The effects of traffic light labelling versus cartoon labelling on food and beverage purchases in a children's hospital setting.

This study's purpose was to examine changes in healthy and unhealthy items purchased following the implementation of traffic light and cartoon labelling in a small retail food venue (Café Bay) in a children's hospital in eastern North Carolina. Between October 2015 and March 2016, daily food and beverage sales from Café Bay were obtained during baseline, traffic light labelling, a washout period, cartoon labelling (on healthy foods only) and a final washout period. Pearson chi-squared tests and multiple linear regressions were used to examine effects of labelling strategies, controlling for the holidays. In unadjusted analyses, traffic light labelling was associated with significant decreases in purchases of unhealthy items purchased, while cartoon labelling was associated with increases in unhealthy items purchased. In adjusted linear regression analysis, traffic light labelling was associated with fewer unhealthy purchases and thus may have potential to decrease the amount of unhealthy items purchased in a children's hospital food retail venue.

The calcium-sensing receptor stimulates JNK in MDCK cells.

The calcium-sensing receptor (CaR) stimulates ERK1 in rat fibroblasts, but its effect on other MAP kinases is not known. We used a model of renal distal tubule, the MDCK cell, to determine the effects of CaR stimulation on Jun kinase (JNK) activity. Stimulation of the CaR with 5 mM Ca(2+) resulted in a time-dependent increase in JNK activity. Activation of JNK occurred preferentially with stimulation on the basal surface relative to the apical surface. Basal administration of the CaR agonist gadolinium (30 microm) also stimulated JNK activity. Pertussis toxin blocked the ability of both CaR agonists to stimulate JNK, indicating that the effect was mediated through G(ialpha) class G proteins. Finally, we used confocal microscopy to determine that the CaR was located predominantly on the basal surface. These studies demonstrate for the first time that the CaR stimulates JNK activity.

Multiple cutaneous basal cell carcinomas: glutathione S-transferase (GSTM1, GSTT1) and cytochrome P450 (CYP2D6, CYP1A1) polymorphisms influence tumour numbers and accrual.

The genetic factors that mediate the pathogenesis of multiple primary cutaneous basal cell carcinomas (BCC) are largely unclear. Thus, some patients suffer many BCC (>30) and/or rapid accrual (number of tumours/year from first presentation) of further lesions. We have studied, in 827 English Caucasians, the influence of polymorphism in carcinogen-metabolizing enzymes on susceptibility to this cancer. Accordingly, we describe, first, a cross-sectional analysis of the influence of GSTM1, GSTT1, CYP2D6 and CYP1A1 genotypes on tumour numbers, and secondly, a longitudinal analysis, in 169 of these cases, of the effect of these genes on tumour accrual. We have confirmed the expected importance of age and number of lesions at presentation, and male gender and skin type as risk factors. Furthermore, the cross-sectional analysis showed CYP1A1 m1m1 (P = 0.004; rate ratio 1.242) and CYP2D6 EM (P < 0.001, rate ratio 1.266) are associated with increased numbers of BCC. The longitudinal study showed, after adjustment for age and tumour number at presentation, that GSTT1 null (P < 0.001, rate ratio 2.677) and CYP2D6 EM (P < 0.001, rate ratio 2.154) were significant determinants of accrual while CYP1A1 Ile/Ile was associated with slower accrual than the Ile/Val and Val/Val genotypes (P = 0.008, rate ratio 0.690). We believe these are the first genetic factors to be associated with tumour accrual. No significant interactions between genotypes were identified, though the combinations GSTM1 null/skin type 1 (P < 0.001, rate ratio 2.702), CYP2D6 EM/male gender (P = 0.049, rate ratio 1.279) and CYP2D6 EM/blue+green eyes (P = 0.046, rate ratio 1.388) influenced tumour numbers. Previous studies indicate the importance of effective repair of UV-damaged DNA in the pathogenesis of multiple BCC; indeed the influence of GSTM1 may result from its ability to utilize 5'-hydroxymethyluracil. However, the finding that CYP2D6 and CYP1A1 influence tumour numbers and accrual indicates detoxification of unknown molecules is important and supports the view that factors other than UV are important in the pathogenesis BCC.

