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The comparative toxicity of six per‐ and polyfluoroalkyl substance (PFAS)–free and one PFAS‐containing aqueous film‐forming foam (AFFF) was evaluated in an outbred mouse species as well as several in vitro assays. The in vivo toxicological profile of PFAS‐free AFFFs in short‐term, high‐concentration exposures is different than that of a PFAS‐containing AFFF. The PFAS‐containing reference product induced increased liver weights, while the PFAS‐free AFFFs were linked to either decreased or unaffected relative liver weights. The in vitro toxicological profile across PFAS‐free AFFFs was uniform except in the Microtox® assay, where thresholds were variable and spanned several orders of magnitude. This direct comparison of products through short‐term toxicity tests and in vitro screenings represents early data to support evaluation of potential regrettable substitutions when selecting alternative PFAS‐free AFFFs. Further work in diverse taxa (e.g., aquatic organisms, terrestrial invertebrates, birds) and mammalian studies capturing sensitive life stages will refine and expand this data set across a range of risk‐relevant toxicological endpoints. Environ Toxicol Chem 2023;42:2364–2374. Published 2023. This article is a U.S. Government work and is in the public domain in the USA. [ABSTRACT FROM AUTHOR]

There is an urgent need to understand the toxicity hazards of aqueous film forming foam (AFFF) replacement products to ensure the balance between performance and toxicity hazards and avoid regrettable substitutions during the rapid phasing out of per‐ and polyfluoroalkyl substance (PFAS)‐containing AFFFs. To address this need, we assessed the toxicity of six candidate PFAS‐free products via literature review, estimation techniques, and incorporation of testing data from whole products and compared them against one PFAS‐containing product. Then, we combined the relative hazards across human occupational exposure (e.g., concentrate, foam, or dilute exposures), human environmental exposure (e.g., training, emergency response, cleanup), and environmental exposure to aquatic, mammalian, and other terrestrial species using an index‐based scoring system to quantify potential hazards across these domains. We found that most PFAS‐free products in their concentrated form may cause dermal and ocular irritation, and aquatic toxicity may be a concern from direct or repeated environmental releases. Additionally, all PFAS‐free AFFF products assessed contain chemicals that are notable as plausible hazards resulting from release uncertainties (e.g., concentration, release volume, release timing), but the PFAS‐free AFFF products appear to have a lower likelihood of environmental persistence and bioaccumulation and to have lower oral human health toxicity than the PFAS‐containing reference product. Decision makers can use this information alongside cost–benefit, sustainability, or life‐cycle analyses to make a data‐driven decision for the adoption of PFAS‐free AFFF. Integr Environ Assess Manag 2023;19:1609–1618. © 2023 SETAC Key Points: Per‐ and polyfluoroalkyl substance (PFAS)‐free aqueous film forming foams (AFFFs) will present a toxicity profile different than current PFAS‐containing AFFFs.Most PFAS‐free products in their concentrated form may cause dermal and ocular irritation, and aquatic toxicity may be a concern from direct or repeated environmental releases.PFAS‐free AFFF products appear to have lower likelihood of environmental persistence and bioaccumulation and have lower oral human health toxicity than the PFAS‐containing reference product. [ABSTRACT FROM AUTHOR]

Rationale, Aims and Objectives: To examine factors related to recruitment of eligible patients and retention of enrolled patients in diabetes group visits (GVs). Method: As part of a cluster randomized trial, 272 eligible patients were contacted and 75 patients were eventually enrolled in GVs at six community health centers (CHC). Fisher's exact tests and χ2 tests were used to compare enrolled and nonenrolled patients by patient recruitment method, gender and preferred language. Linear mixed models were used to evaluate characteristics associated with GV attendance such as diabetes self‐empowerment and diabetes‐associated distress. Content analysis was used to analyse patients' open‐ended survey responses, and template analysis was used to analyse CHC staff interviews. Results: In terms of recruitment and enrollment analysis, patients who received in‐person contact only and both phone and in‐person contact comprised a greater fraction of the enrolled than unenrolled group, while those who received phone only and both phone and mail comprised a smaller fraction of the enrolled than unenrolled group (p = 0.004). In terms of retention analysis, 70 of the 75 enrolled patients attended at least one GV (93%). The average number of GVs was 3.2 out of 6 visits. Higher GV attendance was associated with lower baseline diabetes empowerment (p = 0.03). Patients' most common self‐reported motivating factors to attend GVs were to learn more about diabetes, gain improved blood glucose control and find support from peers. Conclusion: In‐person recruitment for GVs at CHCs was more effective than recruitment by telephone/mail. Patients who felt less empowered to manage their diabetes were most motivated to attend GVs. These findings could help clinicians implement targeted recruitment of patient populations who are more likely to attend diabetes GVs and tailor self‐management education interventions to their patient populations, particularly for underserved patients who face disparate clinical outcomes. [ABSTRACT FROM AUTHOR]

(c) BCL2-IGHJ PCR (MBR1) (BIOMED-2 Reaction A assay) shows a positive product for the inguinal lymph node (LN), but not the axillary LN biopsy (left panel). Keywords: in situ follicular neoplasia; mutation; liver transplantation EN in situ follicular neoplasia mutation liver transplantation 58 60 3 01/31/23 20230101 NES 230101 Abbreviations ISFN in situ follicular neoplasia LN Lymph nodes PET-CT positron emission tomography computed tomograph PTLD post-transplant lymphoproliferative disorder PCR polymerase chain reaction TNFRSF14 TNF Receptor Superfamily Member 14 T(14:18)(q32;q21), causing I IGH:BCL2 i , occurs as a result of erroneous genomic rearrangements during VDJ recombination at the pre-B stage of B-cell development in the bone marrow. Clone-specific PCR demonstrates an expected 89 bp product from the inguinal LN biopsy, but not the axillary LN biopsy (right panel). [Extracted from the article]

The ease of direct‐acting antiviral (DAA) medications for hepatitis C virus (HCV) has provided an opportunity to decentralize HCV treatment into community settings. However, the role of non‐specialist clinicians in community‐based pathways has received scant attention to date. This study examined barriers and enablers to expanding the role of general practitioners (GPs) in HCV treatment provision, using simple behaviour change theory as a conceptual framework. A maximum variation sample of 22 HCV treatment providers, GPs and HCV support workers participated in semi‐structured interviews. Data were inductively coded, and the resulting codes deductively mapped into three principal components of behaviour change: capability, opportunity and motivation (COM‐B). By this process, a number of provider‐ and systemic‐level barriers and enablers were identified. Key barriers included the pre‐treatment assessment of liver fibrosis, GP capacity and the 'speciality' of HCV care. Enablers included the simplicity of the drugs, existing GP/patient relationships and the provision of holistic care. In addition to these specific factors, the data also exposed an overarching provider understanding of 'HCV treatment' as triumvirate in nature, incorporating the assessment of liver fibrosis, the provision of holistic support and the treatment of disease. This understanding imposes a further fundamental barrier to GP‐led treatment as each of these three components needs to be individually addressed. To enable sustainable models of HCV treatment provision by GPs, a pragmatic re‐examination of the 'HCV treatment triumvirate' is required, and a paradigm shift from the 'refer and treat' status quo. [ABSTRACT FROM AUTHOR]

