables: perceived competence and psychological distress. The moderating or buffering variables that may contribute to better coping were: sense of family coherence, psychological sense of school membership, and social support. Two hundred and twenty-six 8th graders answered an anonymous self-report inventory. Based on the students' answers, they were divided into two groups: those who reported that they had been maltreated (MC) (n = 81) and those who did not (NMC) (n = 145). RESULTS: The study revealed a significantly high percentage of adolescents (35.6%) who reported having been maltreated within their families. A significant difference was found between the MC and the NMC in levels of perceived competence (higher for the NMC) and psychological distress (higher for the MC group). The moderating variables were found to have a differential effect on the dependent variables within the two groups. Sense of family coherence was found to be the main contributor to variance explanation of perceived competence among the MC, while sense of school membership had the main effect among NMC. CONCLUSIONS: The findings support a salutogenic approach in studying maltreated children. Implications on the possible detection of maltreated children in the community and on their coping resources that may contribute to resilience are discussed.

Adaptation, Psychological↗