[Mucocutaneous lentiginosis, ephelides and cardiac myxoma]. / Lentiginose cutanéo-muqueuse, éphélides et myxome cardiaque.

Abnormalities of skin pigmentation are known to be associated sometimes with cardiovascular diseases. Such cases have been reported first in 1954 (14), then in 1962 (16) and 1966 (11), leading to the individualization of the leopard syndrome. In 1973 Rees et al. (21) described a lentiginosis, cardiac myxoma association, and this in turn resulted, in 1985, in a new syndrome (4) supported by several similar findings. We report here a new case with this association.

Toxic epidermal necrolysis. Clinical findings and prognosis factors in 87 patients.

Eighty-seven patients with toxic epidermal necrolysis were observed at Hôpital Henri Mondor in Créteil, France, over the last 12 years. The mean percentage of body surface area involved was 39%. Erosive mucous membrane lesions, identical to those of Stevens-Johnson syndrome, were present in all but three cases. Necrolysis was sometimes generalized within 24 hours but usually spread progressively after a Stevens-Johnson syndrome-like aspect at the onset. Mortality was 25%. Infection, mainly with Staphylococus aureus and Pseudomonas aeruginosa, was the first cause of death, clearly responsible in ten of 20 cases. Age, extension of necrolysis, idiopathic nature of toxic epidermal necrolysis, ingestion of many drugs, elevation of urea, creatinine, and glucose levels, neutropenia, lymphopenia, and thrombocytopenia were statistically linked to a bad prognosis. A multivariant analysis showed that three of these prognosis factors are of paramount importance, namely: age, area of necrolysis, and serum urea level. Pigmentary changes and sicca syndrome were frequently observed sequelae in survivors.

Pulmonary manifestations of rheumatoid arthritis.

The catalogue of respiratory complications of rheumatoid arthritis has grown steadily in recent years. Physiological testing has highlighted surprisingly frequent asymptomatic disease while other respiratory problems are still rare. These and other pulmonary manifestations are discussed.

Diagnostic accuracy of cytology and biopsy in primary bronchial carcinoma.

The accuracy of diagnosis in 656 patients with the four common histopathological types of primary lung cancer has been assessed by comparing the cell type diagnosis made on cytological and histological investigation with that determined by examination of the surgically resected or necroscopy specimen. The accuracy of diagnosis achieved by cytological examination of sputum and bronchial aspirate, and by bronchial biopsy histology was over 85%. The least accurate diagnostic procedure was percutaneous needle biopsy (62%). Squamous and small cell tumours were accurately diagnosed by all four investigations but errors were made in the diagnosis of large cell and adenocarcinomas. Nearly half the number of patients (43%) with large cell carcinoma were later reclassified as having squamous carcinoma and of the patients with adenocarcinoma 32% had been predicted to be squamous and 18% large cell carcinoma. We consider such quality control of pretreatment diagnosis mandatory in management of individual patients and before enrollment in clinical trials.

Comparison of intravenous and inhaled terbutaline in the treatment of asthma.

In a double-blind crossover controlled study, intravenous (IV) or nebulized terbutaline was given to eight patients with moderately severe asthma on two separate days. Four incremental doses of terbutaline were given by each route to establish a maximal effect. Both routes of administration produced significant increases increases in FEV1, FVC, PEFR, MEF50% single-breath TLC, and effective pulmonary blood flow. A decrease in slope of alveolar argon plateau was observed with both routes, but helium responsiveness showed variable changes with no significant or consistent effect seen. There was no significant difference between responses to incremental doses and maximal response apart from pulse rate, which rose during IV treatment. These results showed that the IV route had no advantage in terms of effectiveness or site of action over the inhaled route. Since IV treatment can produce systemic side effects, inhaled bronchodilator therapy should be used as the route of choice.

Lung folding simulating peripheral pulmonary neoplasm (Blesovsky's syndrome).

