Is choline PET useful for identifying intraprostatic tumour lesions? A literature review.

More than 80% of patients with intermediate-risk or high-risk localized prostate cancer are cured with radiation doses of 74-78 Gy, but high doses increase the risk for late bowel and bladder toxicity among long-term survivors. Dose painting, defined as dose escalation to areas in the prostate containing the tumour, rather than to the whole gland, minimizes dose to normal tissues and hence toxicity. It requires accurate identification of the location and size of these lesions, for which functional MRI is the current gold standard. Many studies have assessed the use of choline PET in staging newly diagnosed patients. This review will discuss important imaging variables affecting the accuracy of choline PET scans, how choline PET contributes to tumour identification and is used in radiotherapy planning and how PET can improve the patient pathway involving prostate radiotherapy. In summary, the available literature shows that the accuracy of choline PET improves with higher tracer doses and delayed imaging (although the optimal uptake time is unclear), and tumour identification by MRI is improved by the addition of PET imaging. We propose future research with prolonged choline uptake time and multiphase imaging, which may further improve accuracy.

Using OR patient classification for staffing assignments.

Traditionally, one nurse is assigned per OR. Recent health care reforms and the AORN "Position statement on perioperative safe staffing and on-call practices" require managers to rethink this practice. Staffing levels that are insufficient have been linked to sentinel events. A patient classification system that includes patient acuity and procedure complexity can be used to determine which surgical procedures require more than one RN circulator and offer a scientific basis for increasing staff budgetary requests. The goal is to experience fewer sentinel events while providing better patient care and achieving higher nurse retention.

An educational pathway to fast track evidence-based practice at the bedside.

Enculturation of evidence-based practice (EBP) is a continuing challenge. This article describes a novel pathway for staff development educators to fast track the teaching-learning of the EBP skills set and the immediate full cycle application of the EBP process at point of care. The pathway, called EBP Literacy, offers an asynchronous stepwise approach to learning EBP in an iterative process from the bedside to bench side and back to the bedside.

Developing a perioperative educational video web site.

Nurses frequently have to adjust to changes in technology, particularly in the OR, but cataloging the wealth of resources commonly used in the OR (eg, equipment, supplies, how to use them) has not kept pace. To address this, I worked with the information systems administrative coordinator at the University of Texas Medical Branch, Galveston, to design and implement a perioperative intranet site that includes videos and fact sheets about equipment and supplies and that can be accessed by all perioperative staff members. This required promoting the idea and getting stakeholder sign-on, soliciting videotapes and DVDs and screening all submissions for appropriateness, choosing and formatting applicable resources for use on the site, working with members of the information systems department to create a web site after the video library was assembled, and helping staff members use and accept the site as a valuable educational resource. This intranet web site has been available to staff members for two years, and data from a recent survey of staff members and from mandatory intranet inservice compliance programs show evidence of its effectiveness.

G protein-coupled receptor 101 mRNA expression in supraoptic and paraventricular nuclei in rat hypothalamus is altered by pregnancy and lactation.

In a previous study performed in mouse models of energetic challenge, there was evidence to suggest that the orphan G protein-coupled receptor GPCR101 may have a role in the regulation of energy balance. To further investigate this possibility, we utilised in situ hybridisation to determine the effect of energetic challenges experienced by pregnant and lactating rats on GPCR101 mRNA expression. In the rat hypothalamus, GPCR101 mRNA expression was detected in a number of hypothalamic nuclei. During pregnancy and lactation, GPCR101 mRNA level remained unchanged in most nuclei, but had increased in the supraoptic nucleus by the end of pregnancy and remained elevated during lactation. GPCR101 mRNA expression showed a similar pattern of expression in the rostral ventromedial parvocellular subdivision of the paraventricular nucleus. A common feature of these two nuclei is the production of the peptide oxytocin. Dual in situ hybridisation revealed GPCR101 and oxytocin mRNA co-expression in neurons of these two nuclei. In the supraoptic nucleus, in situ hybridisation revealed that the temporal regulation of oxytocin and GPCR101 mRNA expression were similar. In the paraventricular nucleus, although temporal changes in oxytocin mRNA expression were similar to GPCR101, the spatial expression of the two mRNA species was different; in contrast to GPCR101, oxytocin mRNA expression changed in both parvo- and magnocellular neurons during lactation. In conclusion, increased GPCR101 mRNA expression in supraoptic and paraventricular nuclei from late pregnancy to late lactation may reflect the functional importance of this receptor in the regulation of neurons of these nuclei during this period.

