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Two recent studies question the role of dietary fiber in the prevention of colorectal cancer. However, the duration of dietary intervention, dose of fiber, and the complexity of polyp formation and transformation to carcinomas make interpretation of such studies difficult. Multiple rationales exist for promoting the consumption of high-fiber, low-fat, fruit- and vegetable-rich diets.
The envelope glycoprotein of the arenaviruses (GP-C) is unusual in that the mature complex retains the cleaved, 58-amino-acid signal peptide. Association of this stable signal peptide (SSP) has been shown to be essential for intracellular trafficking and proteolytic maturation of the GP-C complex. We identify here a specific and previously unrecognized role of SSP in pH-dependent membrane fusion. Amino acid substitutions that alter the positive charge at lysine K33 in SSP affect the ability of GP-C to mediate cell-cell fusion and the threshold pH at which membrane fusion is triggered. Based on the presumed location of K33 at or near the luminal domain of SSP, we postulate that SSP interacts with the membrane-proximal or transmembrane regions of the G2 fusion protein. This unique organization of the GP-C complex may suggest novel strategies for intervention in arenavirus infection.
Treatment of complex intracranial aneurysms by means of interventional neurovascular techniques is now being performed with a newly developed silicone detachable-microballoon device. The balloon is composed of unique silicone elastomers that are extremely soft and malleable. It therefore conforms to the blood vessel lumen or aneurysm wall and reduces the risk of rupture. It is affixed onto a 2.0-F catheter and can be either directed by flow or guided with the catheter. For aneurysms with a well-defined neck, the balloon is placed directly into the aneurysm, inflated with 2-hydroxyethyl methacrylate for permanent solidification, and detached. The aneurysm is thus excluded from the circulation, and the parent vessel is preserved. For aneurysms without a well-defined neck, test occlusion can be performed, followed by permanent balloon occlusion of the parent vessel. This balloon technique has been successfully used to treat aneurysms in both the anterior and posterior circulations, where standard neurosurgical techniques have failed, and in surgically inaccessible anatomic locations.
The emerging field of cancer prevention through chemoprevention agents and cancer vaccines offers significant promise for reducing suffering and death from cancer. However, that promise may not be kept unless major barriers to progress are lowered or eliminated. Among the most significant barriers are the relatively small investment from government and industry in research and development of cancer preventive agents; a predominant emphasis of translational cancer research on therapeutic interventions for metastatic or advanced cancer; complexities of prevention trial design; a relatively uncharted Food and Drug Administration (FDA) approval process for preventive agents; insufficient public and patient understanding of the importance and potential for cancer preventive measures, with consequent unpredictable public and patient willingness to take preventive agents; an uncertain reimbursement from payors; and limitations in patent law, liability protection, and data package exclusivity that undermine the opportunity for recouping investment. Viewed individually or collectively, each of these barriers serves as a substantial deterrent to intellectual and financial investment by all sectors of the cancer community. In an effort to ultimately overcome these barriers, a Cancer Prevention Research Summit was assembled June 12-13, 2006 in Bethesda, Maryland, organized by C-Change with support from the AACR. The Summit brought together some 120 leaders from private, public, and not-for-profit entities, including cancer researchers and clinicians; federal health officials; regulatory agency representatives; pharmaceutical, biotech, and food industry leaders; patent attorneys; economists; public and private provider group executives; and advocates. Participants engaged in a detailed process to more carefully define the major barriers, identify potential solutions, and formulate initial priorities and recommendations for action. At the conclusion of this dialogue among experts, the following recommended actions were outlined: define policy solutions to patent, intellectual property, and liability law barriers; create an advisory document about the approval process for cancer chemopreventive agents and vaccines for the FDA; develop new design models for cancer chemopreventive clinical trials; outline the business case for chemopreventive agents and vaccines for federal research agencies, payors and investors; and implement a communications strategy to increase public awareness about the importance of chemoprevention and cancer preventive vaccines.
