Impact of Cold Therapy on Paclitaxel-Induced Peripheral Neuropathy and Quality of Life in Patients With Breast Cancer.

BACKGROUND: Taxane drugs frequently produce peripheral neuropathy (PN). Cold therapy to hands and feet during chemotherapy has been effective in reducing PN. OBJECTIVES: The purpose was to compare the frequency and severity of PN and quality of life in patients with breast cancer receiving cold therapy to their hands and feet versus standard of care during 12 weekly paclitaxel infusions with a follow-up at 16 weeks. METHODS: Forty-eight female participants were consecutively recruited and randomized to treatment versus control groups. This randomized control trial used the Common Terminology Criteria for Adverse Events and the Functional Assessment of Cancer Therapy-Taxane questionnaires to collect data weekly for 12 weeks and at 16 weeks. FINDINGS: A repeated-measures ordinal logistic model and binomial logistic model showed that patients on standard therapy were three times more likely to develop PN, with a progression toward severe PN, when compared to patients who were on cold therapy. There was no effect of treatment on quality of life.

Taking the Pulse on Pediatric Simulation: A National Survey of Pediatric Residency Programs' Simulation Practices and Challenges.

OBJECTIVES: There is abundant literature on simulation use in individual pediatric residency programs but limited overall data on simulation in US pediatric residency programs. This study sought to determine how US pediatric residency programs use simulation for teaching and assessment and the challenges programs face in their use of simulation. METHODS: The Association of Pediatric Program Director's Healthcare Simulation in Pediatrics Learning Community members developed a 15-multipart question survey on the use of simulation in US pediatric residency programs using best practices in survey design. The survey was distributed electronically to US pediatric residency program directors. Qualitative questions were analyzed by content analysis and quantitative questions using descriptive statistics. RESULTS: The survey response rate was 21%; respondents were disproportionately from large academic medical centers. Qualitative analysis found that respondents use simulation to teach pediatric residents in the areas of urgent/emergent situations, procedures, and communication, and common challenges to simulation implementation are time, physical resources, expertise, competing priorities, logistics, and buy-in. Quantitative analysis demonstrated that, although respondents are largely confident that their simulation programs improve resident preparedness and competence, few objectively evaluate their simulation programs. CONCLUSIONS: Pediatric residency programs use simulation for similar purposes and face similar challenges. By collaborating, the resources of the national pediatric simulation community can be leveraged to collect evidence for best practices for simulation use in pediatric residency training.

Assessing Predictors of Emotional Distress by Immigrant Type: An Exploration of Adult Refugees, Asylees, and SIV Holders in Maryland.

Stressors and trauma experienced by persons fleeing harm or persecution can cause elevated distress. This study assessed predictors of elevated distress among newly arrived refugees, asylees, and Special Immigrant Visa (SIV) holders in Maryland. A secondary analysis of Refugee Health Screener-15 data from 4385 refugees, asylees, and SIV holders arriving in Maryland from 2014 to 2017 was conducted. Mean scores were compared across immigrant groups, and positive screening predictors were identified using logistic regression. Mean scores were highest among SIV holders and lowest among asylees. Compared to refugees, SIV holders had greater odds of screening positive; significance was reduced after adjusting for covariates. A significant interaction term was found for SIV women, who had 1.74 greater odds than SIV males. Distress varied between immigrant groups, with asylees having lowest odds of screening positive. SIV women's significant results may owe to acculturation distress, disrupted gender expectations, and resettlement difficulties.

Simultaneous determination of borate, chloride and molybdate in pyrohydrolysis distillates of plant and soil samples by ion chromatography.

Determination of concentrations of micronutrients in plant samples is important in order to assess the growth and quality of plants. An ion chromatography (IC) method was developed for the simultaneous determination of B, Cl and Mo (micronutrients present in their anionic form in aqueous samples) using a gradient elution with d-mannitol and NaOH. Despite their different chemical nature, these elements could be separated from the matrix by employing pyrohydrolysis. IC was employed for their sequential determination from single aliquot injection into the IC column. It was observed that the optimised procedures developed earlier in our laboratory for the separation of B and halogens using d-Mannitol-NaOH or bicarbonate eluents could not be extended to B-Mo-Cl separation. The concentration levels of d-mannitol in the eluent required for separation of boron impeded the conductivity detection of Mo and the peak sensitivity was seen to be critically dependent on d-mannitol concentration in the eluent. In addition, d-mannitol in NaOH eluent altered the retention times of analytes (B, F-, Cl-, NO3-, SO42-and MoO42-) which were not observed in the case of bicarbonate eluent. The current study deals with the investigation on the influence of d-mannitol on the molybdate as well as its role on the retention time. Formation of Mo-mannitol complex at different pH conditions and de-protonation of mannitol were correlated to the observed effects. Based on the observations, a gradient elution method was proposed for the simultaneous separation and determination of B, Cl and Mo in the pyrohydrolysis distillates of plant samples. The method was calibrated for B (0.05-1 mg/L), Cl (0.1-10 mg/L) and Mo (0.5-10 mg/L) and the linear regression coefficients obtained were 0.9992, 0.9998 and 0.997 respectively. The limit of detection (LOD) for B, Cl and Mo was calculated to be 19, 23 and 96 µg/L, respectively. The developed IC method after pyrohydrolytic separation of B, Cl and Mo was successfully applied for the analysis of real samples.