Six cases are reported in whom the diagnosis of benign pleural thickening with lung folding simulating peripheral pulmonary neoplasm was made. Three patients presented with chest pain, two were asymptomatic, and the abnormality was a chance finding in one patient with asthma. The radiographs in all cases showed similar appearances--a peripheral opacity appearing to lie within the lung, usually the lower lobe, and characteristic curvilinear shadows extending from the opacity to the hilum. At thoracotomy, predominantly visceral pleural thickening had caused the underlying lung to fold. Hyaline plaques were present on the parietal pleura elsewhere and pleural adhesions were usually absent. Adequate removal of the thickened visceral pleura in five patients allowed the folded lung to re-expand, with reversion of the chest radiograph to normal. One patient in whom the underlying lung folding was not appreciated at operation still has chest pain and the chest radiograph is unchanged. The radiographic appearances of this non-malignant condition, especially the appearances on lateral tomography, are diagnostic, and recognition may obviate the need for operation in asymptomatic patients. For those patients with chest pain, thoracotomy with removal of the visceral pleura and release of the folded lung appears to be effective in relieving this symptom.

Sarcoidosis and chronic sensory neuropathy.

A patient with long-standing sensory peripheral neuropathy is described who finally presented with acute pulmonary sarcoidosis after a period of 18 years. Purely sensory neuropathy presumably due to sarcoidosis of this duration has not been reported before.

Chronic eosinophilic pneumonia complicating long-standing rheumatoid arthritis.

A 54-year-old patient with long-standing rheumatoid arthritis developed chronic eosinophilic pneumonia in association with a relapse of his arthritic condition. There was a rapid and complete response to oral steroid therapy.

Diagnostic accuracy of cytology and biopsy in primary bronchial carcinoma.

The accuracy of diagnosis of cell type obtained from sputum cytology, bronchial aspirate, bronchial biopsy, or percutaneous lung biopsy in 161 cases of confirmed primary lung cancer has been examined and the pretreatment histological diagnosis has been compared with the final diagnosis made after surgical resection or necropsy. The yield of positive diagnoses of malignancy obtained by each method of investigation in each cell type showed that cytological examination of sputum was the most accurate method, but a high degree of accuracy was also obtained by bronchoscopic aspiration and bronchial biopsy. Percutaneous lung biopsy was the most effective, but the least accurate, means of obtaining carcinoma cells. The level of diagnostic accuracy was highest in patients with squamous cell carcinoma. Accurate pretreatment diagnosis of patients with adenocarcinoma was particularly difficult, and only 20% of these cases were correctly diagnosed by investigation. Of seven patients with adenocarcinoma and a positive diagnosis of malignancy made on percutaneous lung biopsy, none was correctly diagnosed. The causes of error in diagnosis of cell type of primary lung cancer are discussed.

Tuberculosis of the peritoneal cavity.

The clinical presentation and management of 30 consecutive patients with tuberculous peritonitis are reviewed. Seventy per cent of the patients were aged 40 years or less and 80 per cent were immigrants. The main clinical features of abdominal pain, loss of weight, vomiting and sweating at night had been present in a large number of patients for several months before presentation to hospital. The clinical diagnosis of tuberculous peritonitis was difficult in the absence of extraperitoneal tuberculosis. Laboratory investigations were of little value in establishing the diagnosis. An elevated ESR was found in 80 per cent of patients. At laparotomy omental biopsy was performed and was diagnostic in all cases. Laparotomy was a safe and fast method of obtaining tissue for confirmation of the diagnosis in suspected cases, particularly when presenting acutely. Ascitic fluid cultures and guinea-pig inoculations were positive in only 6 out of the 15 patients in whom they were performed. Only 1 patient died.

Surveillance of tuberculosis contacts: experience at Ealing Chest Clinic.

The results of examination of 757 contacts of 186 tuberculosis index cases seen at Ealing Chest Clinic over a period of 7 years (1968--1974 inclusive) are reviewed. The incidence of disease in non-close contacts was low and further analysis was restricted to 574 close contacts. The morbidity in this group was 9%. Asian contacts and contacts aged 15--30 years were at the greatest risk. Fourteen per cent of 151 contacts of respiratory cases positive on direct smear developed disease. The same group had the highest incidence of 'positive' tuberculin skin tests (Heaf grades 2--4). Five per cent of non-Asian contacts and 1% of Asian contacts had disease at initial examination, the excess morbidity in Asian contacts being due to disease diagnosed during follow-up.