Self-efficacy to overcome exercise barriers in individuals with cancer-related lymphedema.

Although cancer survivors are recommended to exercise, they may lack confidence (self-efficacy) to be active. This research aimed to measure exercise barriers and related selfefficacy in individuals with cancer-related lymphedema as well as examine relationships between self-efficacy and participant characteristics. A cross-sectional survey was undertaken in individuals with cancer-related lymphedema using a validated 14-item Likert scale assessing self-efficacy to overcome general and lymphedema-specific exercise barriers (0%=not at all confident, 100%=extremely confident). Demographic, medical and lymphedema data were also collected. Of 109 participants (52% response), 79% (n=86) had breast cancer-related lymphedema. Participants were found to be moderately confident to exercise when facing general (48% [95% CI: 44, 52]) and lymphedema- specific exercise barriers (51% [95% CI: 47, 55]). Participants who were female, sedentary (p<0.05), had lymphedema for ≥2 years, and reported greater symptom burden (p<0.05) recorded lower general exercise barriers selfefficacy. Lower lymphedema-specific exercise barriers self-efficacy was reported by individuals who were sedentary, had cancers other than breast, and higher symptom burden. These findings suggest general and lymphedema- specific barriers challenge exercise confidence in those with cancer-related lymphedema, and strategies tailored to improve confidence in overcoming exercise barriers are warranted. Supporting individuals to be sufficiently active during and following cancer treatment should consider behavior change strategies tailored to the unique needs faced by individuals with lymphedema.

THE PITTING TEST; AN INVESTIGATION OF AN UNSTANDARDIZED ASSESSMENT OF LYMPHEDEMA.

Soft tissue pitting is the occurrence of a temporary indentation on the body surface after the release of sustained thumb or finger pressure. In the management of lymphedema, presence or absence of pitting can contribute to clinical reasoning and guide healthcare management. However, the pitting test and its application has not been described consistently nor is it a standardized part of assessment. Therefore investigations are needed to assess the outcome measures of pitting identification and characterization of lymphedematous tissue. To determine valid testing parameters for a future study, we evaluated six therapists of varying lymphedema experience who assessed a range of locations on six patients with lymphedema representing the breadth of pitting assessment techniques used clinically. The consequence of an unstandardized assessment is demonstrated by the large variation in techniques observed for test duration (1.1 to 76.0 seconds), pressure (1.3 to 14.4 N/cm2) and contact area (0.2 to 6.8 cm2). Experienced therapists performed the pitting test with a significantly different technique from their inexperienced counterparts, involving a longer duration (p < 0.001), higher pressure (p < 0.001) and a larger contact area (p < 0.001). The results of this pilot study support the need for evaluation of the underlying tissue response to sustained pressure and release, in order to inform the development of a standardized procedure.

Selenium absorption and retention from a selenite- or selenate-fortified milk-based formula in men measured by a stable-isotope technique.

The present study was designed to determine the apparent absorption and retention of the inorganic Se compounds SeO3(2-) and SeO4(2-), which are commonly used for Se fortification of clinical nutrition products and infant formulas. Ten healthy men were fed a milk-based formula labelled with 40 microg Se as 74SeO3(2-) or 76SeO4(2-) on two consecutive days using a randomised crossover design. Se stable-isotope analysis of 9 d complete collections of urine and faeces was used to calculate apparent Se absorption and retention. Se retention from 74SeO3(2-) (41.0 (SD 8.4) %) and from 76SeO4(2-) (46.0 (SD 7.9) %) was not significantly different (P > 0.05). However, Se absorption was significantly higher from SeO4(2-) than from SeO3(2-) (91.3 (SD 1.4) % v. 50.2 (SD 7.8) %, P < 0.05). Urinary excretion of the administered dose was 9.2 (SD 1.8) % for 74SeO3(2-) and 45.3 (SD 8.2) % for 76SeO4(2-) (P < 0.05). Urinary Se excretion kinetics differed significantly for the two Se compounds; 90 % of the total urinary Se was excreted after 121 h for 74SeO32- and after 40 h for 76SeO42- These results suggest that although Se absorption and urinary excretion differ for SeO3(2-) and SeO4(2-), both Se compounds are equally well retained when administered at a relatively low dose (40 microg Se). The nutritional impact of Se fortification of foods would thus be expected to be similar when SeO4(2-) or SeO3(2-) are used.

