External breast prostheses in post-mastectomy care: women's qualitative accounts.

A good-quality external breast prosthesis and prosthesis-fitting service is an integral part of the recovery process post-mastectomy. However, this is an area of care that has minimal information or research available. The aim of this research was to investigate women's experience of the provision, fitting, supply and use of breast prostheses in Ireland. To ascertain women's own personal and subjective experiences, five focus groups with 47 women recruited through national cancer advocacy/support organizations and four Follow-up Breast Clinics throughout Ireland were conducted. As a result, five main themes emerged: (1) The fitting experience--Fitting? (2) Post-mastectomy products--Having? (3) Cost--Affording? (4) Information--Knowing? and (5) Adaptation--Accepting? The emerging themes pinpointed the impact of the fitting experience, fitting environment and the qualities of a prosthesis fitter on a woman's experience in obtaining a first or replacement breast prosthesis; the importance of the physical characteristics of the prosthesis and mastectomy bras; cost, affordability and entitlements; a lack of and perceived difficulty in getting information; and the myriad of personal and social impacts of a breast prosthesis for the woman. These findings are integral for the development of standards of practice in the fitting and supply of external breast prostheses in post-mastectomy care.

Experiences in the provision, fitting and supply of external breast prostheses: findings from a national survey.

A good-quality external breast prosthesis and prosthesis-fitting service is integral to recovery post-mastectomy. However, this area of care has minimal information or research available. The aim of this study was to investigate women's experience of the provision, fitting, supply and use of breast prostheses in Ireland. Three national surveys were undertaken with women (n = 527), breast care nurses (BCNs) (n = 32) and retail prosthesis fitters (n = 12). The findings identified the importance of the prosthesis for shape, appearance to self, appearance to others, sense of well-being, self-confidence and femininity. Dissatisfaction with weight, comfort and movement of the prosthesis was identified. Cost and travel distance were found to influence the replacement of the prosthesis. Dissatisfaction emerged with the display and choice of products, and brochure availability at the prosthesis fitting. Women preferred to be fitted for the first silicone prosthesis by a BCN in a hospital setting whereas for the replacement prosthesis they preferred a trained fitter at a specialized prosthesis supplier. BCNs and retail fitters identified the need for service guidelines and increased availability of professional development opportunities in prosthesis-fitting. These findings contributed to the development of standards of care for breast prosthesis-fitting services to benefit women and to provide guidelines for those providing the service.

Nuclear localisation of the endocannabinoid metabolizing enzyme fatty acid amide hydrolase (FAAH) in invasive trophoblasts and an association with recurrent miscarriage.

Endocannabinoids are lipid signalling molecules that are related to the major psychoactive component in marijuana, delta-9-tetrahydrocannabinol and are increasingly recognized as being important in implantation and development of early embryos. The endocannabinoid anandamide, is metabolized by the enzyme fatty acid amide hydrolase (FAAH), and insufficient levels of this enzyme have been implicated in spontaneous miscarriage in women and implantation failure in mice. We screened placental bed biopsies and placental tissue from 45 women with recurrent miscarriage and 17 gestation-matched women with normal pregnancies for the expression of FAAH by immunohistochemistry. Unexpectedly, the enzyme appeared to be localised to the nucleus of trophoblasts and this was confirmed by western blotting of sub-cellular fractions and confocal microscopy. FAAH was expressed in the cytoplasm of large decidual stromal cells and significantly more women with recurrent miscarriage (73%) expressed FAAH in these cells than women with normal pregnancy (31%). FAAH was also expressed in the nucleus of extravillous trophoblasts that had invaded the decidua from 67% of women with recurrent miscarriage but was not expressed by these cells in any women with normal pregnancies. In contrast, FAAH was expressed in extravillous trophoblasts that had migrated out of the villi but that had not yet invaded the decidua in both normal pregnancies and in cases of recurrent miscarriage. FAAH was also present in the nucleus of a small number of villous trophoblasts in some specimens. FAAH appears to be over expressed in trophoblasts that have invaded the decidua, as well as in large decidual stromal cells in many cases of recurrent miscarriage. This may reflect inadequate control of the cannabinoid system in the uterus of women who experience recurrent miscarriages. The functional significance of the unexpected nuclear localisation of FAAH in trophoblasts is not yet clear.

