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Selected AbstractsA survey of language barriers from the perspective of pediatric oncologists, interpreters, and parentsPEDIATRIC BLOOD & CANCER, Issue 6 2006Marisa Abbe MA Abstract Background Oncologists in the US increasingly face the challenge of communicating with non-English speaking parents of children with cancer. This study explores this challenge from the perspectives of a sample of pediatric oncologists, interpreters, and Spanish-speaking parents of children with newly diagnosed leukemia. Procedure Thirty-seven oncologists and 17 professional language interpreters based at two non-profit pediatric hospitals in the US were surveyed on the topic of language barriers in pediatric care. Seventeen parents who communicated with their child's oncologist through an interpreter were also surveyed. Results All groups expressed considerable concern over the process of communicating across a language barrier. For oncologists, these concerns included the accuracy and completeness of interpretations, complexity of information, and loss of confidence and control over the communication process. For interpreters, they included complexity of information, information overload, and lack of clinician sensitivity toward the cultural and socioeconomic backgrounds of limited English proficiency (LEP) families. Parent concerns included difficulties comprehending information and anxiety over the possibility of missing out on important information. All groups provided multiple suggestions for improving communication across a language barrier. Conclusions Oncologists, interpreters, and parents expressed considerable concern over the process of communicating across a language barrier. Some of these concerns could be minimized through efforts to boost interpreter accuracy and completeness, including the use of more simple, easy to understand language. Other issues, such as differences in culture and socioeconomic background, warrant consideration of the intercultural knowledge and skills of interpreters. Pediatric Blood Cancer 2006;47:819,824. © 2006 Wiley-Liss, Inc. [source] Effect of ketamine anesthesia on daily food intake in Macaca mulatta and Cercopithecus aethiops,AMERICAN JOURNAL OF PRIMATOLOGY, Issue 10 2007Danielle A. Springer Abstract Ketamine hydrochloride is frequently administered to non-human primates as a means of chemical restraint. This procedure can be a frequent source of stress to monkeys at research facilities, impacting animal health, well-being and research quality. This study was designed to measure ketamine's effect on daily food intake, a parameter that reflects and influences animal well-being and directly impacts research studies. On five occasions, baseline daily food intake was compared to daily food intake occurring 24, 48, 72, 96, and 120,h after an intramuscular injection of 10,mg/kg ketamine in male African green monkeys (AGMs) (Cercopithecus aethiops) and male and female rhesus macaques (Macaca mulatta). AGMs and female rhesus macaques had significantly reduced daily food intake during the first 4 days after receiving ketamine. The AGMs continued to display significantly reduced daily food intake on the fifth day after ketamine. The male rhesus macagues showed a trend toward reduced daily food intake, greatest during the first 2 days and remaining less than baseline intake through the fifth day following ketamine. The degree of observed food intake reduction was most severe at the 24,h (mean percent intake reduction: AGMs: 57%; rhesus males: 48%; rhesus females: 40%) and 48,h time points (AGMs: 24%; rhesus males: 14%; rhesus females: 13%). A subset of the AGMs that did not receive ketamine, but observed other animals in the room receive ketamine, showed reduced food intake at 24 and 48,h after ketamine, though not to the degree associated with ketamine administration. These results indicate that ketamine anesthesia is associated with a prolonged reduction in daily food intake in AGMs and rhesus macaques. Frequent use of ketamine in non-human primates may have a significant impact on animal health and well-being, and alternatives to its use warrant consideration. Am. J. Primatol. 