Understanding risks to terrestrial wildlife species from exposure to chemicals in the environment requires knowledge of how species make habitat decisions and how subsequent exposure events occur. Heterogeneity of chemical distribution and of habitat quality can influence exposure. Previous studies in birds have shown that individually based, spatially explicit models can be useful in predicting exposure and risk; however, studies investigating these influences in small mammals with limited ranges have been lacking. Here we test a spatially explicit, individually based exposure model (Spatially Explicit Exposure Model [SEEM]) in which model predictions based on life history traits, habitat preferences, and varying soil Pb concentrations are used and compared to those with field‐collected blood or tissue Pb concentrations in small (e.g., Peromyscus, Blarina spp.) and medium‐sized mammalian species (e.g., Lepus spp.) at 3 Pb‐contaminated sites. These species were chosen because they were expected to be present in suitable habitat, and Pb was modeled when adequate tissue‐based toxicity thresholds were available. Oral exposure estimates from SEEM were compared with a traditional deterministic model and with field‐collected tissue Pb concentrations using ecological hazard quotients (EHQs) to normalize between oral and real‐time tissue Pb concentrations. Ecological hazard quotients at the 90% population effect level (for SEEM) and at the 95% upper confidence level (assuming a single Pb concentration with no consideration of habitat quality in the deterministic model) were compared with maximum EHQs developed from blood or tissue Pb concentrations. Deterministic estimates and SEEM were similar for small mammal species, yet slightly overpredicted risk compared to field tissue or blood Pb data. Estimates for hares (medium‐sized mammals) using SEEM provided more accurate predictions compared with field tissue data. These data suggest that spatially explicit models may be sensitive to grain size, given that small mammals experience the environment in limited spatial contexts, a scale at which habitat may not change significantly. Integr Environ Assess Manag 2021;17:259–272. Published 2020. This article is a US Government work and is in the public domain in the USA. KEY POINTS: Spatially explicit exposure models allows for improved estimates of exposure for wildlife using space and habitat preferences within a landscape.Improvement of risk estimates are somewhat dependent upon resolution of soil chemistry results and movement of small mammalian species.Exposure estimates improve with wide‐ranging species. [ABSTRACT FROM AUTHOR]

We tested the efficacy of religiously tailored and ethically balanced education upon living kidney organ donation intent among Muslim Americans. Pre‐post changes in participant stage of change, preparedness, and likelihood judged efficacy. Among 137 participants, mean stage of change toward donation appeared to improve (0.59; SD ± 1.07, P <.0001), as did the group's preparedness to make a donation decision (0.55; SD ± 0.86, P <.0001), and likelihood to donate a kidney (0.39; SD ± 0.85, P <.0001). Mean change in likelihood to encourage a loved one, a co‐worker, or a mosque community member with ESRD to seek a living donor also increased (0.22; SD ± 0.84, P =.0035, 0.23; SD ± 0.82, P =.0021, 0.33; SD ± 0.79, P <.0001 respectively). Multivariate ordered logistic regression models revealed that gains in biomedical knowledge regarding organ donation increased odds for positive change in preparedness (OR = 1.20; 95% CI 1.01‐1.41, P =.03), while increasing age associated with lower odds of positive change in stage of change (OR = 0.98, 95% CI 0.96‐0.998, P =.03), and prior registration as an organ donor lowered odds for an increase in likelihood to donate a kidney (OR = 0.22; 95% CI 0.08‐0.60, P =.003). Our intervention appears to enhance living kidney donation‐related intent among Muslim Americans [Clinicaltrials.gov number: NCT04443114]. [ABSTRACT FROM AUTHOR]

SUMMARY: Background: Renal replacement therapies (RRT) other than in‐centre haemodialyses are underutilised by African Americans with end‐stage renal disease (ESRD) even though they are associated with reduced costs, morbidity and mortality as well as improved quality of life for patients. Objectives: To understand African American patients' knowledge of RRT options and how patient, provider and system‐factors contribute to knowledge and preferences. Participants' interviews were conducted at the University of Chicago Medical Center with African American patients with chronic kidney disease (CKD). The final analysis included 28 interviews; 22 patients had CKD not yet on dialysis or having received a transplant, while 6 had reached ESRD and were receiving treatment for kidney failure. Approach Transcripts were uploaded into NVivo8 for coding. Thematic analysis was used for data interpretation. Results: Four themes were identified: (1) limited knowledge of home modalities and deceased donor options, (2) CKD patients gave little thought to choosing RRT options, (3) CKD patients relied on doctors for treatment decisions, and (4) while patients reported knowledge of living kidney donation transplants (LKDT), it did not translate to receiving an LKDT. Conclusion: African Americans face significant knowledge and access barriers when deciding on their RRT treatment. Even patients with advanced CKD were still in the early stages of RRT selection. Understanding the knowledge gaps and barriers patients face will inform our subsequent intervention to educate and motivate patients to increase CKD self‐care and improve communication between patients, their families and their providers about different RRT treatments. [ABSTRACT FROM AUTHOR]

Background: Adenocarcinoma in situ of cervix is increasingly managed by local excision rather than hysterectomy and this study will ascertain if conservative management by excision alone is adequate. Aims: To evaluate the long‐term outcomes of conservative management of adenocarcinoma in situ of cervix, particularly in relation to excisional margin status. Materials and Methods: Retrospective analysis of women diagnosed with adenocarcinoma in situ and their management between 1992 and 2010 retrieved from the Victorian Cervical Cytology Registry, Australia. Failure of conservative treatment is defined by histologically proven adenocarcinoma in situ or adenocarcinoma at follow‐up after negative excisional margins. Results: adenocarcinoma in situ of the cervix was managed primarily with cold knife cone biopsy or loop electrosurgical excision of the cervix. Most excisions were in one piece (83.4%) with average depth of 16.1 mm and 21.9% had involved excisional margins. Women with adenocarcinoma in situ on any excisional margin were more likely to have residual or recurrent disease (28.7%) compared with negative excisional margins (4.3%). Residual adenocarcinoma in situ was twice as common if adenocarcinoma in situ was present at endocervical (29.6%) and stromal (23.1%) margins compared with an ectocervical margin (13.6%). Cancer incidence at follow‐up was 2.3% for women with positive excisional margins compared to 1.3% with negative margins. Conclusions: Women with adenocarcinoma in situ of cervix can be managed with local excisional procedures, best in single pieces to provide the important information on excisional margins. Adenocarcinoma in situ at endocervical and stromal excisional margins needs re‐excision or where appropriate, hysterectomy, while negative excisional margins have a low rate of recurrence and can be followed up with test of cure. [ABSTRACT FROM AUTHOR]

