Analysis of prognostic factors of acute lymphoblastic leukemia in infants: report on CCG 1953 from the Children's Oncology Group.

Infant acute lymphoblastic leukemia (ALL) has a poor therapeutic outcome despite attempts to treat it based on prognostic factor-guided therapy. This is the first cooperative group trial characterizing all infants at the molecular level for MLL/11q23 rearrangement. All infants enrolled on Children's Cancer Group (CCG) 1953 were tested for MLL rearrangement by Southern blot and the 11q23 translocation partner was identified (4;11, 9;11, 11;19, or "other") by reverse-transcriptase polymerase chain reaction (PCR). One hundred fifteen infants were enrolled; overall event-free survival (EFS) was 41.7% (SD = 9.2%) and overall survival (OS) was 44.8% at 5 years. Five-year EFS for MLL-rearranged cases was 33.6% and for MLL-nonrearranged cases was 60.3%. The difference in EFS between the 3 major MLL rearrangements did not reach statistical significance. Multivariate Cox regression analyses showed a rank order of significance for negative impact on prognosis of CD10 negativity, age younger than 6 months, and MLL rearrangement, in that order. Toxicity was the most frequent cause of death. Relapse as a first event in CCG 1953 was later (median, 295 days) compared with CCG 1883 historic control (median, 207 days). MLL/11q23 rearrangement, CD10 expression, and age are important prognostic factors in infant ALL, but molecular 11q23 translocation partners do not predict outcome.

Effects of vascular endothelial growth factor on wound closure rates in the genetically diabetic mouse model.

Impaired wound healing is characteristic of diabetic patients. Potential reasons include poor inflammatory response, granulation tissue formation, and abnormal patterns of cytokine release and response. Vascular endothelial growth factor, abnormally regulated during healing in diabetics, is the major factor stimulating angiogenesis during normal wound healing. We tested our hypothesis that topically applied vascular endothelial growth factor would improve wound closure rates in diabetic animals in a full-thickness wound model in genetically diabetic mice (C57 BL/KsJ db/db). Animals received either 1.0 micro g of vascular endothelial growth factor165 or polyethylene glycol alone topically to wounds daily between days 0 and 4 post-wounding. Wound area was measured at days 0, 5, 10, 15, and 21. Data were analyzed using probit analysis and expressed as length-of-time (LT) to 50, 90, and 95% wound closure. Among untreated animals, nondiabetics had an LT50 of 8.5 days (fiducial limits 8.3-8.7), while diabetics had an LT50 of 15.8 days (15.6-16.1). Vascular endothelial growth factor-treated animals had LT50 values of 7.8 (7.6-8.1) and 11.8 days (11.6-12.0) for nondiabetics and diabetics, respectively, representing a 25% improvement in time to 50% closure in treated diabetics. We conclude that topically applied vascular endothelial growth factor improves time to wound closure in the genetically diabetic mouse model.

Assessment of emergency medicine residents' computer knowledge and computer skills: time for an upgrade?

OBJECTIVE: To describe emergency medicine residents' (EMRs') personal computer (PC) use and educational needs and to compare their perceived and actual PC skills. METHODS: This was a prospective, cross-sectional study. Subjects were all EMRs at seven midwestern Accreditation Council for Graduate Medical Education (ACGME) residency programs. The EMRs completed a questionnaire about their PC use and ability to perform 23 tasks derived from two national retail-training programs. The tasks covered word processing, slide making, and Internet use. The EMRs then took a three-part test performing the skills in the questionnaire. Two independent raters scored the tests. Frequencies with 95% confidence intervals (95% CIs) were calculated for categorical data. Positive and negative predictive values were used to report information comparing residents' performance with their self-assessment of skills. Cohen's kappa was used to test agreement between raters. RESULTS: One hundred twenty-four of 158 (79%) eligible EMRs participated. Since not all participants engaged in all parts of the study, the sample size varies between 121 and 124. One hundred one of 122 (83%; 95% CI = 75 to 89) owned a PC. The EMRs use home PCs a mean of 3.8 hours/week for physician duties and use residency PCs 1.9 hours/week (range 0-20). Ninety-six of 122 (79%; 95% CI = 70 to 86) EMRs reported no formal PC training during residency. Thirty-five percent (43/122; 95% CI = 27 to 44) passed the word-processing test and 50% (62/123; 95% CI = 41 to 60) passed the slide-making test. Reasons for failure were because of errors and not having a presentable product. Thirty-eight of 122 (31%; 95% CI = 23 to 40) failed the literature search, including 33 who said they could perform it. One hundred fifteen of 123 (94%; 95% CI = 88 to 98) EMRs were able to find an Internet address, including ten who stated they could not. Twenty-one percent of the residents who attempted any test (26/124; 95% CI = 14 to 29) passed all three tests. There was no association between year of training and success on the tests (p = 0.374). Thirty-seven of 115 (32%; 95% CI = 24 to 42) EMRs said they had insufficient PC training to meet their physician needs. CONCLUSIONS: Emergency medicine residents have much access to computer technology and possess some computer skills; however, many are unable to produce a usable product or conduct a literature search. Emergency medicine residents have not had sufficient computer training prior to residency. The computer skills of EMRs should be assessed through skills testing rather than self-assessment, and computer training during residency should be improved.