[The ZEBET database on alternative methods to animal experiments in the Internet--a concrete contribution to the protection of animals]. / Die ZEBET-Datenbank über Alternativen zu Tierversuchen im Internet - ein konkreter Beitrag zum Schutz von Versuchstieren.

Up from February of the year 2000 ZEBET (German Centre for the Documentation and Validation of Alternative Methods) at the Federal Institute for Consumer Health Protection and Veterinary Medicine (BgVV) put the ZEBET-database on alternative methods to animal experiments on the Internet in English via DIMDI, the German Institute for Medical Documentation and Information (http://gripsdb.dimdi.de/engl/guieng.html). The access is free, moreover DIMDI's complete service is available to visitors of the ZEBET-database. The ZEBET database contains documents on alternatives to testing in animals, which have been carefully evaluated by ZEBET's staff according to the "3Rs"-concept established by Russel and Burch in 1959. Therefore, methods documented in the ZEBET database must meet at least one of the following criteria: "replacement" of an animal experiment by a non-animal method, "reduction" of the number of animals used, "refinement" of an experiment by minimising pain and suffering of animals. In addition, the ZEBET-database provides information on the current stage of development and validation of a method and on the acceptance for either scientific or regulatory purposes. Each document is characterised by the following criteria: the title of a method, keywords, assessment, summary and bibliographic references. To search DIMDI<

Neglected traumatic posterior dislocations of the shoulder: controversies on indications for treatment and new CT scan findings.

We report seven missed traumatic posterior dislocations of the shoulder in six patients. In all seven shoulders, anteroposterior radiographs did not provide the diagnosis in the emergency room after the trauma (epileptic seizure in four patients) and diagnosis was delayed for at least 24 h. The final diagnosis was reached by clinical suspicion and computed tomography (CT) scan of the seven shoulders. Two shoulders were treated by closed reduction and three were treated by closed reduction and percutaneous pinning, although four of these five shoulders presented a defect in the humeral head involving 20%-25% of the articular surface. Two shoulders dislocated for more than 6 months were treated according to Mc Laughlin's technique modified by Hawkins instead of an arthroplasty. At a minimum follow-up of 2 years and 2 months, the functional results according to Hawkins were good in all seven shoulders. There was no recurrence of the dislocation in any patient. Radiographs showed mild degenerative changes. The establishment of indications for treatment, based on the proportion of articular surface of the humeral head involved and the time of evolution of the dislocation, needs more clinical or experimental evidence. In epileptic patients, strict control of medication is of the utmost importance.

Behavior of Ochratoxin A during Green Coffee Roasting and Soluble Coffee Manufacture.

As considerable inconsistencies are found in the literature regarding the influence of roasting and subsequent operations on the ochratoxin A (OTA) content of green coffee, experiments were undertaken to assess the evolution of OTA along an industrial soluble coffee manufacturing line. Both the variability and the amount of OTA naturally present in a lot of Thai Robusta green coffee were drastically reduced during soluble coffee manufacture. A small proportion of OTA was eliminated during green coffee cleaning, but the most significant reduction took place during roasting. The roast and ground coffee contained only 16% of the OTA originally present in the green coffee. Two phenomena are responsible for the elimination of OTA during roasting: a thermal degradation and a removal with chaff. Thermal degradation is the most important route of elimination, with <20% accounted for by the chaff. A further 20% reduction was observed during soluble coffee manufacture, so that the powder contained only 13% of the OTA initially present in the green beans.

Formation and persistence of DNA adducts of 2-amino-3-methylimidazo[4,5-f]quinoline in the rat and nonhuman primates.