Background: This report details the cost effectiveness of a non-nurse patient navigation (PN) program that was implemented at the University of Chicago Medical Center to increase colonoscopy-based colorectal cancer (CRC) screening.Methods: The authors investigated the impact of the PN intervention by collecting process measures. Individuals who received navigation were compared with a historic cohort of non-navigated patients. In addition, a previously validated data-collection instrument was tailored and used to collect all costs related to developing, implementing, and administering the program; and the incremental cost per patient successfully navigated (the cost of the intervention divided by the change in the number who complete screening) was calculated.Results: The screening colonoscopy completion rate was 85.1% among those who were selected to receive PN compared with 74.3% when no navigation was implemented. With navigation, the proportion of no-shows was 8.2% compared with 15.4% of a historic cohort of non-navigated patients. Because the perceived risk of noncompletion was greater among those who received PN (previous no-show or cancellation, poor bowel preparation) than that in the historic cohort, a scenario analysis was performed. Assuming no-show rates between 0% and 50% and using a navigated rate of 85%, the total incremental program cost per patient successfully navigated ranged from $148 to $359, whereas the incremental intervention-only implementation cost ranged from $88 to $215.Conclusions: The current findings indicate that non-nurse PN can increase colonoscopy completion, and this can be achieved at a minimal incremental cost for an insured population at an urban academic medical center. [ABSTRACT FROM AUTHOR]

Abstract: Plerixafor is a CXC chemokine receptor (CXCR4) antagonist that mobilizes stem cells in the peripheral blood. It is indicated (in combination with granulocyte‐colony stimulating factor [G‐CSF]) to enhance the harvest of adequate quantities of cluster differentiation (CD) 34+ cells for autologous transplantation in patients with lymphoma or multiple myeloma whose cells mobilize poorly. Strategies for use include delayed re‐mobilization after a failed mobilization attempt with G‐CSF, and rescue or pre‐emptive mobilization in patients in whom mobilization with G‐CSF is likely to fail. Pre‐emptive use has the advantage that it avoids the need to re‐schedule the transplant procedure, with its attendant inconvenience, quality‐of‐life issues for the patient and cost of additional admissions to the transplant unit. UK experience from 2 major centers suggests that pre‐emptive plerixafor is associated with an incremental drug cost of less than £2000 when averaged over all patients undergoing peripheral blood stem cell (PBSC) transplant. A CD34+ cell count of <15 µl−1 at the time of recovery after chemomobilization or after four days of G‐CSF treatment, or an apheresis yield of <1 × 106 CD34+ cells/kg on the first day of apheresis, could be used to predict the need for pre‐emptive plerixafor. [ABSTRACT FROM AUTHOR]

Primary HPV screening enables earlier diagnosis of cervical lesions compared to cytology, however, its effect on the risk of treatment and adverse obstetric outcomes has not been extensively investigated. We estimated the cumulative lifetime risk (CLR) of cervical cancer and excisional treatment, and change in adverse obstetric outcomes in HPV unvaccinated women and cohorts offered vaccination (>70% coverage in 12-13 years) for the Australian cervical screening program. Two-yearly cytology screening (ages 18-69 years) was compared to 5-yearly primary HPV screening with partial genotyping for HPV16/18 (ages 25-74 years). A dynamic model of HPV transmission, vaccination, cervical screening and treatment for precancerous lesions was coupled with an individual-based simulation of obstetric complications. For cytology screening, the CLR of cervical cancer diagnosis, death and treatment was estimated to be 0.649%, 0.198% and 13.4% without vaccination and 0.182%, 0.056% and 6.8%, in vaccinated women, respectively. For HPV screening, relative reductions of 33% and 22% in cancer risk for unvaccinated and vaccinated women are predicted, respectively, compared to cytology. Without the implementation of vaccination, a 4% increase in treatment risk for HPV versus cytology screening would have been expected, implying a possible increase in pre-term delivery (PTD) and low birth weight (LBW) events of 19 to 35 and 14 to 37, respectively, per 100,000 unvaccinated women. However, in vaccinated women, treatment risk will decrease by 13%, potentially leading to 4 to 41 fewer PTD events and from 2 more to 52 fewer LBW events per 100,000 vaccinated women. In unvaccinated women in cohorts offered vaccination as 12-13 year olds, no change to lifetime treatment risk is expected with HPV screening. In unvaccinated women in cohorts offered vaccination as 12-13 year olds, no change to lifetime treatment risk is expected with HPV screening. HPV screening starting at age 25 in populations with high vaccination coverage, is therefore expected to both improve the benefits (further decrease risk of cervical cancer) and reduce the harms (reduce treatments and possible obstetric complications) associated with cervical cancer screening. [ABSTRACT FROM AUTHOR]

Objective: Studies suggest that American Muslim women underutilize mammography. While religion has a strong influence upon Muslim health behaviors, scant research has examined how religion-related beliefs inform Muslim women's intention for mammography. Our study identifies and examines such beliefs.Methods: Muslim women aged 40 years and older sampled from mosques participated in focus groups and individual interviews. Drawing upon the theory of planned behavior, interviews elicited salient behavioral, normative, and control beliefs regarding mammography and the influence of Islam upon screening intention.Results: Fifty women participated in 6 focus groups and 19 in semistructured interviews, with near-equal numbers of African American, South Asian, and Arab Muslims. Forty-two percent of participants had not had a mammogram within the past 2 years. Across differences in race/ethnicity and mammography status, women voiced four religion-related salient beliefs that inform mammography intention: (1) the perceived duty to care for one's health, (2) religious practices as methods of disease prevention, (3) fatalistic notions about health, and (4) comfort with gender concordant health care.Conclusions: Religious beliefs influence decisions to pursue mammography across the ethnic/racial diversity of Muslim women. Notions about duty to God and the stewardship of one's body appear to enhance mammography intention. Theocentric notions of cure and illness and varied views regarding personal agency also inform decisional frames that impact mammography intention. Given the salience of religion among our participants, religiously tailored messages in interventions have the potential to enhance cancer screening. [ABSTRACT FROM AUTHOR]