The mitogen-activated/extracellular signal-regulated kinase kinase 1/2 inhibitor U0126 induces glial fibrillary acidic protein expression and reduces the proliferation and migration of C6 glioma cells.

The extracellular signal-regulated kinase (ERK) signaling pathway has been implicated in diverse cellular functions. ERK and its activating kinase, mitogen-activated/extracellular signal-regulated kinase kinase (MEK), are downstream of cell surface receptors known to be up-regulated in many malignant gliomas. We sought to investigate the role of ERK in glioma cell migration, proliferation and differentiation using the rat-derived C6 glioma cell line and the MEK inhibitor, U0126. Treatment of C6 cells with U0126 caused a significant concentration-dependent reduction in cell proliferation and migration and also induced expression of glial fibrillary acidic protein, a marker of astrocytic differentiation. These results suggest that the ERK pathway regulates glioma cell proliferation, migration and differentiation.

Valproic acid induces caspase 3-mediated apoptosis in microglial cells.

Valproic acid is widely used for the treatment of epilepsy and mood disorders, but its mode of action is unclear. Treatment of neuronal cells with valproic acid promotes neurite sprouting, is neuroprotective and drives neurogenesis; however its effects on non-neuronal brain cells are less clear. We report that valproic acid induces apoptosis in the mouse microglial cell line, BV-2, at concentrations within the therapeutic range. When BV-2 cells were incubated for 24 h with 500-1000 microM valproic acid we observed a reduction in cell number, the appearance of apoptotic morphology and increased caspase 3 cleavage. Exposure of a macrophage cell line (RAW 264.7) to similar concentrations of valproic acid also led to reduced cell number but no caspase 3 cleavage, suggesting these cells responded to valproic acid with reduced proliferation rather than apoptosis. This was confirmed using bromodeoxyuridine incorporation studies. Similar concentrations of valproic acid added to Neuro-2a, SK-N-SH and C6 cell lines as well as human NTera-2 astrocytes did not evoke cell death. The caspase 3 inhibitor DEVD-CHO inhibited valproic acid-induced apoptosis in BV-2 cells whereas the MEK inhibitor U0126 potentiated valproic acid-mediated apoptosis. These results demonstrate that valproic acid selectively induces apoptosis in BV-2 cells by way of a caspase 3-mediated action. As activated microglia secrete neurotoxins in neurodegenerative diseases such as Alzheimer's, Parkinson's, and HIV dementia, valproic acid may alleviate these diseases by selectively killing microglia.

High incidence of single nucleotide substitutions in the mitochondrial genome is associated with poor semen parameters in men.

Single nucleotide polymorphisms (SNPs) in 7000 bp of the mitochondrial genome, encompassing 15 coding regions from COI to ND5, were characterized by single strand polymorphism analysis and confirmed by DNA sequencing. About 2.4% of normozoospermic men and 8.4% of men with poor semen quality had at least one nucleotide substitution. Most of the substitutions occurred in the third codon and did not change the amino acid. Hydrophobicity plots of the proteins with changes in an amino acid as a result of a nucleotide substitution suggested that they did not affect the function of the protein. The two most common substitutions at nucleotide (nt) 9055 and 11719 had significantly higher frequencies in men with reduced sperm motility. Eleven percent of the men with poor semen parameters and 1.3% of normozoospermic men had a 9055 substitution, 12% of the men with poor semen parameters had a substitution at nt 11719, but none of the normozoospermic men had this substitution. All the patients with these substitutions had reduced sperm motility and/or low sperm count. These SNPs in the mitochondrial genome were in a homoplasmic state. Thus, we propose that possessing these mitochondrial mutations compromises the semen quality of these men.

Performance of black and white South African children on the Wechsler Intelligence Scale for Children--Revised and the Kaufman Assessment Battery.

The validity of traditional intelligence tests for cultural groups that differ from those for whom the tests were normed has come under scrutiny. This is particularly the case for the previously disadvantaged black majority in South Africa. The Kaufman Assessment Battery for Children (K-ABC) is reportedly a relatively nondiscriminatory test of intellectual functioning. This study compared the performance of 21 black and 35 white third-grade South African children on the K-ABC and the Wechsler Intelligence Scale--Revised (WISC-R) at two schools for children with learning problems. While the WISC-R Verbal and Full Scale IQ of black children were significantly lower than that of whites, there was no significant difference between these groups on the K-ABC. Teachers' ratings for white and black pupils were acceptably concordant with students' performance on the K-ABC but not on the WISC-R. Support is provided for the usefulness of the K-ABC as a relatively nondiscriminatory alternative to the WISC-R for South African children.

