Impact of oophorectomy and hormone suppression in low grade endometrial stromal sarcoma: A multicenter review.

OBJECTIVES: Low grade endometrial stromal sarcoma (LG-ESS) is a rare cancer with an indolent course. We aimed to assess the effectiveness of adjuvant hormonal suppression (HT) with or without oophorectomy (BSO) in prolonging progression free survival (PFS) and overall survival (OS) in patients with LG-ESS. METHODS: We performed a multi-institutional retrospective review of patients treated for low grade LG-ESS from 1985 to 2014. Demographics, treatment and recurrence data were abstracted from medical records. Pathologic diagnosis was confirmed by a gynecologic pathologist. Long-term patient-reported outcomes were obtained via mailed survey. RESULTS: One-hundred-twelve patients underwent surgery for LG-ESS; 59 had postoperative data with a median follow-up of 55months (1-325months). The mean age at diagnosis was 48.5years (22-82years). Forty-nine (61%) had stage I disease. The most common presenting symptoms were abnormal uterine bleeding (38%) and pelvic mass (17%). Seventy-one (63%) patients had BSO at the time of diagnosis. Of the 59 patients with postoperative follow-up information, 49 (73%) underwent BSO, 26 (44%) received HT, 20 (33%) were expectantly managed, and 6 (10%) received chemotherapy, radiation or both. Median PFS for the entire group was 53months and OS was 63months. PFS for those who underwent BSO compared with those who retained their ovaries was 38 vs 11months, p=0.071. PFS for HT vs no HT was 28 vs 23months, p=0.77. CONCLUSIONS: Consistent with prior series, our results support BSO to prolong PFS in LG-ESS but are limited by sample size. Larger studies with more complete follow-up are needed to determine the effect of adjuvant hormonal suppression.

Parish nursing: renewing a long tradition of caring.

Parish nurses are experienced registered nurses committed to helping people meet the health needs of their body, mind, and spirit. To fulfill this goal, parish nurses must be health educators and counselors, referral sources, facilitators, patient advocates, healthcare plan interpreters, and multitalented coordinators. The parish nurse uses the skill of nursing assessment of individual and congregational needs and matches the assessment findings to available resources. The parish nurse also advocates increased awareness of health-related issues that lead to earlier and more effective treatment and care. All ages benefit within a context of personal caring and attention offered by a parish nursing model that is often lacking from healthcare delivery systems. Congregations of all sizes, both urban and rural, have successfully started parish nurse programs. Parish nursing programs are a religious response to help bring wholeness and healing to the faith community. The purpose of this article is to explore parish nursing as it has evolved into a model of health care delivery contributing to the empowerment and health of both the individual and the community.

Information analysis of Fis binding sites.

Originally discovered in the bacteriophage Mu DNA inversion system gin, Fis (Factor for Inversion Stimulation) regulates many genetic systems. To determine the base frequency conservation required for Fis to locate its binding sites, we collected a set of 60 experimentally defined wild-type Fis DNA binding sequences. The sequence logo for Fis binding sites showed the significance and likely kinds of base contacts, and these are consistent with available experimental data. Scanning with an information theory based weight matrix within fis, nrd, tgt/sec and gin revealed Fis sites not previously identified, but for which there are published footprinting and biochemical data. DNA mobility shift experiments showed that a site predicted to be 11 bases from the proximal Salmonella typhimurium hin site and a site predicted to be 7 bases from the proximal P1 cin site are bound by Fis in vitro. Two predicted sites separated by 11 bp found within the nrd promoter region, and one in the tgt/sec promoter, were also confirmed by gel shift analysis. A sequence in aldB previously reported to be a Fis site, for which information theory predicts no site, did not shift. These results demonstrate that information analysis is useful for predicting Fis DNA binding.

Genetic markers in ribosomal DNA for hookworm identification.

Polymerase chain reaction-linked restriction fragment length polymorphism (PCR-RFLP) analysis of ribosomal (r) DNA was conducted on Uncinaria stenocephala, Ancylostoma caninum, A. tubaeforme and A. ceylanicum. The rDNA region spanning the first and second internal transcribed spacers (ITS1 and ITS2) plus the 5.8S (ITS+) gene was amplified by PCR from each of the species, digested separately with 9 restriction endonucleases and the fragments separated by agarose gel electrophoresis. Characteristic PCR-RFLP patterns were produced for each morphologically defined species using some of the endonucleases. The present study demonstrated that the ITS+ provides genetic markers for the delineation of each species examined and suggests that this region of rDNA will be useful for the identification of other hookworms from a range of hosts. The results are likely to have important implications for studying the genetic structure of hookworm populations, the systematics and the epidemiology of hookworm infections.