The importance of lowering blood pressure (BP) in hypertensive subjects is well-known and recent studies suggest that lowering of BP in patients who may already be in the normotensive range further reduces the risk of vascular events, particularly stroke. Epidemiological data have also shown that lower BP and antihypertensive treatment may be associated with cognitive impairment once cerebrovascular disease is established. However, the relationship between hypertension and cerebrovascular disease is more complex than suggested by epidemiological or intervention studies. Cerebral imaging studies have shown that cerebral blood flow (CBF) is reduced in areas of small-vessel disease (SVD) and the degree of hypoperfusion correlates with disease severity. Furthermore, impaired neuropsychological performance has been found to correlate with cerebral hypoperfusion in patients with established SVD. These findings raise questions surrounding the desirability of lowering of BP beyond a certain level in such patients. It is conceivable that indiscriminate BP reduction may compromise cerebral perfusion and function in these patients, increasing the risk of cognitive decline and cerebrovascular disease progression. Randomized clinical trials addressing the relationship between antihypertensive treatment and vascular cognitive impairment are lacking. Further studies are therefore needed to assess the cognitive consequences of BP reduction in people with established cerebrovascular disease. This will help to direct appropriate protective strategies and treatments in a vulnerable group of people, many of whom have hypertension and cerebrovascular disease at the same time.
The telephone is being widely used by the private sector as a communication medium for understanding and influencing consumer behavior. Coinciding with the growth of telephone use in the private sector is the expansion of telephone use in health care to include complex health promotion and disease prevention interventions aimed at initiating and maintaining health-related behavioral changes. While several studies have evaluated the impact of telephone interventions on a wide range of health behaviors, no published reports synthesizing current knowledge about using the telephone as a communication medium for health education were identified. In this article, the authors therefore (1) examine recent applications of telephone use in health education by describing three example interventions, (2) outline key features and alternatives in conceptualizing and designing health education using the telephone, (3) review advantages and disadvantages of using the telephone for health education, and (4) discuss implications for health education practice and research.
PURPOSE/OBJECTIVES: To describe the concerns of family caregivers of patients undergoing palliative surgeries for advanced malignancies. DESIGN: Descriptive study with repeated measures. SETTING: A National Cancer Institute-designated Comprehensive Cancer Center in the western United States. SAMPLE: Family caregivers (N = 45) of patients with cancer. METHODS: Family caregivers were assessed prior to planned palliative surgery and at two weeks and six weeks postsurgery. Quantitative assessment of caregiver quality of life (QOL) occurred at each interval. A subset of nine caregivers also participated in a structured interview presurgery and at two weeks postsurgery. MAIN RESEARCH VARIABLES: Caregiver concerns, QOL, decision making. FINDINGS: Family caregivers have important QOL concerns and needs for support before and after surgery for advanced disease. Psychological issues were most pronounced, and common concerns included uncertainty, fears regarding the future, and loss. Family caregivers have concerns about surgical risks and care after surgery and voiced recognition of the declining status of patients. CONCLUSIONS: Surgery is an important component of palliative care and profoundly impacts family caregivers of patients with cancer. The needs of family caregivers are multiple and complex, requiring ongoing assessment to provide interventions that help them cope and ultimately improve their QOL. This important topic requires further research and clinical attention. IMPLICATIONS FOR NURSING: Findings suggest that family caregivers experience their own trajectory during the course of their loved ones' cancer, with surgery being a part of the course. This includes their profound emotions that may swing like a pendulum from one minute to the next. Nurses need to assess family caregivers in addition to patients to provide support and resources that will help increase caregivers' QOL.