Aims Cyclophosphamide was widely used as a single agent prior to the advent of platinum-based regimens for epithelial ovarian cancer, and, in combination with platinum, prior to the adoption of platinum and paclitaxel as standard first-line therapy. As cyclophosphamide currently has no defined role in ovarian cancer we aimed to assess its activity in women with recurrent disease. Methods A retrospective review was conducted of patients from three centers in Melbourne, Australia who had received oral cyclophosphamide treatment for recurrent ovarian cancer. The primary end-point was response rate to oral cyclophosphamide (150 mg p.o. day 1-14) based on Gynecologic Cancer InterGroup ( GCIG) CA125 and/or Response Evaluation Criteria in Solid Tumors ( RECIST) criteria. Secondary end-points included overall and progression-free survival and toxicity. Results In all, 26 patients were identified and 23 patients were evaluable for response. The median number of prior chemotherapy regimens was three (range 1-6). The response rate to oral cyclophosphamide was 44% with 10 of the 23 patients achieving a partial response ( PR) based on GCIG ( CA125) criteria. The median number of cycles received was three (range 1-16). Cyclophosphamide showed activity both in patients with platinum-sensitive (seven of 13 PR) and resistant or refractory disease (three of 10 PR). There was no grade 3 or 4 toxicity but two patients ceased cyclophosphamide due to less severe non-hematological toxicity. Conclusion Single agent oral cyclophosphamide is active and well tolerated in recurrent ovarian cancer. Further investigation of oral cyclophosphamide in patients with platinum-sensitive and platinum-resistant disease is warranted. [ABSTRACT FROM AUTHOR]

In many western countries, attention deficit hyperactivity disorder (ADHD) has achieved celebrity status, such that it probably no longer requires introduction. The disorder is a global phenomenon, spreading rapidly as result of the increasing dominance internationally of US psychiatric models, the need for new markets for major pharmaceutical companies, increasing use of the internet by parents and professionals and changing approaches to schooling. There is a broad consensus among international experts and organisations that ADHD is a genuine neurodevelopmental disorder based on empirical research. However, many critics have questioned the legitimacy of ADHD. This paper reviews the arguments for and against the ADHD construct. First, the review examines the literature and research endorsing ADHD as a 'real' disorder. Second, the criticisms levelled against the ADHD construct are examined. [ABSTRACT FROM AUTHOR]

Treatment options for patients with brain metastases ( BMs) have limited efficacy and the mortality rate is virtually 100%. Targeted therapy is critically under-utilized, and our understanding of mechanisms underpinning metastatic outgrowth in the brain is limited. To address these deficiencies, we investigated the genomic and transcriptomic landscapes of 36 BMs from breast, lung, melanoma and oesophageal cancers, using DNA copy-number analysis and exome- and RNA-sequencing. The key findings were as follows. (a) Identification of novel candidates with possible roles in BM development, including the significantly mutated genes DSC2, ST7, PIK3R1 and SMC5, and the DNA repair, ERBB- HER signalling, axon guidance and protein kinase-A signalling pathways. (b) Mutational signature analysis was applied to successfully identify the primary cancer type for two BMs with unknown origins. (c) Actionable genomic alterations were identified in 31/36 BMs (86%); in one case we retrospectively identified ERBB2 amplification representing apparent HER2 status conversion, then confirmed progressive enrichment for HER2-positivity across four consecutive metastatic deposits by IHC and SISH, resulting in the deployment of HER2-targeted therapy for the patient. (d) In the ERBB/ HER pathway, ERBB2 expression correlated with ERBB3 ( r2 = 0.496; p < 0.0001) and HER3 and HER4 were frequently activated in an independent cohort of 167 archival BM from seven primary cancer types: 57.6% and 52.6% of cases were phospho- HER3Y1222 or phospho- HER4Y1162 membrane-positive, respectively. The HER3 ligands NRG1/ 2 were barely detectable by RNAseq, with NRG1 (8p12) genomic loss in 63.6% breast cancer- BMs, suggesting a microenvironmental source of ligand. In summary, this is the first study to characterize the genomic landscapes of BM. The data revealed novel candidates, potential clinical applications for genomic profiling of resectable BMs, and highlighted the possibility of therapeutically targeting HER3, which is broadly over-expressed and activated in BMs, independent of primary site and systemic therapy. Copyright © 2015 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Myeloma is one of the most common malignancies that results in osteolytic lesions of the spine. Complications, including pathological fractures of the vertebrae and spinal cord compression, may cause severe pain, deformity and neurological sequelae. They may also have significant consequences for quality of life and prognosis for patients. For patients with known or newly diagnosed myeloma presenting with persistent back or radicular pain/weakness, early diagnosis of spinal myeloma disease is therefore essential to treat and prevent further deterioration. Magnetic resonance imaging is the initial imaging modality of choice for the evaluation of spinal disease. Treatment of the underlying malignancy with systemic chemotherapy together with supportive bisphosphonate treatment reduces further vertebral damage. Additional interventions such as cement augmentation, radiotherapy, or surgery are often necessary to prevent, treat and control spinal complications. However, optimal management is dependent on the individual nature of the spinal involvement and requires careful assessment and appropriate intervention throughout. This article reviews the treatment and management options for spinal myeloma disease and highlights the value of defined pathways to enable the proper management of patients affected by it. [ABSTRACT FROM AUTHOR]

Diabetes self-care is a critical aspect of disease management for adults with diabetes. Since family members can play a vital role in a patient's disease management, involving them in self-care interventions may positively influence patients' diabetes outcomes. We systematically reviewed family-based interventions for adults with diabetes published from 1994 to 2014 and assessed their impact on patients' diabetes outcomes and the extent of family involvement. We found 26 studies describing family-based diabetes interventions for adults. Interventions were conducted across a range of patient populations and settings. The degree of family involvement varied across studies. We found evidence for improvement in patients' self-efficacy, perceived social support, diabetes knowledge, and diabetes self-care across the studies. Owing to the heterogeneity of the study designs, types of interventions, reporting of outcomes, and family involvement, it is difficult to determine how family participation in diabetes interventions may affect patients' clinical outcomes. Future studies should clearly describe the role of family in the intervention, assess quality and extent of family participation, and compare patient outcomes with and without family involvement. [ABSTRACT FROM AUTHOR]

Objectives Dementia prevalence and the demand for dementia care are increasing. Informal caregiving accounts for a large proportion of dementia care, but can come at high cost for caregivers. Informal dementia caregivers are at higher risk for mental health problems than the general population. This study examines whether perceived change in leisure activities is one working mechanism linking stress and burden experience in dementia caregiving to lower mental health (depressive symptoms, anxiety symptoms, and reduced satisfaction with life), and whether there are group-based leisure activities that can buffer this detrimental effect. Methods A total of 346 informal Australian dementia caregivers (88.15% female, age 18-82 years) participated in an online study. Results Mediation and moderation analyses using multiple regression demonstrated that perceived changes in leisure activities linked caregiving stress and burden to lower mental health, and that membership in groups engaging in affiliation or social activities attenuates negative effects of caregiving. Conclusion Informal dementia caregivers benefit from satisfying leisure activities. In particular, engaging in social activities and self-help groups buffered the negative impact of caregiving. [ABSTRACT FROM AUTHOR]