The formation and persistence of the two principal DNA adducts of the food derived carcinogen 2-amino-3-methylimidazo[4,5-f]quinoline (IQ) have been investigated in rats and nonhuman primates. DNA adduct formation in the liver of male Fischer-344 rats occurred in a dose-dependent manner (0.01-20 mg/kg) where N-(deoxyguanosin-8-yl)-2-amino-3-methylimidazo[4,5-f]quinoline (dG-C8-IQ) and 5-(deoxyguanosin-N2-yl)-2-amino-3-methylimidazo[4,5-f] quinoline (dG-N2-IQ) accounted for approximately 60-80% and 20-40%, respectively, of the total adducts observed by 32P postlabeling. Similar DNA adduct profiles were observed in kidney and colorectal tissue of rats given a single oral dose of IQ (20 mg/kg) which, when given chronically to this species, results in tumorigenesis in liver and colorectum, but not in kidney. dG-C8-IQ was removed more rapidly than dG-N2-IQ from liver and kidney, but removal of both adducts from the colorectum closely followed cell replication. Similar DNA adduct profiles were observed in liver and extrahepatic tissues of nonhuman primates following a single dose of IQ (20 mg/kg). In chronically treated monkeys undergoing carcinogen bioassay, there was a sharp increase in the contribution of dG-N2-IQ to total DNA adducts in all slowly dividing tissues. There was no preferential accumulation of dG-N2-IQ in the colon, a tissue with a high rate of cell division, and dG-C8-IQ remained the predominant lesion. These findings point to a preferential removal of the dG-C8-IQ adduct by enzyme repair system(s) in slowly dividing tissues in both rats and nonhuman primates.

Calcium bioavailability from a calcium- and sulfate-rich mineral water, compared with milk, in young adult women.

Some mineral waters have a high calcium content and may contribute a significant part of the human daily requirements. Calcium bioavailability from a calcium- and sulfate-rich mineral water (CS-W) containing 11.2 mmol Ca/L (467 mg/L) was compared with that from milk in nine healthy young women. Calcium absorption was measured in the fasting state with a dual-label stable-isotope technique. Fractional absorption rates from milk and CS-W were 25.0 +/- 6.7% and 23.8 +/- 4.8% (means +/- SD), respectively, and did not differ significantly (P = 0.05). Urine was collected for 36 h after the administration of the oral stable isotope while the subjects consumed a controlled diet and a quantity of milk or CS-W providing 25 mmol (1000 mg) Ca. No significant difference was found in the excretion of calcium, nor in the excretion of the two stable isotopes. Mean urinary sulfate excretion was significantly increased by 35% when the CS-W was consumed. No significant correlation was found between 36-h urinary excretion of the intravenous calcium tracer and sulfate, sodium, or urine volume. Therefore, calcium from the CS-W was as well absorbed and retained as that from milk, and no calciuric effect of sulfate was found, showing that such mineral waters can be valuable dietary sources of calcium.

Zinc absorption in healthy elderly humans and the effect of diet.

Absorption of a zinc stable isotope was measured on two consecutive occasions in nine young and eight elderly healthy men aged 24-40 and 70-83 y, respectively. A zinc stable-isotope label (0.8 mg 70Zn) was added to a test meal of either high or low zinc bioavailability, depending mainly on phytic acid content. Zinc absorption from the high-bioavailability test meal was not significantly different (P > 0.05) in the young (38.9 +/- 9.8%, mean +/- SD) and elderly (35.0 +/- 10.9%) subjects. Zinc absorption from the low-bioavailability test meal was 40% and 43% lower, at 23.4 +/- 10.2% and 19.8 +/- 6.1% in these young and elderly men, respectively. Again, no significant effect of age was found. These results show that aging does not lead to nutritionally relevant changes in zinc absorption and in the effect of dietary inhibitors on zinc absorption. Thus, zinc absorption ability seems to be preserved in healthy elderly people, at least until the age of 80 y.