Prevalence of Salmonella in broiler flocks: effect of litter water activity, house construction, and watering devices.

Litter samples from 24 flocks of broilers and four flocks of broiler breeders were evaluated for Salmonella contamination, water activity (Aw), and total moisture content (MC). The drag swab (DS) monitoring system was used to collect samples to detect Salmonella contamination. Simultaneously, representative samples of the uppermost surfaces of dry (loose) litter and wet (caked) litter were collected for Aw and MC analyses. On dry litter surfaces, high Aw values (0.90-0.95) were associated with flocks Salmonella-positive using DS; low Aw values (0.79-0.84) were associated with flocks Salmonella-negative by DS; and transition Aw values (0.85-0.89) were associated with flocks having an increased risk for the presence of Salmonella. The association of high Aw values with Salmonella risk was not observed for wet (caked) litter surfaces. Observations suggest that limiting Aw in the litter base of broiler houses may create a less favorable environment for the multiplication of Salmonella and thus a more hygienic environment for broiler production.

A demonstration project of interdisciplinary dairy herd extension advising funded by industry and users. 1. Implementation and evaluation.

An interdisciplinary team of extension workers conducted a 2-yr demonstration project using 30 herds with the objectives of increasing production efficiency and profitability and gaining experience in integrated problem solving. After 1 yr, 88% of the participants thought that the monthly fee paid to extension was a profitable investment. At the end of the project, 70% of the participants thought that increases in milk yield per cow were due to a combination of improvements in two to four management areas rather than to changes in any single management discipline. Additional labor was necessary to implement recommendations. Two issues were key in successfully convincing dairy operators and families to accept management recommendations: 1) a coordinated team effort aimed at integrated problem solving, followed by written recommendations and regular dialogue with the producer, and 2) possession of effective social decision-making skill by the participant family. Most farms in the project depended primarily on family labor and social decision making to implement management changes. Only those families that could jointly agree to implement a new management decision fully benefited from professional advice. A demonstration project of interdisciplinary dairy advising was an effective method to gain problem-solving expertise and to build credibility for extension services.

A demonstration project of interdisciplinary dairy herd extension advising funded by industry and users. 2. Impact on herd performance.

The objectives of this 24-herd, demonstration project of extension advising were to measure the impact of integrated problem solving on measures of DHI performance for 2 yr during and 2 yr after the project. During project advising, increases in rolling herd average milk and fat yields and 3.5% FCM were similar for project and state herds. When rolling herd average for milk yield for state herds was adjusted for two USDA milk reduction programs, milk yield of project herds was estimated to have increased 434 lb more per cow than that of DHI state herds. Compared with state DHI trends, project producers significantly improved in percentage of low SCC, days open, and age at first calving. Two years postproject, DHI milk yield declined for project and state herds, probably because of drought. Demonstration herds did not outperform state DHI herd average in milk yield or in other efficiency parameters during the 2-yr postproject. The extension advising in the demonstration project had the most positive impact on management of low ranking herds. Only low ranking herds had an advantage in rate of improvement, compared with high ranking herds, in rolling herd average for milk yield during and after the project and in SCC and days open during the project. Gains by managers of herds ranking low and in the middle in DHI parameters were generally lost or declining postproject.

A demonstration project of interdisciplinary dairy herd extension advising funded by industry and users. 3. Impact on management practices.

The objectives of this 24-herd, demonstration project of integrated problem solving and extension advising were 1) to evaluate dairy production management practices, 2) to formulate recommendations for guiding producers to correct management deficiencies, and 3) to measure the rate of practice adoption. Management evaluations focused on herd nutrition and forage crops, mastitis control and milking equipment, reproduction, and herd health. Sixty-eight management practices or milking equipment components were evaluated on each farm. A total of 216 recommendations were made in nutrition and forage crops as follows: calf and heifer management, 89; forage crops, 73; dry cows, 26; lactating cows, 19; and general, 9. The least adopted suggestions for nutrition and crops were for forage crop management. A total of 283 recommendations were made in mastitis management or milking equipment as follows: milking practices, 90; milking equipment, 90; general mastitis control, 61; environment, 32; calf management, 9; and stray voltage, 1. Producers most resisted updating and maintaining milking equipment within the milking management area. Detection of estrus was the focus of reproductive management advising. A total of 80 practices were recommended as follows: one person responsible, 24; specific location, 24; specific time, 24; and regular veterinary visits, 10. Designation of a specific site was the least adopted of these recommendations. Overall, 419 of 581, or 72%, of all recommendations were adopted.