Background The prognostic significance of oestrogen and progesterone receptors ( ER/ PR) in endometrial stromal sarcoma ( ESS) has conflicting reports in the literature, and the routine use of adjuvant progestogen is of uncertain efficacy. Aims To examine the prognostic significance of ER/ PR positivity and of primary adjuvant progestogen use with outcome in ESS. Materials and Methods All women with a diagnosis of ESS in our tertiary institution and associated private practices over the last 23 years were included. Primary variables were ER/ PR positivity and adjuvant progestogen use. Other variables included high-grade disease and extrauterine disease. The primary outcome was survival, and the secondary outcome was recurrence-free survival (both overall and at 5 years). Survival was calculated using the Kaplan-Meier method. Univariate analyses were performed with t-test for means and chi-squared test for proportions, and multivariate analysis was used to control for age. Results 35 women were included. ER/ PR positivity was associated with a survival benefit ( OR death 0.22, P = 0.02), but primary adjuvant progestogen was not. High-grade disease ( OR 13, P = 0.02) and extrauterine disease ( OR 8.7, P = 0.04) were associated with decreased survival. No variable significantly affected recurrence-free survival. Eight of ten cases of recurrence treated with progestogen have survived more than 3 years. Conclusions ER/ PR positivity appears to be useful for prognosis, but routine administration of primary adjuvant progestogen is not supported. There may be a role for progestogen in ER/ PR positive tumours with recurrence or incomplete surgical clearance, but further research is required. [ABSTRACT FROM AUTHOR]

Policies to deter illegal entry and reduce the number of undocumented immigrants have a complex impact on migration patterns, border crossings, and duration. However, studies generally assume the method of crossing into the United States is exogenous with respect to migration duration. Using data from the Mexican Migration Project, this paper finds that the migrant's decision to hire a coyote (smuggler) to cross the border is endogenous with respect to duration. Instrumental variable estimates provide evidence that migrants who incur the cost of hiring a coyote have longer migration durations as they need to work longer in the United States. The migrants most likely to hire coyotes have less education, little migration experience, and/or come from rural communities. Results suggest that continuing to increase guest worker programs could actually decrease the number of Mexican immigrants in the United States by eliminating the need for coyotes which would reduce migration durations. This would better utilize the immigrant population in the United States by encouraging immigrants to stay while employed and to migrate home when unemployed, with the knowledge they can later return. Reducing coyote use would also reduce income flowing to Mexican cartels which have profited from human smuggling. ( JEL O15, J61, J64) [ABSTRACT FROM AUTHOR]

Background Dimethyl sulfoxide ( DMSO) is essential for the preservation of liquid nitrogen-frozen stem cells, but is associated with toxicity in the transplant recipient. Study Design and Methods In this prospective noninterventional study, we describe the use of DMSO in 64 European Blood and Marrow Transplant Group centers undertaking autologous transplantation on patients with myeloma and lymphoma and analyze side effects after return of DMSO-preserved stem cells. Results While the majority of centers continue to use 10% DMSO, a significant proportion either use lower concentrations, mostly 5 or 7.5%, or wash cells before infusion (some for selected patients only). In contrast, the median dose of DMSO given (20 mL) was much less than the upper limit set by the same institutions (70 mL). In an accompanying statistical analysis of side effects noted after return of DMSO-preserved stem cells, we show that patients in the highest quartile receiving DMSO ( mL and mL/kg body weight) had significantly more side effects attributed to DMSO, although this effect was not observed if DMSO was calculated as mL/min. Dividing the myeloma and lymphoma patients each into two equal groups by age we were able to confirm this result in all but young myeloma patients in whom an inversion of the odds ratio was seen, possibly related to the higher dose of melphalan received by young myeloma patients. Conclusion We suggest better standardization of preservation method with reduced DMSO concentration and attention to the dose of DMSO received by patients could help reduce the toxicity and morbidity of the transplant procedure. [ABSTRACT FROM AUTHOR]

The article presents a study on the survival patterns of Australian women with epithelial ovarian cancer, by clinical and sociodemographic factors. Topics discussed include 1,192 women with invasive epithelial ovarian cancer diagnosed in 2005 and were identified through state-based cancer registries, survival differences by histological subtype, presence of ascites and comorbidities, and the ongoing poor long-term prognosis for women with ovarian cancer.

Background For select women with early endometrial cancer, particularly nulliparous women, nonsurgical options may be considered. There is increasing experience using progestogens, but little is known about the long-term outcomes and safety of such treatment. Aims To present the cancer and pregnancy outcomes of women with greater than five years follow-up after progestogen treatment for early endometrial cancer. Methods Ten women who underwent greater than six months of continuous progestogen therapy for early endometrial cancer were included in the study. All were managed by a gynaecological oncologist at a major tertiary centre in Melbourne, Australia. The histology of each subsequent curette was recorded, as was the timing and histology of hysterectomy (if relevant), and the results of any subsequent pregnancies. Results All ten women showed histological regression of cancer with no cases of recurrence on follow-up curette. Four of ten women have undergone hysterectomy with one case of occult disease persistence in a woman noncompliant with therapy. The mean follow-up time was 89 months (range 62-142 months), there were no deaths and no woman was lost to follow-up. All four women attempting pregnancy were successful. There were eight pregnancies and five live births. Conclusions This form of treatment appears to be successful and safe in the long term with good pregnancy outcomes. However, it is not standard and should be supervised in a specialised gynaecological oncology unit. [ABSTRACT FROM AUTHOR]

Aim We aimed to investigate the relationship between movement disorders, changes on brain magnetic resonance imaging ( MRI), and vigabatrin therapy in children with infantile spasms. Method Retrospective review and brain MRI analysis of children enrolled in the International Collaborative Infantile Spasms Study ( ICISS) who developed a movement disorder on vigabatrin therapy. Comparisons were made with controls within ICISS who had no movement disorder. Results Ten of 124 infants had a movement disorder and in eight it had developed on vigabatrin therapy. Two had a movement disorder that resolved on dose-reduction of vigabatrin, one had improvement on withdrawing vigabatrin, two had resolution without any dose change, and in three it persisted despite vigabatrin withdrawal. The typical brain MRI changes associated with vigabatrin therapy were noted in two infants. Ten control infants were identified. Typical MRI changes noted with vigabatrin were noted in three controls. Interpretation It is possible that in two out of eight cases, vigabatrin was associated with the development of a movement disorder. In six out of eight cases a causal relationship was less plausible. The majority of infants treated with vigabatrin did not develop a movement disorder. MRI changes associated with vigabatrin do not appear to be specifically related to the movement disorder. [ABSTRACT FROM AUTHOR]

