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Care home residents often feel grateful to the employees who care for them, so what could be more natural than wanting to give or leave them a gift? But is it really that simple? And how do we safeguard against potential abuse? Jo Oliver investigates

This study, coordinated by the SFTG (French branch of European Environmental Mutagen Society), included 38 participants from Europe, Japan and America. Clastogens (bleomycin, urethane), including base and nucleoside analogs (5-fluorouracil and cytosine arabinoside), aneugens and/or polyploidy inducers (colchicine, diethylstilboestrol, griseofulvin and thiabendazole), as well as non-genotoxic compounds (mannitol and clofibrate), were tested. Four cell types were used, i.e. human lymphocytes in the presence of cytochalasin B and CHO, CHL and L5178Y cell lines, in the presence or absence of cytochalasin B, with various treatment-recovery schedules. Mitomycin C was used as a positive control for all cell types. Mannitol and clofibrate were consistently negative in all cell types and with all treatment-recovery conditions. Urethane, known to induce questionable clastogenicity, was not found as positive. Bleomycin and mitomycin C were found positive in all treatment-recovery conditions. The base and nucleoside analogs were less easy to detect, especially 5-fluorouracil due to the interference with cytotoxicity, while cytosine arabinoside was detected in all cell types depending on the treatment-recovery schedule. Aneugens (colchicine, diethylstilboestrol and griseofulvin) were all detected in all cell types. In this study, the optimal detection was ensured when a short treatment followed by a long recovery was associated with a long continuous treatment without recovery. There was no impact of the presence or absence of cytochalasin B on the detection of micronucleated cells on cell lines. Scoring micronucleated cells in both mononucleated and binucleated cells when using cytochalasin B was confirmed to be useful for the detection and the identification of aneugens. In conclusion, these results, together with previously published validation studies, provide a useful contribution to the optimisation of a study protocol for the detection of both clastogens and aneugens in the in vitro micronucleus test.

The Mouse Lymphoma Assay (MLA) Workgroup of the International Workshop on Genotoxicity Tests (IWGT) met on June 28th and 29th, 2002, in Plymouth, England. This meeting of the MLA group was devoted to discussing the criteria for assay acceptance and appropriate approaches to data evaluation. Prior to the meeting, the group conducted an extensive analysis of data from both the microwell and soft agar versions of the assay. For the establishment of criteria for assay acceptance, 10 laboratories (6 using the microwell method and 4 using soft agar) provided data on their background mutant frequencies, plating efficiencies of the negative/vehicle control, cell suspension growth, and positive control mutant frequencies. Using the distribution curves generated from this data, the Workgroup reached consensus on the range of values that should be used to determine whether an individual experiment is acceptable. In order to establish appropriate approaches for data evaluation, the group used a number of statistical methods to evaluate approximately 400 experimental data sets from 10 laboratories entered into a database created for the earlier MLA Workshop held in New Orleans [Environ. Mol. Mutagen. 40 (2002) 292]. While the Workgroup could not, during this meeting, make a final recommendation for the evaluation of data, a general strategy was developed and the Workgroup members agreed to evaluate this new proposed approach using their own laboratory data. This evaluation should lead to a consensus global approach for data evaluation in the near future.