Current models of radiation carcinogenesis generally assume that the DNA is damaged in a variety of ways by the radiation and that subsequent cell divisions contribute to the conversion of the damage to heritable mutations. Cancer may seem complex and intractable, but its complexity provides multiple opportunities for preventive interventions. Mitotic inhibitors are among the strongest cancer preventive agents, not only slowing the growth rate of preneoplasias but also increasing the fidelity of DNA repair processes. Ionizing radiation, including electrons, is a strong inducer of cancer in rat skin, and dietary retinoids have shown potent cancer preventive activity in the same system. A non-toxic dietary dose of retinyl acetate altered gene expression levels 24 hours after electron irradiation of rat skin. Of the 8740 genes on an Affymetrix rat expression array, the radiation significantly (5 fold or higher) altered 188, while the retinoid altered 231, including 16 radiation-altered genes that were reversely altered. While radiation strongly affected the expression of stress response, immune/inflammation and nucleic acid metabolism genes, the retinoid most strongly affected proliferation-related genes, including some significant reversals, such as, keratin 14, retinol binding protein, and calcium binding proteins. These results point to reversal of proliferation-relevant genes as a likely basis for the anti-radiogenic effects of dietary retinyl acetate.
The Centers for Disease Control and Prevention (CDC), through its Diffusion of Effective Behavioral Interventions (DEBI) program, trained over 260 agencies on VOICES/VOCES between August 2003 and April 2005. ORC Macro conducted interviews with agency staff 3 months after receiving VOICES/VOCES training. This article discusses the diffusion of VOICES/VOCES; agencies' adoption, adaptation, and implementation of this intervention; and needs for ongoing proactive technical assistance (TA) for agencies to successfully integrate behavioral interventions into their programs. The vastmajority of agencies implemented VOICES/VOCES with fidelity to the core elements, and agencies successfully adapted the intervention to make it more appealing to target populations. TA is needed for interventions to be successfully adapted and implemented with fidelity to the core elements, and to ensure program sustainability. More effective interventions of short duration and minimum complexity to easily match with existing resources and conditions of agency capacity among HIV prevention providers in the community are needed.
All articles published in the first 25 years of JABA (1968 to 1992) were reviewed to classify the percentage of articles published in the following categories: (a) type of article, (b) subjects, (c) setting, (d) behavior-change agent, (e) target behavior, (f) use of basic principles, and (g) miscellaneous procedures. Overall percentages and trends are reported in each category. Results indicate an increase in the percentage of articles with participants and target behaviors in developmental disabilities and a decrease in the percentage of studies targeting academic behavior, verbal behavior, and other child behavioral excesses. The most frequent setting continues to be a school; however, there is a clear trend towards community and other naturalistic settings. Results also highlight the increasing complexity and multicomponent nature of JABA interventions. Potential implications for future applications are discussed.
The objective of this paper was to show the historical perspective of the "long centric" occlusal concept and its importance in the modern dentistry, especially from the gnathological aspect. The "long centric" concept represents therapeutic modality used in modern dentistry and occlusal adjustment in all patients showing differences in strong and weak closure of the lower jaw starting from the position of physiological rest. "Long centric" concept is applied only for anterior teeth and occlusal movements from rather than toward the center. Whenever the "long centric" parameters are not adequate, occlusal disturbance, resulting from the "wedge" effect during the initial closure of the lower jaw, is present. Different degrees of abrasion or hypermobility of the teeth are often the result of the above-mentioned occlusal disturbances and can potentially trigger bruxism and malfunction. Modus procedendi should be the regular approach of every dentist to any occlusion, because only the built-in "long centric" efficiently contributes to the occlusal stability of the anterior portion of the dentition. All occlusions should be routinely tested regarding their need for "long centric", especially when the extensive therapeutic interventions (conservative, prosthetics) of the occlusal complex are required.
For treatment of patients with complex craniosynostosis, increased intracranial pressure, severe exophthalmos, and apnea attacks are important indications for operative intervention. Little has been reported on obstructive sleep apnea in complex craniosynostosis. Obstructive sleep apnea attacks in complex craniosynostosis are evaluated in relation to the upper and middle pharyngeal space and to the dimensions of the maxilla and mandible measured on cephalograms. The value of the pharyngeal air space in craniosynostosis had no relationship with either the frequency of sleep apnea attack or with severity of snoring. The dimensions had a close relationship with obstructive sleep apnea attack.