Discovery and Subsequent Confirmation of Novel Serum Biomarkers Diagnosing Alzheimer's Disease.

BACKGROUND: Alzheimer's disease (AD) remains challenging to diagnose, especially early disease. Having serum AD biomarkers would be of significant interest both in the clinical setting and in drug development efforts. OBJECTIVE: We applied a novel serum proteomic approach to interrogate the low-molecular weight proteome for serum AD biomarkers. METHODS: A discovery study used sera from 58 any-stage AD cases and 55 matched controls analyzed by capillary liquid chromatography-electrospray ionization-tandem mass spectrometry. Candidate biomarkers were statistically modeled and promising biomarkers were retested in a second, blinded confirmatory study (AD cases = 68, controls = 57). Biomarkers that replicated in the second study were modeled for the diagnosis of any-stage and very early stage AD. Further, they were chemically identified by tandem MS. RESULTS: The initial discovery study found 59 novel potential AD biomarkers. Thirteen recurred in more than one multi-marker panel. In a second, blinded, confirmatory study, these same biomarkers were retested in separate specimens. In that study, four markers validated comparing controls to patients with any-stage AD and also with very early AD. The four biomarkers with replicable ability to diagnose AD were then chemically identified. CONCLUSION: These results suggest novel serum AD diagnostic biomarkers can be found using this approach.

Direct Separation of Molybdenum from Solid Uranium Matrices Employing Pyrohydrolysis, a Green Separation Method, and Its Determination by Ion Chromatography.

Pyrohydrolysis is a well-established separation method, and it is being used as a sample preparation method for several materials for further determination of non-metals such as halogens, boron, and sulfur. Analytes are retained in a diluted solution that is suitable for carrying out analysis by several determination techniques and minimizing the use of concentrated reagents. Pyrohydrolysis separation of metals has not been reported yet. The present study demonstrates the pyrohydrolysis separation of Mo as MoO4(2-) from uranium materials and its subsequent determination using ion chromatography coupled with suppressed conductivity detector. With use of TGA and XRD the volatilization behavior of Mo was studied. Important parameters for the pyrohydrolysis method required for the quantitative separation of Mo were evaluated. The precision of the method was better than 5% at 25 ppm of Mo. The accuracy was evaluated by analysis of a CRM (U3O8-ILCE-IV). The method was applied to determine Mo in ammonium diuranate samples, where the conventional methods suffer from the loss of Mo.

Antepartum Mastitis: A Rare Occurrence.

Puerperal or lactational mastitis is an inflammatory condition of the breast that is commonly encountered in breastfeeding mothers. It occurs most commonly in the postpartum period, generally in the first 6 weeks of breastfeeding. In contrast, antepartum mastitis is an uncommon condition, and if not treated adequately, it may be complicated by the formation of a breast abscess. The authors present a case of a 24-year-old, second gravida mother who developed unilateral antepartum mastitis with abscess formation at 34 weeks of gestation, which was initially treated with antibiotics and surgical drainage. However, her symptoms persisted over the next 2 weeks, and she was referred to the authors' institution, where she was managed with antibiotics and surgical drainage after delivering a healthy near-term infant. The abscesses healed completely 2 months later, with sequelae of residual scarring and a nonprotractile nipple. The authors wish to emphasize that health care providers should be aware of the occurrence of mastitis in the antepartum period. Early recognition with adequate treatment of mastitis is the key to avoiding complications, and this will prevent lactation issues and also reduce morbidity in the mother and neonate.

Separation of boron from borated paraffin wax by pyrohydrolysis and alkali extraction methods and its determination using ion chromatography.

A method based on the pyrohydrolysis extraction of boron and its quantification with ion chromatography was proposed for paraffin waxes borated with H3BO3 and B4C. The optimum pyrohydrolysis conditions were identified. Wax samples were mixed with U3O8, which prevents the sample from flare up, and also accelerates the extraction of boron. Pyrohydrolysis was carried out with moist O2 at 950°C for 60 and 90 min for wax with H3BO3 and wax with B4C, respectively. Two simple methods of separation based on alkali extraction and melting wax in alkali were also developed exclusively for wax with H3BO3. In all the separations, the recovery of B was above 98%. During IC separation, B was separated as boron-mannitol anion complex. Linear calibration was obtained it between 0.1 and 50 ppm of B, and LOD was calculated as 5 ppb (S/N = 3). The reproducibility was better than 5% (RSD).