69:1080,1092, 2007. Published 2007 Wiley-Liss, Inc. [source] The Role of Intracranial Electrode Reevaluation in Epilepsy Patients After Failed Initial Invasive MonitoringEPILEPSIA, Issue 5 2000Adrian M. Siegel Summary: Purpose: Intracranial electrode recording often provides localization of the site of seizure onset to allow epilepsy surgery. In patients whose invasive evaluation fails to localize seizure origin, the utility of further invasive monitoring is unknown. This study was undertaken to explore the hypothesis that a second intracranial investigation is selected patients warrants consideration and can lead to successful epilepsy surgery. Methods: A series of 110 consecutive patients with partial epilepsy who had undergone intracranial electrode evaluation (by subdural strip, subdural grid, and/or depth electrodes) between February 1992 and October 1998 was retrospectively analyzed. Of these, failed localization of seizure origin was thought to be due to sampling error in 13 patients. Nine of these 13 patients underwent a second intracranial investigation. Results: Reevaluation with intracranial electrodes resulted in satisfactory seizure-onset localization in seven of nine patients, and these seven had epilepsy surgery. Three frontal, two temporal, and one occipital resection as well as one multiple subpial transection were performed. Six patients have become seizure free, and one was not significantly improved. The mean follow-up is 2.8 years. There was no permanent morbidity. Conclusions: In selected patients in whom invasive monitoring fails to identify the site of seizure origin, reinvestigation with intracranial electrodes can achieve localization of the region of seizure onset and allow successful surgical treatment. [source] Treatment of neutral glycosphingolipid lysosomal storage diseases via inhibition of the ABC drug transporter, MDR1FEBS JOURNAL, Issue 9 2006Cyclosporin A can lower serum, liver globotriaosyl ceramide levels in the Fabry mouse model We have shown that the ABC transporter, multiple drug resistance protein 1 (MDR1, P-glycoprotein) translocates glucosyl ceramide from the cytosolic to the luminal Golgi surface for neutral, but not acidic, glycosphingolipid (GSL) synthesis. Here we show that the MDR1 inhibitor, cyclosporin A (CsA) can deplete Gaucher lymphoid cell lines of accumulated glucosyl ceramide and Fabry cell lines of globotriaosyl ceramide (Gb3), by preventing de novo synthesis. In the Fabry mouse model, Gb3 is increased in the heart, liver, spleen, brain and kidney. The lack of renal glomerular Gb3 is retained, but the number of verotoxin 1 (VT1)-staining renal tubules, and VT1 tubular targeting in vivo, is markedly increased in Fabry mice. Adult Fabry mice were treated with ,-galactosidase (enzyme-replacement therapy, ERT) to eliminate serum Gb3 and lower Gb3 levels in some tissues. Serum Gb3 was monitored using a VT1 ELISA during a post-ERT recovery phase ± biweekly intra peritoneal CsA. After 9 weeks, tissue Gb3 content and localization were determined using VT1/TLC overlay and histochemistry. Serum Gb3 recovered to lower levels after CsA treatment. Gb3 was undetected in wild-type liver, and the levels of Gb3 (but not gangliosides) in Fabry mouse liver were significantly depleted by CsA treatment. VT1 liver histochemistry showed Gb3 accumulated in Kupffer cells, endothelial cell subsets within the central and portal vein and within the portal triad. Hepatic venule endothelial and Kupffer cell VT1 staining was considerably reduced by in vivo CsA treatment. We conclude that MDR1 inhibition warrants consideration as a novel adjunct treatment for neutral GSL storage diseases. [source] Endoscopic laser coagulation of feeding vessels in large placental chorioangiomas: report of three cases and review of invasive treatment optionsPRENATAL DIAGNOSIS, Issue 3 2009Waldo Sepulveda Abstract Objective To report three cases of large placental chorioangiomas managed with endoscopic laser coagulation of the feeding vessels, and review the literature regarding cases of chorioangioma treated with invasive techniques. Methods Intrauterine endoscopic surgery was performed using a 2.5-mm fetoscope under epidural anesthesia. Coagulation of the feeding vessels was attempted with laser energy, and the operation was completed with amniodrainage. Results The feeding vessels were successfully coagulated in one case, resulting in a term delivery. Histopathologic examination of the placenta confirmed a capillary chorioangioma with extensive necrosis. There were intraoperative complications in the other two cases, including bleeding at the site of coagulation