Evaluation of possible alternatives to double-strength skim milk used to saturate drag swabs for Salmonella detection.

The drag-swab Salmonella screening technique was evaluated using less expensive alternatives to double-strength skim milk (2 x SM) as a saturating medium for drag swabs. Ten pre-determined Salmonella-positive poultry houses were studied. In the first phase, Salmonella screening efficiency of drag swabs impregnated with 2 x SM and commercially available canned Carnation evaporated skim milk (CESM) were compared. Results showed CESM to be a less efficient alternative. In the second phase of the study, the Salmonella screening efficiency of drag swabs impregnated with 2% buffered peptone water (BPW), physiological saline (PS), and distilled water (DW) were evaluated along with an unimpregnated drag swab (dry drag swab) (DD) as possible alternatives to 2 x SM. The efficiency of Salmonella detection using various impregnation treatments were in the following order: 2 x SM > PS > BPW > DW > DD.

Correlation of water activity and other environmental conditions with repeated detection of Salmonella contamination on poultry farms.

Three flocks on 13 different broiler farms were monitored for Salmonella over three consecutive growout periods using the drag swab (DS) technique. One house was consistently negative for Salmonella contamination (7.7%); four houses were consistently positive (30.8%); and eight houses (61.5%) alternated between either a DS Salmonella-negative or -positive status. Simultaneously, numerous environmental parameters of the litter surface were measured, including water activity (Aw), ammonia, temperature, pH, moisture content (MC), ash content, and volatile solids. Analysis of these data as a corollary to either Salmonella-negative or -positive DS results revealed significant correlation coefficients for some of the parameters, especially Aw. The results suggest that there should be further exploration of remedial intervention based on control of some of the physical features of litter (e.g., controlling litter Aw and possibly MC and pH levels) in poultry houses.

A comparison of the WAIS and WAIS-R in matched UK samples.

A matched samples design was employed to compare WAIS and WAIS-R IQ in UK subjects. The WAIS yielded significantly higher mean Full Scale, Verbal and Performance IQs. The mean differences were 7.5, 6.4 and 7.9 IQ points respectively. The WAIS and WAIS-R samples were broadly representative of the UK adult population in terms of age, sex and social class distribution, and therefore provide tentative estimates of population mean scores for both Wechsler scales. Mean WAIS IQ was 108.6, suggesting that the WAIS yields inflated IQ scores in the contemporary UK population. Encouragingly, mean WAIS-R Full Scale IQ was 101.1, suggesting that it neither markedly underestimates nor overestimates IQ in the UK.

Demonstration of savings on the AVLT and development of a parallel form.

The purposes of the present study were (1) to investigate whether significant savings occur with repeat testing on Rey's Auditory-Verbal Learning Test and (2) to develop a parallel version of the AVLT. Subjects (N = 60) were divided into pairs (individually matched for sex, age, and education) to form two groups and were administered either the AVLT or a parallel version. Results indicated no significant differences on all AVLT measures of learning, recall, and recognition, suggesting that the parallel version can be used as an equivalent form of the AVLT. Subjects were retested after an interval of 27 (+/- 3) days, with half receiving the same version and half receiving a different version. In contrast to subjects receiving different lists, those who were retested with the same version demonstrated a significant improvement in performance on the majority of AVLT variables.

Estimating premorbid IQ from demographic variables: regression equations derived from a UK sample.

The purpose of the study reported here was to build regression equations for the estimation of premorbid IQ from demographic variables in a UK population. Subjects (n=151) free of neurological, psychiatric or sensory disability, were administered the Wechsler Adult Intelligence Scale (WAIS) and had their demographic details recorded (age, sex, occupation and education). WAIS Full Scale (FSIQ), Verbal (VIQ), and Performance IQ (PIQ) were regressed on the demographic variables. The regression equations generated by this procedure predicted 50, 50, and 30 percent of the variance in FSIQ, VIQ, and PIQ respectively. These equations should provide a convenient and useful supplement to psychometric estimates of premorbid IQ. Unlike psychometric estimates, demographic estimates are entirely independent of a patient's current cognitive status.

The relationship between demographic variables and NART performance in normal subjects.

The relationship between NART performance and demographic variables was examined in a group of subjects free of neurologic or psychiatric disorder (n = 201). NART estimated IQ was significantly correlated with education, social class and age. The correlation between age and NART IQ was no longer significant after partialling out either education or social class. There was no evidence of a curvilinear relationship between age and NART performance. There was no significant sex difference in NART performance. Nelson's (1982) report of a high split-half reliability was confirmed.