Objective This study aims to investigate the course and prevalence of anxiety and depression symptoms over 56 weeks in women with newly diagnosed breast and gynaecologic cancer and determine the acceptability and efficiency of incorporating routine screening into practice. Methods Participants completed the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A) and Centre for Epidemiological Studies Depression Scale (CES-D) at diagnosis and again every 8 weeks for 56 weeks. Changes over time were analysed with repeated measures ANOVA adjusted for post hoc comparisons. Thresholds for caseness/referral to mental health were ≥11 and ≥16 on the HADS-A and CES-D, respectively. Results Participants were 167 women (101 breast, 66 gynaecologic). Mean ± SD age was 57.63 ± 22.66 years. Rates of anxiety (17.7%), depression (32.5%) and combined anxiety and depression (35%) symptoms were highest at diagnosis. Mean ± SD scores of anxiety (6.43 ± 3.83) and depression symptoms (12.68 ± 9.47) were highest at diagnosis with significant improvements observed by 8 and 24 weeks, respectively, and maintained thereafter. Overall rates of anxiety, depression and combined symptoms were 7.5%, 23.4% and 24.1%, respectively. Patients with breast and gynaecologic cancer did not differ. Referral was offered at least once to 94 women (56.3%), of whom 45 (47.9%) declined, 23 (24.5%) accepted and 26 (27.7%) were already receiving treatment. Patient evaluation was favourable. Conclusions Women are most vulnerable to psychological morbidity at diagnosis. Symptoms improve significantly over time. Reported rates are lower than those in the literature. Regular screening by self-report is acceptable to patients but may not be the most efficient method of improving patient outcomes. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Previous studies have implicated vestigial like 3 (VGLL3), a chromosome 3p12.3 gene that encodes a putative transcription co‐factor, as a candidate tumor suppressor gene (TSG) in high‐grade serous ovarian carcinomas (HGSC), the most common type of epithelial ovarian cancer. A complementation analysis based on microcell‐mediated chromosome transfer (MMCT) using a centric fragment of chromosome 3 (der3p12‐q12.1) into the OV‐90 ovarian cancer cell line haploinsufficient for 3p and lacking VGLL3 expression was performed to assess the effect on tumorigenic potential and growth characteristics. Genetic characterization of the derived MMCT hybrids revealed that only the hybrid that contained an intact VGLL3 locus exhibited alterations of tumorigenic potential in a nude mouse xenograft model and various in vitro growth characteristics. Only stable OV‐90 transfectant clones expressing low levels of VGLL3 were derived. These clones exhibited an altered cytoplasmic morphology characterized by numerous single membrane bound multivesicular‐bodies (MVB) that were not attributed to autophagy. Overexpression of VGLL3 in OV‐90 was achieved using a lentivirus‐based tetracycline inducible gene expression system, which also resulted in MVB formation in the infected cell population. Though there was no significant differences in various in vitro and in vivo growth characteristics in a comparison of VGLL3‐expressing clones with empty vector transfectant controls, loss of VGLL3 expression was observed in tumors derived from mouse xenograft models. VGLL3 gene and protein expression was significantly reduced in HGSC samples (>98%, p < 0.05) relative to either normal ovarian surface epithelial cells or epithelial cells of the fallopian tube, possible tissues of origin of HGSC. Also, there appeared to be to be more cases with higher staining levels in stromal tissue component from HGSC cases that had a prolonged disease‐free survival. The results taken together suggest that VGLL3 is involved in tumor suppressor pathways, a feature that is characterized by the absence of VGLL3 expression in HGSC samples. Highlights: ► Microcell mediated transfer of chromosome 3p12.3‐pcen affects tumorigenic potential.► Loss of VGLL3 expression in tumors formed in vivo from transfectant clones.►VGLL3 expression significantly reduced in high grade serous ovarian carcinomas.►VGLL3 expressed in normal epithelial cells of fallopian tube and ovarian surface. [ABSTRACT FROM AUTHOR]

Management of recreational fisheries involves understanding how anglers interact with the fishery resource. Managers must understand the source (spatial distribution), efficiency, and behavior of angler effort in order to develop optimal management strategies in a social-ecological framework. We interviewed anglers (n = 1,956) and assessed fish populations in 21 lakes that are part of a multistock, spatially structured fishery for Rainbow Trout Oncorhynchus mykiss in the interior of British Columbia, Canada. Our objective was to assess the spatial behavior, harvest behavior, and catch efficiency of anglers and to understand the strengths of interactions between anglers and fish populations in three regions within this large fishery. Our results suggest a diverse angler population that varied in its behavior and its impact on the fishery. Using a hierarchical cluster analysis, we identified four distinct angler groups based on three variables that directly described how anglers interacted with the fishery (spatial distribution, catchability, and harvest behavior). Angler characteristics varied between groups, and the relative proportions of the four discrete angler groups varied among management regions. Substantial variation in angler characteristics across groups and variation in the relative distribution of the groups across regions imply that a "one size fits all" management approach is not optimal for this fishery. Instead, strategies that are attuned to angler characteristics would constitute a better approach for managing this large, spatially structured fishery. [ABSTRACT FROM AUTHOR]

Background: Transabdominal cervical cerclage has been performed via laparotomy for over four decades. A laparoscopic approach has recently been developed and offers the potential for lower morbidity. Aims: The experience of one operator with transabdominal cervical cerclage via laparotomy is reviewed to establish a baseline with which to compare results from the laparoscopic approach. Methods: Transabdominal cervical cerclage was performed with Mersilene tape. The pregnancy outcome prior to transabdominal cervical cerclage was compared with the outcomes after its insertion. Results: Prior to transabdominal cervical cerclage, there were 58 pregnancies of which 18 ended with a first trimester pregnancy loss. Twenty-eight of the 36 pregnancies delivering between 13- and 26-week gestation resulted in a pregnancy loss. Three of the four children delivered after 26-week gestation survived. Following transabdominal cervical cerclage, there were no first trimester pregnancy losses. Of the 23 pregnancies after transabdominal cerclage, one was terminated at 18-week gestation for spina bifida and the remaining 22 babies were delivered at a mean gestation of 36.2 weeks. Maternal morbidity was limited to a single wound infection. Respiratory distress was the only significant neonatal morbidity with all babies recovering completely. Conclusions: Transabdominal cervical cerclage via laparotomy is a safe and successful method of treating women who need a cervical cerclage but are unable to have a vaginal suture. A baseline has been established with which to compare the results from laparoscopic transabdominal cervical cerclage in the future. [ABSTRACT FROM AUTHOR]

The article focuses on a study which identified the prognostic factors in cutaneous desmoplastic melanoma (DM). The study included patients diagnosed with clinically localized primary cutaneous melanoma (PCM) containing desmoplastic component. The clinical and pathologic features of the patients' primary tumors were examined and correlated with DM type, sentinel lymph node (SLN) status and outcome. The study found that SLN-positive rate was lower in patients with DM compared to those with conventional melanoma.