Acceptance of isotonic and hypotonic rehydrating beverages by athletes during training.

This study compared the acceptance of two beverages (5% carbohydrate) of distinct osmolarities (hypotonic, 180 mOsm/kg and isotonic, 295 mOsm/kg) during the usual training practice of 97 athletes. A quantitative sensory profile by independent tasters ensured that organoleptic recognition would be unlikely during the tests. Each drink was consumed ad libitum during 3 different training sessions, at home. At each session, a subjective appreciation of hedonic and post-ingestive physiological effects (6 criteria) was obtained by means of a questionnaire. At the end of the experiment, the athletes were asked to express a preference for one of the "six" drinks. More athletes (blindly) chose the isotonic compared to the hypotonic drink (p = 0.03). This difference was not due intrinsically to the drinks, which the subjects were unable to distinguish on any of the criteria, but was related to certain aspects of the consumer's characteristics. Both groups had different drinking practices: the subjects choosing the isotonic beverage drank less before (p = 0.001) and more during (p = 0.013) the exercise. Age, sex, dimensions or type of physical activity (i.e. endurance vs speed/strength disciplines) were unrelated to the preference, except perhaps the duration of habitual exercise (p less than 0.05). We concluded that athletes, although unable to distinguish a hypotonic from an isotonic drink, may have specific habits and/or personal characteristics prompting them to favour one of them.

The motor performance of preschool-aged children after surgery for congenital heart disease.

This study compared the motor performance of preschool-aged children who had undergone surgery for congenital heart disease with that of a group of children matched for age, sex, preschool experience, racial and socio-economic background. Analysis of the results indicated that the performances of the children with congenital heart disease were significantly immature compared to the performances of the control children on the total assessment and in the areas of gross motor, muscle strength, fine motor, tone and postural reactions. Sex, age at first surgical intervention and presence of a cyanotic heart defect did not influence the performances of the study group children. Age at assessment and socio-economic background were found to influence motor performances. The need for physiotherapists to be involved in the follow-up of children with congenital heart disease is supported.

Induction of growth-related metabolism in human vascular smooth muscle cells by low density lipoprotein.

Human vascular smooth muscle cells (hVSMC) rendered quiescent by maintenance under serum-free culture conditions for 48 h exhibited several metabolic responses, normally associated with proliferation, following exposure to low density lipoprotein (LDL). LDL induced a time- and dose- (half-maximally effective concentration, ED50 25.0 +/- 8 nM) dependent activation of S6 kinase which could be negated following pretreatment of hVSMC with 12-O-tetradecanoylphorbol-13-acetate (TPA) for 48 h. In myo-[3H]inositol-prelabeled hVSMC, LDL caused a rapid (maximum within 1 min) decrease in phosphatidylinositol 4,5-bisphosphate (35% p less than 0.001) and phosphatidylinositol 4-phosphate (20%, p less than 0.01) with a return to prestimulated levels within 5-10 min. LDL induced a concomitant increase in [3H]inositol phosphates for which the order of generation was inositol-tris greater than -bis greater than -mono phosphate and which reached threshold levels of significance (p less than 0.05) above control values within 1, 2, and 10 min, respectively. The effect of LDL on hVSMC phosphoinositide metabolism was dose-dependent (half-maximally effective concentration, ED50 32.1 +/- 5.0 nM). This concentration, like that for S6 kinase, approximates with the KD (5-21 nM) for high affinity binding of 125I-LDL to specific receptors (1.5 x 10(4) sites/cell) on hVSMC. LDL induced a rapid but transient translocation of protein kinase C from the cytosol to membranes as assessed using both immunoblotting and [3H] 4-beta-phorbol-12-13-dibutyrate-binding procedures. Exposure of quiescent hVSMC to LDL elevated intracellular pH (delta pH 0.30 +/- 0.03, p less than 0.001). Such alkalinization was prevented in the presence of Na+/K+ exchange inhibitors such as amiloride, dimethylamiloride, and ethylisopropylamiloride. In an investigation of the nuclear action of LDL, a time-dependent induction of both c-myc and c-fos was observed. Such LDL-induced expression of these nuclear proto-onco-genes was not detectable in protein kinase C down-regulated hVSMC. Nevertheless, in spite of the cascade of "growth-promotional" responses elicited by LDL in quiescent hVSMC, this lipoprotein alone (under serum-free conditions) was neither mitogenic in nuclear labeling experiments, nor could it support growth of hVSMC in culture. We demonstrate that LDL might function in a complementary/synergistic fashion with other weakly mitogenic (to VSMC) growth factors and suggest that activation of protein kinase C (vis à vis intrinsic tyrosine kinase characteristic of other growth factor receptors) may be crucial to the signal transduction pathway for LDL.