Follicular fluid stimulation of progesterone secretion: time course, dose-response and effect of inhibiting de novo cholesterol synthesis.

This study extends our previous observations of follicular fluid stimulation of progesterone secretion by granulosa cells from immature porcine antral follicles in vitro. Granulosa cells were incubated with either charcoal-treated fluid from large porcine follicles or serum in TC medium 199. Within minutes of the addition of follicular fluid to the cells, enhanced progesterone secretion was observed. A second, more substantial enhancement of progesterone secretion was observed after an additional incubation of 24 to 48 h. As we were unable to detect significant amounts of progesterone within either freshly collected or incubated cells, follicular fluid appears to stimulate both the synthesis and secretion of progesterone rather than just the secretion of preformed progesterone. Inhibition of de novo cholesterol synthesis with an inhibitor of the conversion of 7-dehydrocholesterol to cholesterol, reduced progesterone secretion by cells incubated with serum to a greater extent than by cells incubated with follicular fluid. These studies suggest that follicular fluid may stimulate both de novo cholesterol synthesis and progesterone synthesis from preformed cholesterol. A dose-response test for follicular fluid stimulation of progesterone secretion indicated that 30% follicular fluid in TC medium 199 was as stimulatory as 50% follicular fluid. Ten percent follicular fluid was not stimulatory by itself, but in combination with 1 microgram of FSH/ml (ovine follicle-stimulating hormone), stimulated progesterone secretion to a greater extent than 30% or 50% follicular fluid alone.

A study of the heparin-manganese chloride method for determination of plasma alpha-lipoprotein cholesterol concentration.

To assess the limits of the heparin MnCl2 precipitation method for quantitation of alpha-lipoprotein cholesterol (C-HDL), effects of varying final McCl2 and heparin concentrations were studied, and the precipitation method was compared to preparative ultracentrifugation. In 65 parallel plasma aliquots, C-HDL (X+/-SE) determined by ultracentrifugation (54.3+/-1.8 mg/dl) correlated significantly (r=0.98, P less than 0.001) with the precipitation method (56.0+/-1.9 mg/dl). C-HDL by ultracentrifugal and precipitation methods were also similar in 16 subjects with triglycerides ranging from 150 to 312 mg/dl (41.4+/-2.6, 43.4+/-2.8, r=0.97, P less than .001). A constant amount of cholesterol in the supernatant was measured over a final McCl2 range of 0.046-0.23 M, and cholesterol values in the supernatant at final McCl2 concentrations of 0.046, 0.05, and 0.055 M did not differ from each other, P greater than 0.1. However, cholesterol levels in the supernatant at final MnCl2 concentration of 0.042 M differed from those at concentrations of 0.046, 0.05, and 0.055 M, P less than 0.05 and the amount of supernatant cholesterol increased as the final McCl2 concentration was reduced from 0.042 to 0.02 M. A constant amount of cholesterol in the supernatant was measured over a heparin concentration range of 92-734 USP units/ml. The final MnCl2 and heparin concentrations of 0.046 M and 184 USP units/ml, which are incorporated in widely used procedures, gave C-HDL values for the precipitation method which were in close agreement with the ultracentrifugal method. There is no evidence for a heparin-Mn++ precipitation of HDL and systematic underestimation of HDL by the precipitation method. However, the final MnCl2 concentration is very near the minimum required for accurate measurement of C-HDL. To preclude incomplete precipitation of low and very low density lipoproteins by insufficient manganese concentration, an increase of the manganese concentration should be considered.

Nuclear ribonucleoproteins as inhibitors of mammalian RNA polymerase.

A ribonucleoprotein complex isolated from rabbit thymus nuclear lysates was found to be an inhibitor of DNA-dependent RNA polymerase II. The inhibition appeared to be of a competitive type and was completely reversed by high concentration of DNA. Highest inhibition was observed when enzyme and complex were preincubated before addition of DNA while there was little inhibition after enzyme had started synthesis on the DNA template. The RNA isolated from the complex was equally inhibitory and was a more effective inhibitor than either tRNA or rRNA.

Direct quantitation of cholestanol in plasma by gas-liquid chromatography.

A gas-liquid chromatographic (GLC) method for quantitation of cholestanol in plasma was developed using SP-1000 without the need for argentation thin-layer chromatography and silylation. Cholestanol was resolved well before cholesterol and the phytosterols. This method was sensitive, specific for cholestanol, and reproducible.