No Abstract. Ghana Medical Journal Vol. 38(3) 2004: 109-115

Objective : This prospective, cross-sectional study was done to define the prevalence and age of onset of gallstones in Ghanaina children with Sickle Cell Disease (SCD) in steady state, using ultrasonography. Materials and method : The study was conducted at the Paediatric SCD clinic, Korle Bu Teaching Hospital, Accra, Ghana. Three hundred and fifteen (315) children comprising 162 males and 153 females aged 2 to 13 years with a confirmed diagnosis of SCD of haemoglobin SS, (HbSS), Haemoglobin SC, (HbSC) or Haemoglobin S-βthalassemia (SβThal) genotype whose parents/guardians gave informed conset, were recruited consecutively. The main outcome measure was the detection of gallstones in the gall bladder or common bile duct by ultrasonography. Results : Thirteen children, 12 males and 1 female had gallstone, giving an overall prevalence of 4%. The youngest was aged 6. Four children had sludge only. Peak age of prevalence was 12 years. All patients under 12 years with gallstone were males (92.3%). The very high male: female ratio in these sickle cell disease children is at variance with the normal male: female ratio of 1: 4.6. Although twenty percent of all the patients were genotype SC, only one SC patient had gallstones, giving a prevalence rate of 0.3%, and a prevalence ratio of stone in SS: SC of 12:1. Twenty patients had no spleen detectable clinically or on ultrasoound examination and none of them had gallstones. Conclusion : Gallstones occur at an early age in children with sickle cell disease in Ghana. Keywords : Sickle cell disease, Gallstones, Ghanaian children, Ultrasonography. Resume Objectif : Cette etude en prospective et en coupe-transversale etait effectuee afin de determiner la prevalence et l'âge et la premiere attaque du calcul biliaire chez des enfants ghanaians atteints de la drepanocytose dans un etat regulier a travers l'utilisation d'echographie. Materiels et methode : Cette etude a ete effectuee au centre medical pediatrique de la drepanocytose, centre hospitalier universitaire du Korle Bu, Accra, Ghana. Trois cents quinze (315) enfants y compris 162 du sexe masculin et 153 du sexe feminin âges de 2 a 13 ans avec un diagnostic confirme d'hemoglobine SS, (HbSS) de la drepanocytose, Hemoglobine SC, (HbSC) ou Hemoglobine S - Bthalassemie (SBThal) genotype dont les parants/gardiens ont donne du consentement, ont ete recrutes l'un apres l'autre. Le resultat principal etait la detection du calcul biliaire dans la resicule ou bien canal biliaire ordinaire a travers l'echographie. Resultats : Treize enfants, 12 du sexe masculin et 1 du sexe feminin etaient atteints du calcul biliaire ce qui donne une prevalence du rendement globale de 4%. Le plus jeune etait âge de 6 ans. Quatre enfants avaient eu la fange seulement. L'âge maximum de la prevalence etait 12 ans. Tous les patients moins de 12 ans avec calcul biliaire etait du sexe masculin soit 92,3%. Le taux eleve d'une proportion sexe masculin et sexe feminin chez ces enfants atteints de la drepanocytose est incompatible avec une proportion normale du sexe masculin: feminin 1: 4,6. Bien que vingt pourcent de tous les patients soient du genotype SC, un patient SC seulement avait eu le calcul biliaire, ce qui donne un taux de la prevalence de 0,3% et un rapport de la prevalence de caullou dans SS: SC de 12: 1 Vingt patients n'avaient aucune rate detectee cliniquement ou a travers l'ultrason et aucun d'entre eux n'avait le calcul biliaire. Conclusion : Calcul biliaire arrive tout jeune chez des enfants atteints de la drepanocytose au Ghana. West African Journal of Medicine Vol. 24(1) 2005: 295-298

The Mouse Lymphoma Assay (MLA) Workgroup of the International Workshop on Genotoxicity Test Procedures held a second harmonization meeting just prior to the U.S. Environmental Mutagen Society Meeting in New Orleans, LA, in April 2000. The discussion focused on several important aspects of the MLA, including: 1) cytotoxicity measures and their determination, 2) use of a 24-hr treatment, 3) the ability of the assay to detect aneugens, and 4) concentration selection. Prior to the meeting the group developed Microsoft Excel Workbooks for data entry. Ten laboratories entered their data into the workbooks (primarily as coded chemicals). The Excel Workbooks were used to facilitate data analysis by generating an extensive set of graphs that were evaluated by the meeting participants. Based on the Workgroup's previous agreement that a single cytotoxicity measure should be established for both the microwell and soft agar versions of the assay, the Workgroup analyzed the submitted data and unanimously agreed that the relative total growth (RTG) should be used as the cytotoxicity measure for concentration selection and data evaluation. The Workgroup also agreed that the various cytotoxicity measures should be calculated using the same methods regardless of whether the soft agar or microwell version of the assay was used. In the absence of sufficient data to make a definitive determination, the Workgroup continued to endorse the International Committee on Harmonization recommendation for the use of 24-hr treatment and made some specific 24-hr treatment protocol recommendations. The Workgroup recognized the ability of the MLA to detect at least some aneugens and also developed general guidance and requirements for appropriate concentration selection.

The Bill of Rights Act 1990 gives everyone the right to refuse medical treatment. In Re CMC, the right of an anorexic patient to refuse treatment was overridden by the Family Court. Anorexia nervosa is recognised as a mental illness which predominantly affects women. This article considers the philosophical and legal basis for that decision. The writer also touches on the wider ethical and social issues raised by the decision.