Tissue proteomics of the low-molecular weight proteome using an integrated cLC-ESI-QTOFMS approach.

Analysis of the protein/peptide composition of tissue has provided meaningful insights into tissue biology and even disease mechanisms. However, little has been published regarding top down methods to investigate lower molecular weight (MW) (500-5000 Da) species in tissue. Here, we evaluate a tissue proteomics approach involving tissue homogenization followed by depletion of large proteins and then cLC-MS (where c stands for capillary) analysis to interrogate the low MW/low abundance tissue proteome. In the development of this method, sheep heart, lung, liver, kidney, and spleen were surveyed to test our ability to observe tissue differences. After categorical tissue differences were demonstrated, a detailed study of this method's reproducibility was undertaken to determine whether or not it is suitable for analyzing more subtle differences in the abundance of small proteins and peptides. Our results suggest that this method should be useful in exploring the low MW proteome of tissues.

Comparing the effect of a resin based sealer on crown retention for three types of cements: an in vitro study.

To determine the effect of resin based sealer on retention of casting cemented with three different luting agents. 55 extracted molar teeth were prepared with a flat occlusal surface, 20° taper and 4 mm axial height. The axial surface of each specimen was determined. The specimen were then distributed into five groups based on decreasing surface area, so each cementation group contained 11 specimens with similar mean axial surface area. A two-step, single bottle universal adhesive system (One-Step-Resinomer, Bisco) was used to seal dentin after the tooth preparation. Sealer was not used on the control specimens except for the modified-resin cement (Resinomer, Bisco) specimens that required use of adhesive with cementation. Using ceramometal (Wirobond(®), BEGO), a casting was produced for each specimen and cemented with either zinc phosphate (Harvard), glass ionomer (Vivaglass) or modified resin cement (Resinomer) with single bottle adhesive. All the castings were cemented with a force of 20 kg. Castings were thermal cycled at 5 and 55 °C for 2,500 cycles and were then removed along the path of insertion using a universal testing machine at 0.5 mm/min. A single-factor ANOVA was used with a = 0.05. The nature of failure was also recorded. The mean stress removal for non sealed zinc phosphate, sealed zinc phosphate, non sealed glass ionomer, sealed glass ionomer and modified resin cement was found to be 3.56, 1.92, 2.40, 4.26, 6.95 MPa respectively. Zinc phosphate cement remained principally on the castings when the tooth surface was treated with the sealer and was found on both the tooth and the casting when the sealer was not used. Fracture of root before dislodgement was seen in 9 of 11 specimens with modified resin cement. Resin sealer decreases the retention of the castings when used with zinc phosphate and increases it when used with glass ionomer cement. The highest mean dislodgement force was measured with modified resin cement.

An in-vitro evaluation of the flexural strength of heat-polymerized poly (methyl methacrylate) denture resin reinforced with fibers.

Fracture strength of denture base resins is of great concern and many approaches have been made to improve the fracture resistance of acrylic resin dentures by strengthening them. Purpose of the study was to assess the effect of a Novel pre-impregnated glass fiber reinforcement system and nylon fiber reinforcement on the flexural strength of conventional heat-polymerized poly(methylmethacrylate) [PMMA] denture resin under dry and wet storage conditions. Forty specimens of standard dimensions were prepared for each of the four experimental groups; unreinforced conventional acrylic resin and the same reinforced with unidirectional Stick (S) glass fibers, woven Stick Net (SN) glass fibers and nylon fibers. Each group was further subdivided into two groups of 20 specimens each on the basis of storage conditions (dry and wet). All 160 specimens were then subjected to a 3-point bending test and flexural strength was calculated. Statistical analysis was carried out using student t test and 1-way analysis of variance (ANOVA). Stick and Stick Net glass fiber reinforcements enhanced the flexural strength of conventional heat-cured PMMA denture resin. Specimens reinforced with Stick glass fibers exhibited highest flexural strength followed by those reinforced with Stick Net glass fibers. Nylon fiber reinforcement decreased the flexural strength of acrylic resin. All the specimens in the four groups stored under wet conditions showed decrease in flexural strength in comparison to those stored in dry conditions. The reinforcement of denture base resin with pre-impregnated glass fibers may be a useful means of strengthening denture bases. Use of nylon as a reinforcement fiber is not desirable as it decreased the flexural strength of acrylic resin.