Quantitative comparison of bromoacetylated derivatives of alprenolol and pindolol on beta-adrenergic receptor binding and mobility in S49 cells.

The reactivities with beta-adrenergic receptors of the bromoacetyl derivatives of the beta-adrenergic antagonists alprenolol and pindolol, BAAM and BIM, respectively, were compared in intact S49 mouse lymphoma cells. Both compounds caused irreversible blockade of receptors and changes in the mobility of the remaining non-modified receptors. BIM proved to be an irreversible blocker of high potency, with an IC50 of 40-60 nM at 4 degrees C, whereas the IC50 for BAAM was 600-900 nM. Moreover, treatment with both compounds resulted in an inhibition of internalization of non-modified receptors (IC50 = 200-300 nM for both). After treatment of desensitized cells which have internalized 50-60% of their surface receptors, with BIM or BAAM, receptor reappearance was found to be slowed down (IC50 about 100 nM for both compounds). The effects of the bromoacetylated antagonists on receptor internalization were apparently selective for beta-adrenergic receptors, since binding and internalization of transferrin or low-density lipoprotein were not affected.

Changes in beta-adrenoceptors and leucocyte subpopulations after physical exercise in normal subjects.

Seven healthy volunteers were subjected to standardized bicycle ergometry. Before and at the end of exercise, leucocyte and lymphocyte subset distribution was assessed by immunofluorescence labelling with monoclonal antibodies and the cytofluorograf. Competition binding studies were performed on mononuclear leucocytes with a fixed amount of the radioligand 125I-(-)-cyanopindolol (125I-CYP) and increasing concentrations of the hydrophilic ligand (-)4-(3-tertiary-butylamino-2-hydroxypropoxy)-benzimidazol-2-one hydrochloride (CGP-12177). Total numbers of beta-adrenoceptors per cell and the receptor-ligand affinities were then derived by computer analysis. In separate experiments with blood obtained from resting subjects, beta-adrenoceptor numbers of lymphocyte subsets, which had been sorted by the fluorescence activated cell sorter, were determined by saturation binding of 125I-CYP. During exercise there was a twofold increase in total leucocyte numbers. The ratio between monocytes (4%) and lymphocytes (55%) remained constant, but the composition of lymphocyte subsets had changed. A twofold increase was observed for the lymphocyte population carrying the Leu-7 and the CD8 antigens or only the Leu-7 antigen, whereas the number of B cells and CD4 positive T cells increased only slightly. The lymphocyte phenotype changes appeared after 3 min, reached a maximum at the end of ergometry and had disappeared 30 min after exercise. Exercise led to a doubling of the number of beta-adrenoceptors in unseparated mononuclear leucocytes from 240 +/- 46 to 535 +/- 190 sites per cell (SD, n = 6). beta-Adrenoceptor numbers were higher on sorted Leu-7 positive cells (KD 14 +/- 6 pmol/l, Bmax 1174 +/- 233 sites/cell) and on CD8 positive cells (KD 145 +/- 79 pmol/l, Bmax 1577 +/- 670 sites/cell) than on monocytes (KD 39 +/- 31 pmol/l, 647 +/- 91 sites/cell). Very low specific 125I-CYP binding was found on Leu-7 and CD8 negative cells (less than 0.2 pmol/l). Before exercise the displacement curves with CGP-12177 fitted best a single site model, whereas after exercise 12% of the receptors were in a low affinity state for CGP-12177 indicating internalized receptors. (ABSTRACT TRUNCATED AT 250 WORDS)

Similarities in cAMP responses between murine lymphoid cell lines and subsets of mouse lymphocytes.