requiring intrauterine transfusion in one, and incomplete vascular ablation in the other. In the former case the infant was born prematurely and developed chronic renal insufficiency. In the latter, the fetus died within the first week of the surgery. Conclusions There are limited interventions available for the management of large, symptomatic placental chorioangiomas. Although they can be treated with endoscopic laser coagulation of the feeding vessels, fetal bleeding, exsanguination, and death are potential complications of the procedure; therefore, this technique should be used with caution. The role of this treatment modality in the early devascularization of placental chorioangiomas prior to the development of significant complications warrants consideration. Copyright © 2009 John Wiley & Sons, Ltd. [source] Prevalence and correlates of excessive daytime sleepiness in high school students in KoreaPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 4 2005SOONJAE JOO phd Abstract, The purpose of the present study was to determine the prevalence of excessive daytime sleepiness (EDS) and its associations with sleep habits, sleep problems, and school performance in high school students in South Korea. A total of 3871 students (2703 boys and 1168 girls with a mean age of 16.8 years and 16.9 years, respectively) aged 15,18 years in the 11th grade of high school completed a questionnaire that contained items about individual sociodemographic characteristics, sleep habits, and sleep-related problems. The overall prevalence of EDS was 15.9% (14.9% for boys and 18.2% for girls). Mean reported total sleep time was similar in EDS and non-EDS (6.4 ± 1.6 and 6.4 ± 1.3 h/day, respectively). The increased risk of EDS was related to perceived sleep insufficiency (P < 0.001), teeth grinding ,,4 days/week (P < 0.001), witnessed apnea ,1,3 days/week (P < 0.01), nightmares ,4 days/week (P < 0.05), low school performance (P < 0.01), and two or more insomnia symptoms (P < 0.05). Students with low school performance had a 60% excess in the odds of EDS compared to those whose school performance was high. These findings suggest that EDS is associated with multiple sleep-related factors in adolescents. Whether interventions to modify associated correlates can alter EDS warrants consideration, especially because it may also improve academic performance in high school students. [source] Differences in histopathological and biochemical outcomes in patients with low Gleason score prostate cancerBJU INTERNATIONAL, Issue 6 2010Hendrik Isbarn Study Type , Diagnosis (case series) Level of Evidence 4 OBJECTIVE To test whether the number or percentage of positive biopsy cores can be used to discriminate between patients with prostate cancer of a favourable and less favourable Gleason score (GS) ,3 + 3, as prognostically, not all GS 3 + 3 prostate cancers are the same. PATIENTS AND METHODS In all, 1106 consecutive patients with a prostate-specific antigen (PSA) level of ,10 ng/mL and a biopsy GS of ,3 + 3 or 3 + 4 had an open radical prostatectomy. The number of positive biopsy cores (,2 vs ,3) were stratified into low- vs high-risk groups. Subsequently, we stratified patients according to the GS and the percentage of positive biopsy cores (<50% vs ,50%). The pathological stage and the 5-year biochemical recurrence (BCR)-free survival rates were examined in univariable and multivariable models. RESULTS Based on the number of positive cores, the rate of extraprostatic disease was 11.7% and 23.3%, respectively, in the low-and high-risk GS ,3 + 3 groups (P < 0.001). The 5-year BCR-free survival rates were 95.0%, 77.8%, 81.2% and 66.5% for, respectively, low- and high-risk GS ,3 + 3 and for low- and high-risk GS 3 + 4 patients. Univariable and multivariable intergroup BCR rate differences were statistically significant between low- vs high-risk GS 3 + 3 patients (P < 0.001), but not significant between high-risk GS ,3 + 3 vs low-risk GS 3 + 4 patients (P = 0.6). Comparable results were obtained when comparisons were made according to the percentage of positive biopsy cores. CONCLUSIONS Our results corroborate the finding that not all patients with a biopsy GS of ,3 + 3 prostate cancer have low-risk disease. High-risk GS ,3 + 3 patients have a similar risk profile as more favourable GS 3 + 4 patients. This finding warrants consideration when deciding on treatment. [source] | |||||||||||||