Risk factors for sporadic cryptosporidiosis among immunocompetent persons in the United States from 1999 to 2001.

Many studies have evaluated the role of Cryptosporidium spp. in outbreaks of enteric illness, but few studies have evaluated sporadic cryptosporidiosis in the United States. To assess the risk factors for sporadic cryptosporidiosis among immunocompetent persons, a matched case-control study was conducted in seven sites of the Foodborne Diseases Active Surveillance Network (FoodNet) involving 282 persons with laboratory-identified cryptosporidiosis and 490 age-matched and geographically matched controls. Risk factors included international travel (odds ratio [OR] = 7.7; 95% confidence interval [95% CI] = 2.7 to 22.0), contact with cattle (OR = 3.5; 95% CI = 1.8 to 6.8), contact with persons >2 to 11 years of age with diarrhea (OR = 3.0; 95% CI = 1.5 to 6.2), and freshwater swimming (OR = 1.9; 95% CI = 1.049 to 3.5). Eating raw vegetables was protective (OR = 0.5; 95% CI = 0.3 to 0.7). This study underscores the need for ongoing public health education to prevent cryptosporidiosis, particularly among travelers, animal handlers, child caregivers, and swimmers, and the need for further assessment of the role of raw vegetables in cryptosporidiosis.

Impediment profiling for smoking cessation. Preliminary experience.

INTRODUCTION: Cigarette smoking is a leading cause of preventable death. METHODS: Long and short "impediment profilers" (LIPs and SIPs, respectively) addressing nicotine addiction, depression, anxiety, stress, chemical dependency, weight control, and household smoking were developed and applied in a pilot smoking cessation study to tailor treatment. RESULTS: Quit rate 72 hours after the target quit date was 50%; at 8 and 12 weeks it was 61% and 39%, respectively. The LIP identified fewer impediments than the SIP. CONCLUSIONS: Impediment profiling for tailored smoking cessation intervention is associated with high initial quit rates and warrants further study.

Multiple determinants contribute to the virulence of HSV ocular and CNS infection and identification of serine 34 of the US1 gene as an ocular disease determinant.

PURPOSE: The virulence of any given strain of herpes simplex virus (HSV) is probably due to the effects of the constellation of genes in that strain and how they act in concert to promote disease. The goal of this work was to develop a system to identify and study the role of multiple genes in HSV disease. METHODS: Mixed ocular infection with HSV-1 strains CJ394 and OD4 yield recombinants with increased ocular and central nervous system (CNS) virulence. Clones and subclones of the CJ394 genome were cotransfected with intact OD4 DNA into Vero cells, the transfection pools were inoculated into BALB/c mouse eyes, and disease severity was scored. Fragments transferring increased ocular or CNS disease were sequenced. Site-directed mutagenesis was used to revert one mutation to wild type. RESULTS: Five of the determinants (UL9, -33, -41, and -42 and US1) increased ocular disease when transferred singly. Transfer of the UL36/37 determinant increased both ocular and CNS disease. Transfer of the UL41 and -42 genes increased mortality and a combination of the UL36/37, -41, and -42 determinants increased virulence further. Reversion of the S34A change in the OD4 US1 gene to wild type restored ocular virulence. CONCLUSIONS: Multiple HSV genes can operate to increase virulence. The UL9, -33, -36/37, and -42 genes have not previously been identified as virulence determinants. The UL41 and US1 genes are known to affect disease, but the changes identified had not been described. Multiple novel mutations were found in the OD4, UL9, UL36, and US1 genes, and we showed that S34 in the US1 gene is essential in ocular disease.

Impediment profiling for smoking cessation: results of a pilot study.

OBJECTIVE: To test the effectiveness of a smoking cessation program based on "impediment profiling," the elucidation of an individual participant's personal barriers, with provision of tailored interventions accordingly. METHODS: A literature search was conducted to identify established impediments to smoking cessation. A long impediment profiler (LIP) was developed from validated survey instruments and used as a screening tool to identify individuals' barriers to quitting. Once barriers were identified, participants were assigned to up to seven interventions. Self-reported smoking cessation was confirmed with measurements of carbon monoxide concentrations in expired air of < or = 10 ppm. RESULTS: Nineteen adults participated in the pilot program. At the year 1 mark, 63.2% of the study population was smoke-free. The mean number of impediments of the study population was 3.5 +/- 1.5. There was a negative association between subjects' quit status and the following impediments: stress (p = .0061), anxiety (p = .0445), and depression (p < .001). No single impediment was predictive of quit status. CONCLUSIONS: Impediment profiling as a basis for tailored smoking cessation intervention is associated with a high quit rate in this initial study, and it appears promising. Long-term follow-up is warranted, as is replication in a larger cohort with a concurrent control group.