The five health promotion and education committees (CODES) from the Pays de la Loire region are carrying out health promotion projects involving socially disadvantaged people. These projects are referred to as ateliers santé (literally meaning "health workshops"). These interventions are conducted over a series of participatory sessions, which creates a more supportive structure to guide people with difficulties assisting them to better recognise and formulate their health needs, as they are normally part of a population group which is neither accustomed to expressing their health needs nor to being heard on this subject. At present little is known about these projects; therefore the Inter-regional and departmental health education committee from Nantes chose to carry out an evaluation of 7 of the 47 existing "workshops". Each one of the seven interventions required an average of 31 hours of preparation. Overall, there were 9 sessions organised with 8 to 9 participants, each lasting for the duration of 2.5 hours, held over a period of 32 weeks. At the end of each session, 85% of the participants claimed that there were satisfied. When questioned six months after the end of their "workshop", half of the 37 participants reported that their perceived health status was a little or much better after having taken part in the process. The evaluation demonstrates that a more clear definition of the operational objectives is necessary in order to promote increased input from the participants and to clarify the intentions of the project team towards a population group which needs a means by which it can enter into this critical debate. The process appears to be in accordance with the criteria and goals of health promotion: negotiation of the content, participation of members of the target audience throughout various stages of the project, and adjustment of the size and scale of the project being to involve a small total number of participants in order to favour effective follow up. Although evaluating the effectiveness and impact of such interventions is difficult and complicated by complex methodological questions, these "workshops" seem to have been greatly appreciated both by those who requested them and those who participated in them, with encouraging results having been witnessed in the lives of certain participants, which all serves as an incentive to pursue this kind of project.
BACKGROUND AND OBJECTIVE: To provide a tool for analyzing optical coherence tomography data in patients with diabetic macular edema. PATIENTS AND METHODS: Retrospective series of 206 patients with diabetic macular edema involving at least one eye and receiving focal laser photocoagulation, intravitreal triamcinolone acetonide injection, or vitrectomy, membrane peeling, and intravitreal triamcinolone acetonide injection, and of untreated fellow eyes without diabetic macular edema. Main outcome measures included foveal subfield mean thickness and thickening relative to normal (microns), total macular volume and its increase relative to normal (mm3), visual acuity (Snellen decimal), and intraocular pressure (mm Hg). RESULTS: The authors demonstrate a graphical display of data based on a spreadsheet template for the longitudinal management of diabetic macular edema. Complex relationships of ocular response and interventions are concisely displayed. CONCLUSION: A graphical display of optical coherence tomography, visual acuity, and intraocular pressure data is a practical aid in the management of diabetic macular edema.
As the complexity, cost, and risks of cardiac interventions direct attention to careful selection of patients, the ability of diagnostic imaging techniques to provide quantitative documentation of the hemodynamic severity of coronary artery disease will assume greater importance. Among the various techniques currently in use, positron emission tomography yields superior spatial resolution and attenuation correction and has high sensitivity and specificity. The correlation of positron emission tomography results with coronary stenosis severity and the possibility of making quantitative flow measurements using oxygen-15 water suggest that cardiac positron emission tomography may be the best noninvasive approach for diagnostic purposes.