Carcinoma of the cervix and its precursor, high-grade cervical intraepithelial neoplasia (CIN2/3), are associated with persistent oncogenic Human papillomavirus (HPV) infection, particularly HPV 16 and 18. HPV genotype distribution varies with severity of cervical disease, patient demographics such as age, as well as geographical location. In this study, HPV genotype prevalence was determined, using the Roche Linear Array genotyping test, among a cohort of 1,676 women being managed with ablative or excisional treatment following colposcopically directed biopsies, who were referred initially due to cytological abnormalities. HPV genotype prevalence, including presence of single and multiple infections was assessed against both histological diagnosis and age. Overall, 83.9% of women were identified as HPV positive, comprising of 32.2% single and 51.7% multiple HPV infections. Of those with an available histological diagnosis at time-of-treatment (n = 899), HPV positivity increased significantly with disease severity: 62.4% (normal), 77.6% (CIN1), 92.6% (CIN2), and 97.9% (≥CIN3) ( P < 0.006). Similarly, a significant increase in high-risk (HR) HPV detection was observed with severity of disease ( P < 0.005). The five most prevalent genotypes were HPV 16 (35.1%), 31 (12.6%), 51 (11.1%), 52 (9.9%), and 18 (8.5%). HPV 16 was the only genotype to demonstrate a significant increase in prevalence with increasing severity of histological or cytological disease ( P < 0.0001). Multiple HPV infections, including multiple HR-HPV infections, declined significantly with age ( P < 0.02). These findings provide the largest dataset of HPV genotype prevalence rates within Australian women, though are not representative of the general population. J. Med. Virol. 81:1283-1291, 2009. © 2009 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

The article discusses the recurrence rates of desmoplastic neurotropic melanoma (DNM) on patients after surgery and radiotherapy (RT) in Sydney, New South Wales. It notes that the head and neck are common recurrence location of DNM. Moreover, it highlights that surgical treatment and RT decrease the recurrence of DNM.

Objective. To identify predictors of changes in staff morale and burnout associated with participation in a quality improvement (QI) initiative at community health centers (HCs). Data Sources. Surveys of staff at 145 HCs participating in the Health Disparities Collaboratives (HDC) program in 2004. Data Collection and Study Design. Self-administered questionnaire data collected from 622 HC staff (68 percent response rate) were analyzed to identify predictors of reported change in staff morale and burnout. Predictive categories included outcomes of the QI initiative, levels of HDC integration, institutional support, the use of incentives, and demographic characteristics of respondents and centers. Principal Findings. Perceived improvements in staff morale and reduced likelihood of staff burnout were associated with receiving personal recognition, career promotion, and skill development opportunities. Similar outcomes were associated with sufficient funding and personnel, fair distribution of work, effective training of new hires, and consistent provider participation. Conclusions. Having sufficient personnel available to administer the HDC was found to be the strongest predictor of team member satisfaction. However, a number of low-cost, reasonably modifiable, organizational and leadership characteristics were also identified, which may facilitate improvements in staff morale and reduce the likelihood of staff burnout at HCs participating in the HDC. [ABSTRACT FROM AUTHOR]

In the context of dramatically increasing U.S. health-care costs, this paper contributes to an ongoing debate discussing proposals to replace the government's current policy of matching state Medicaid spending with a block grant system. State-level panel data analysis provides evidence that, ceteris paribus, increasing the federal matching formula has a negative impact on prenatal care. This aggregate result masks significant differences between high- and low-spending states and appears to be driven by the high-spending states thus implying that a 2-track approach to Medicaid funding may be more appropriate than the current system. [ABSTRACT FROM AUTHOR]

Cancer that arises from the ovarian surface epithelium (OSE) accounts for approximately 90% of human ovarian cancer, and is the fourth leading cause of cancer-related deaths among women in developed countries. The pathophysiology of epithelial ovarian cancer is still unclear because of the poor understanding of the complex nature of its development and the unusual mechanism(s) of disease progression. Recent studies have reported epithelial–mesenchymal transition (EMT) in cultured OSE and ovarian cancer cell lines in response to various stimuli, but our understanding of the importance of these observations for normal ovarian physiology and cancer progression is not well established. This review highlights the current literature on EMT-associated events in normal OSE and ovarian cancer cell lines, and discusses its implication for normal ovarian function as well as acquisition of neoplastic phenotypes. The pathological changes in OSE in response to EMT during neoplastic transformation and the contribution of hormones, growth factors, and cytokines that initiate and drive EMT to sustain normal ovarian function, as well as cancer development and progression are also discussed. Finally, emphasis is placed on the clinical implications of EMT and potential therapeutic opportunities that may arise from these observations have been proposed. J. Cell. Physiol. 213:581–588. © 2007 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Military activities associated with training have resulted in soil residues of munition compounds and their breakdown products. Often, these areas are valuable habitats used by birds. To evaluate the possibility of adverse effects in birds, the effects from oral exposures of 2,6-dinitrotoluene (2,6-DNT) and 1,3,5-trinitro-1,3,5-triazine (RDX) were tested using a controlled dosing regime in northern bobwhite (Colinus virginianus). Nine groups of birds of mixed sex received either corn oil or 50, 100, 190, or 350 mg 2,6-DNT/kg body weight/d or 20, 80, 125, or 180 mg RDX/kg body weight/d mixed in corn oil via gavage for 14 d. Etiology of disease was markedly different between compounds. Increased RDX exposure caused an inverse relationship to time of death, symptoms including clonic followed by tonic convulsions, and death shortly thereafter. Brain concentrations of RDX postmortem, however, were relatively consistent (mean ± standard error, 20.5 ± 2.9 mg/kg tissue). Observations of 2,6-DNT effects included gastrointestinal distress, dehydration, and a reduction in body mass and feed consumption. Together, these data suggest that RDX is more toxic from short, repeated exposures than 2,6-DNT, resulting in central nervous system—related effects, whereas 2,6-DNT causes gastrointestinal disturbances at higher exposures. [ABSTRACT FROM AUTHOR]