PIXImus DXA with different software needs individual calibration to accurately predict fat mass.

OBJECTIVE: To validate GE PIXImus2 DXA fat mass (FM) estimates by chemical analysis, to compare previously published correction equations with an equation from our machine, and to determine intermachine variation. RESEARCH METHODS AND PROCEDURES: C57BL/6J (n = 16) and Aston (n = 14) mice (including ob/ob), Siberian hamsters (Phodopus sungorus) (n = 15), and bank voles (Clethrionomys glareolus) (n = 37) were DXA scanned postmortem, dried, then fat extracted using a Soxhlet apparatus. We compared extracted FM with DXA-predicted FM corrected using an equation designed using wild-type animals from split-sample validation and multiple regression and two previously published equations. Sixteen animals were scanned on both a GE PIXImus2 DXA in France and a second machine in the United Kingdom. RESULTS: DXA underestimated FM of obese C57BL/6J by 1.4 +/- 0.19 grams but overestimated FM for wild-type C57BL/6J (2.0 +/- 0.11 grams), bank voles (1.1 +/- 0.09 grams), and hamsters (1.1 +/- 0.13 grams). DXA-predicted FM corrected using our equation accurately predicted extracted FM (accuracy 0.02 grams), but the other equations did not (accuracy, -1.3 and -1.8 grams; paired Student's t test, p < 0.001). Two similar DXA instruments gave the same FM for obese mutant but not lean wild-type animals. DISCUSSION: DXA using the same software could use the same correction equation to accurately predict FM for obese mutant but not lean wild-type animals. PIXImus machines purchased with new software need validating to accurately predict FM.

Temporal changes in gene expression in the arcuate nucleus precede seasonal responses in adiposity and reproduction.

In anticipation of seasonal climate changes, Siberian hamsters display a strategy for survival that entails profound physiological adaptations driven by photoperiod. These include weight loss, reproductive quiescence, and pelage growth with shortening photoperiod and vice versa with lengthening photoperiod. This study reports gene expression changes in the hypothalamus of Siberian hamsters switched from short days (SD) to long days (LD), and also in photorefractory hamsters. Siberian hamsters were maintained in either LD or SD for 14 wk, conditions that generate physiological states of obesity under LD and leanness under SD. After 14 wk, SD lighting was switched to LD and gene expression investigated after 0, 2, 4, and 6 wk by in situ hybridization. Genes encoding nuclear receptors (RXR/RAR), retinoid binding proteins (CRBP1 and CRABP2), and histamine H3 receptor were photoperiodically regulated with significantly lower expression in SD, whereas VGF mRNA expression was significantly higher in SD, in the dorsomedial posterior arcuate nucleus. After a SD-to-LD switch, gene expression changes of CRABP2, RAR, H3R, and VGF occurred relatively rapidly toward LD control levels, ahead of body weight recovery and testicular recrudescence, whereas CRBP1 responded less robustly and rxrgamma did not respond at the mRNA level. In this brain nucleus in photorefractory animals, the CRABP2, RAR, H3R, and VGF mRNA returned toward LD levels, whereas CRBP1 and rxrgamma remained at the reduced SD level. Thus, genes described here are related to photoperiodic programming of the neuroendocrine hypothalamus through expression responses within a subdivision of the arcuate nucleus.