The sole human cathelicidin peptide, LL-37, has been demonstrated to protect animals against endotoxemia/sepsis. Low, physiological concentrations of LL-37 (< or =1 microg/ml) were able to modulate inflammatory responses by inhibiting the release of the proinflammatory cytokine TNF-alpha in LPS-stimulated human monocytic cells. Microarray studies established a temporal transcriptional profile and identified differentially expressed genes in LPS-stimulated monocytes in the presence or absence of LL-37. LL-37 significantly inhibited the expression of specific proinflammatory genes up-regulated by NF-kappaB in the presence of LPS, including NFkappaB1 (p105/p50) and TNF-alpha-induced protein 2 (TNFAIP2). In contrast, LL-37 did not significantly inhibit LPS-induced genes that antagonize inflammation, such as TNF-alpha-induced protein 3 (TNFAIP3) and the NF-kappaB inhibitor, NFkappaBIA, or certain chemokine genes that are classically considered proinflammatory. Nuclear translocation, in LPS-treated cells, of the NF-kappaB subunits p50 and p65 was reduced > or =50% in the presence of LL-37, demonstrating that the peptide altered gene expression in part by acting directly on the TLR-to-NF-kappaB pathway. LL-37 almost completely prevented the release of TNF-alpha and other cytokines by human PBMC following stimulation with LPS and other TLR2/4 and TLR9 agonists, but not with cytokines TNF-alpha or IL-1beta. Biochemical and inhibitor studies were consistent with a model whereby LL-37 modulated the inflammatory response to LPS/endotoxin and other agonists of TLR by a complex mechanism involving multiple points of intervention. We propose that the natural human host defense peptide LL-37 plays roles in the delicate balancing of inflammatory responses in homeostasis as well as in combating sepsis induced by certain TLR agonists.
A case of congenital lingual angiodysplasia with macroglossia in a 5-year-old girl is presented. A diffusely enlarged tongue was present at birth and continued to grow as the child aged. It was accompanied by impaired speech, difficulty in eating and breathing, and sleep apnea, necessitating surgical intervention. The fundamental lesion represents a complex vascular malformation of the lymphangioma-hemangioma type, involving extensively the deep musculature of the tongue. Multifocal and multicentric cavernous lymphangioma-like and hemangioma-like areas merge with benign angioendotheliomatous-like foci in a background of variable muscle degeneration and marked fibrosis. Neither a borderline nor an overtly malignant vasoformative neoplasm was present. Because of its distinctively widespread, multicentric intramuscular distribution, this lesion may be construed as a diffuse variant of lingual lymphangioma-hemangioma malformation, closely resembling a previously described case of macroglossal lymphangioendotheliomatosis.
BACKGROUND: Epidemiologic studies suggest that vegetable protein intake is inversely related to blood pressure. OBJECTIVE: To examine the effect of soybean protein supplementation on blood pressure in persons with prehypertension or stage 1 hypertension. DESIGN: Randomized, double-blind, controlled trial. SETTING: Three communities in the People's Republic of China. PATIENTS: 302 participants 35 to 64 years of age with an initial untreated systolic blood pressure of 130 to 159 mm Hg, diastolic blood pressure of 80 to 99 mm Hg, or both. INTERVENTION: Study participants were randomly assigned to receive 40 g of isolated soybean protein supplements per day or complex carbohydrate control for 12 weeks; 91.4% completed the intervention. MEASUREMENTS: Blood pressure measurements were obtained by using random-zero sphygmomanometers at baseline and at 6 and 12 weeks. RESULTS: At baseline, the mean systolic and diastolic blood pressures were 135.0 mm Hg (SD 10.9) and 84.7 mm Hg (SD 6.9), respectively. Compared with the control group, the net changes in systolic blood pressure and diastolic blood pressure were -4.31 mm Hg (95% CI, -2.11 to -6.51 mm Hg; P < 0.001) and -2.76 mm Hg (CI, -1.35 to -4.16 mm Hg; P < 0.001), respectively, after the 12-week intervention. The net changes in systolic and diastolic blood pressure reductions were -7.88 mm Hg (CI, -4.66 to -11.1 mm Hg) and -5.27 mm Hg (CI, -3.05 to -7.49 mm Hg), respectively, in persons with hypertension and -2.34 mm Hg (CI, 0.48 to -5.17 mm Hg) and -1.28 mm Hg (CI, 0.52 to -3.07 mm Hg), respectively, in those without hypertension. LIMITATIONS: This trial did not examine whether the blood pressure reduction was due to protein or isoflavones in soybean. CONCLUSIONS: Soybean protein supplementation resulted in a reduction in systolic and diastolic blood pressure. These findings suggest that increased intake of soybean protein may play an important role in preventing and treating hypertension.