Young people with chronic diseases face the challenge of moving from the pediatric to the adult health care environment, in addition to the normal hurdles of young adulthood. To most effectively help them through this process, we must first understand their perspective. Design: Qualitative study of the social and emotional impact of having diabetes. Sample: Young adults ( n=23), aged 19–26, who had been living with diabetes for a median of 12 years (range 4–19) were contacted; all but one were from underserved ethnic minorities. Measurements: Semistructured telephone interviews were conducted, transcribed, and coded. Results: Having diabetes profoundly affected the life choices and expectations of these young people; their feelings and attitudes evolved over time. Financial and insurance concerns were key, because managing diabetes care on one's own as an adult was a major challenge. Most young people reported that family, friends, and coworkers were sources of support, but that disclosure of their diabetes was problematic. Conclusions: Offering emotional and practical support to young adults coping with diabetes is key to ensuring adequate medical management as they move into the adult system and assume full responsibility for their health. [ABSTRACT FROM AUTHOR]

The expression of neutrophil gelatinase-associated lipocalin (NGAL) has been shown to be upregulated in ovarian cancer cells. In this study, we report that the expression of immunoreactive NGAL (irNGAL) in ovarian tumors changes with disease grade and that this change is reflected in the concentration of NGAL in peripheral blood. A total of 59 ovarian tissues including normal, benign, borderline malignant and grades 1, 2 and 3 malignant were analyzed using immunohistochemistry. irNGAL was not present in normal ovaries and the NGAL expression was weak to moderate in benign tissues. Both borderline and grade 1 tumors displayed the highest amount of NGAL expression with moderate to strong staining, whereas in grade 2 and 3 tumors, the extent of staining was significantly less ( p < 0.01) and staining intensity was weak to moderate. Staining in all cases was confined to the epithelium. NGAL expression was analyzed by ELISA in 62 serum specimens from normal and different grades of cancer patients. Compared to control samples, the NGAL concentration was 2 and 2.6-fold higher in the serum of patients with benign tumors and cancer patients with grade 1 tumors ( p < 0.05) and that result was consistent with the expression of NGAL performed by Western blot. NGAL expression was evaluated by Western blot in an immortalized normal ovarian cell line (IOSE29) as well as ovarian cancer cell lines. Moderate to strong expression of NGAL was observed in epithelial ovarian cancer cell lines SKOV3 and OVCA433 while no expression of NGAL was evident in normal IOSE29 and mesenchyme-like OVHS1, PEO.36 and HEY cell lines. NGAL expression was downregulated in ovarian cancer cell lines undergoing epithelio-mesenchymal transition (EMT) induced by epidermal growth factor (EGF). Downregulation of NGAL expression correlated with the upregulation of vimentin expression, enhanced cell dispersion and downregulation of E-cadherin expression, some of the hallmarks of EMT. EGF-induced EMT phenotypes were inhibited in the presence of AG1478, an inhibitor of EGF receptor tyrosine kinase activity. These data indicate that NGAL may be a good marker to monitor changes of benign to premalignant and malignant ovarian tumors and that the molecule may be involved in the progression of epithelial ovarian malignancies. © 2007 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the effectiveness of cytology and colposcopy in the follow up of women treated by laser CO2 ablation for cervical intraepithelial neoplasia (CIN). Methods: A retrospective analysis of 1784 patients with CIN treated with laser CO2 ablation from 1998 to 2003 at the Royal Women's Hospital, Melbourne. Data were collected prospectively in a computerised colposcopy database utilised in the Dysplasia Unit. Results: There was equal distribution in the study population treated for low-grade intraepithelial neoplasia (LSIL) and high-grade intraepithelial neoplasia (HSIL), with no significant age difference in both groups (mean 27.6 years). The success rate of treatment of LSIL (94%) was similar to that of HSIL (92%). Fifty-seven per cent of all failures occurred within the first year of treatment. Colposcopy was more sensitive in detecting intraepithelial neoplasia (SIL) than cytology, whereas cytology was more specific. No case of cancer was diagnosed on follow up. Conclusions: CO2 laser ablation was equally effective in treating different grades of CIN. There is a continuing incidence of recurrent CIN, even up to five years after initial treatment, which suggests that it is necessary for patients to adhere to long-term follow up. The combination of cytology and colposcopic assessment is essential for surveillance of SIL in the initial two years after treatment. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine how often patients with complete hydatidiform mole (CHM) who spontaneously achieve normal human chorionic gonadotrophin (hCG) levels subsequently develop persistent or recurrent gestational trophoblast disease. Methods: Four hundred and fourteen cases of CHM registered at the Hydatidiform Mole Registry of Victoria were reviewed retrospectively after molar evacuation. Maternal age, gestational age, gravidity and parity were determined for each patient, as well as the need for chemotherapy. Results: Among the 414 patients, 55 (13.3%) required chemotherapy for persistent trophoblastic disease. None of the patients whose hCG levels spontaneously fell to normal subsequently developed persistent molar disease. Conclusion: Weekly hCG measurements are recommended for all patients until normal levels are achieved. For patients who attain normal hCG levels within 2 months after evacuation, it seems safe to discontinue monitoring once normal levels are achieved. Patients who fail to achieve normal hCG levels by 2 months after evacuation should be monitored with monthly hCG measurements for 1 year after normalisation to assure sustained remission. [ABSTRACT FROM AUTHOR]

Objective: Human chorionic gonadotrophin (hCG) follow-up data were analysed retrospectively in all patients registered in the Hydatidiform Mole Registry at the Royal Women's Hospital, Melbourne from January 1992 to January 2001 to determine the risk of persistent trophoblast disease following partial molar pregnancy and to review the present follow-up protocol of patients suffering from partial hydatidiform molar pregnancy (PHM). Methods: Demographic factors were determined for all 344 cases with a review diagnosis of PHM, included age, history of previous hydatidiform mole, gestation length, hCG levels and compliance with follow-up. Findings: Six of the 344 patients diagnosed with PHM required treatment with single-agent methotrexate and folinic acid rescue. All six patients achieved and maintained a complete biochemical remission after chemotherapy. hCG regression assays were analysed for 235 patients: 225 patients had at least one normal hCG measurement during follow-up, of whom 152 (64.7%) patients obtained normal values within 2 months after evacuation. All patients obtained normal levels within 32 weeks after evacuation of the partial hydatidiform mole. Only 63 (25.6%) patients completed the recommended follow-up program. No patient who achieved normal hCG levels required chemotherapy because of a recurrent gestational trophoblastic tumour. Recommendations: This study indicates that 1.7% of all partial mole pregnancy patients needed treatment for malignant sequelae. In contrast, no patient diagnosed with partial mole had a biochemical or clinical relapse after achieving normal levels of hCG, consistent with previous studies. Patients who have had a partial hydatidiform mole should be followed by hCG assays until normal levels are achieved and then follow-up can be safely discontinued. [ABSTRACT FROM AUTHOR]