Intracellular cAMP responses to forskolin (which stimulates independently of hormone receptors) and to several hormones were studied in mouse lymphoid cell lines of B- and T-cell origin and in subpopulations of mouse lymphocytes. In the T-cell lines, isoproterenol caused an increase in cAMP amounting at most to 28% of that caused by 100 microM forskolin. In contrast, in the B-cell lines the increase ranged from 50% to over 100%. In 11 of 13 T-cell lines, forskolin at 1 microM concentration potentiated the isoproterenol response five- to tenfold. Forskolin potentiation was also found in thymocytes and peripheral T-cells but not in B-cell lines. The relative increases in intracellular cAMP evoked by isoproterenol, prostaglandin E2 (PGE2) and histamine varied markedly from cell line to cell line. For instance, three lines carrying the T-helper cell marker L3T4 responded only to PGE2 and not to isoproterenol, whereas two cell lines carrying the Ly2 marker gave a higher response to isoproterenol than to PGE2. The results indicate that subsets of lymphocytes respond differently to various hormones and that these differences are maintained in continuous cell lines.

Bromoacetylalprenololmenthane binding to beta-receptors modulates the rate of hormone-induced internalization but not desensitization in S49 cells.

Bromoacetylalprenololmenthane was found to inhibit hormone-induced beta-adrenergic receptor internalization in a dose-dependent fashion in S49 lymphoma cells, besides its known ability to bind to beta-receptors irreversibly. This new found property of BAAM+ was taken advantage of in studying whether receptor internalization is a necessary step in the desensitization of adenylate cyclase. BAAM-treated cells showed functional desensitization even when receptor internalization had been blocked substantially by 50-65%. This finding suggests that receptor internalization is not directly involved in desensitization.

Instant and brewed coffees in the in vitro human lymphocyte mutagenicity test.

Incubation of instant and 'home brew' coffees (caffeinated and decaffeinated) and of coffee aroma with cultured human lymphocytes in the presence and absence of S-9 increased the number of total aberrations. However, the increase was smaller in the presence of S-9 than in its absence. Pure caffeine tested with or without S-9 at doses equivalent to levels in caffeine-containing coffee did not give statistically significant increases of any type of aberration when compared with controls. In all in vitro test systems used to date, coffee and coffee aroma or their reactive compounds were metabolically deactivated in the presence of S-9. This could explain the negative results obtained in mutagenicity assays in vivo.

Aqueous extract of valerian root (Valeriana officinalis L.) improves sleep quality in man.

The effect of an aqueous extract of valerian (Valeriana officinalis L.) root on subjectively rated sleep measures was studied on 128 people. Each person received 9 samples to test (3 containing placebo, 3 containing 400 mg valerian extract and 3 containing a proprietary over-the-counter valerian preparation). The samples, identified only by a code number, and presented in random order, were taken on non-consecutive nights. Valerian produced a significant decrease in subjectively evaluated sleep latency scores and a significant improvement in sleep quality: the latter was most notable among people who considered themselves poor or irregular sleepers, smokers, and people who thought they normally had long sleep latencies. Night awakenings, dream recall and somnolence the next morning were relatively unaffected by valerian. With the proprietary valerian-containing preparation, the only change was a significant increase in reports of feeling more sleepy than normal the next morning. Thus the questionnaire, simple to use and non-invasive, provides a sensitive means for detecting the effects of mild sedatives on different aspects of sleep in man. It also allows identification within the test population of the subgroups most affected.