Efficient induction of cell death by adenoviruses requires binding of E1B55k and p53.

The use of an Elb55k-deficient adenovirus, ONYX-015, to selectively target tumor cells containing a mutated p53 gene has produced promising results. However, recent reports have questioned the selectivity of this virus, showing that ONYX-015 can replicate in cells containing a wild-type p53 and that p53 may actually be required for cell death. To address these apparent contradictions in the literature, we infected a number of mutant and wild-type p53-containing cell lines with ONYX-015 and wild-type adenovirus and observed their death profiles up to 10 days postinfection. We demonstrate that two distinct cell death phenotypes exist, one of which is rapid and dependent on the presence of p53 and one of which is p53 independent. Using adenoviruses expressing E1b55k proteins deficient in their ability to bind p53, we show that formation of a complex between p53 and the adenoviral Elb55k protein is necessary for the activation of the rapid cell death pathway. In the absence of p53 or the absence of complex formation between p53 and Elb55k, cell death is delayed considerably. These data suggest three things: that the selectivity of killing appears to be dependent on the presence of the E1b55k/p53 complex; that viruses lacking Elb55k (such as ONYX-015) kill cells in a delayed manner independent of p53; and that binding of E1b55k to p53 does not merely serve to inactivate p53, but rather is required for the induction of rapid cell death. The components of this complex that lead to rapid cell death remain to be determined.

p53-dependent cell death/apoptosis is required for a productive adenovirus infection.

The p53 tumor suppressor protein binds to both cellular and viral proteins, which influence its biological activity. One such protein is the large E1b tumor antigen (E1b58kDa) from adenoviruses (Ads), which abrogates the ability of p53 to transactivate various promoters. This inactivation of p53 function is believed to be the mechanism by which E1b58kDa contributes to the cell transformation process. Although the p53-E1b58kDa complex occurs during infection and is conserved among different serotypes, there are limited data demonstrating that it has a role in virus replication. However, loss of p53 expression occurs after adenovirus infection of human cells and an E1b58kDa deletion mutant (Onyx-015, also called dl 1520) selectively replicates in p53-defective cells. These (and other) data indicate a plausible hypothesis is that loss of p53 function may be conducive to efficient adenovirus replication. However, wild-type (wt) Ad5 grows more efficiently in cells expressing a wt p53 protein. These studies indicate that the hypothesis may be an oversimplification. Here, we show that cells expressing wt p53, as well as p53-defective cells, allow adenovirus replication, but only cells expressing wt p53 show evidence of virus-induced cytopathic effect. This correlates with the ability of adenovirus to induce cell death. Our data indicate that p53 plays a necessary part in mediating cellular destruction to allow a productive adenovirus infection. In contrast, p53-deficient cells are less sensitive to the cytolytic effects of adenovirus and as such raise questions about the use of E1b58kDa-deficient adenoviruses in tumor therapy.

Determination of contact area in 'cushion form' bearings for artificial hip joints.

Current forms of artificial hip joints produce wear debris, which contributes to loosening of the prostheses. These 'hard' joints articulate with boundary or mixed lubrication, whereas the natural joint articulates with full fluid film lubrication. An artificial joint that articulates with full fluid film lubrication could greatly reduce wear and frictional torque and hence reduce the incidence of loosening and inflammatory tissue reaction. The use of a thin lining of low elastic modulus in the acetabular cup is one possible way of promoting full fluid film lubrication. In the design of such cushion forms of bearings, it is important to be able to predict the contact area, stress distribution and film thickness. This paper presents experimental techniques to determine the contact area in low elastic modulus layers and compares these measured areas with theoretical predictions using linear elasticity theory. At low loads experimental results and theoretical predictions were close. However, at loads above 300 N, the theory overestimated the width of the contact area by up to 8.5 per cent. This difference is mainly attributed to the non-linear behaviour of the elastomer at the higher levels of stress.