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These studies characterized cardiovascular responses after an acute inhalation exposure to COREXIT EC9500A, the oil dispersant used in the Deepwater Horizon oil spill. Male Sprague-Dawley rats underwent a single 5-h inhalation exposure to COREXIT EC9500A (average exposure level 27.12 mg/m(3)) or air. On d 1 and 7 following the exposure, rats were implanted with indwelling catheters and changes in heart rate and blood pressure were assessed in response to increasing levels of adrenoreceptor agonists. A separate group of rats was euthanized at the same time points, ventral tail arteries were dissected, and vascular tone along with dose-dependent responses to vasoconstricting and dilating factors were assessed in vitro. Agonist-induced dose-dependent increases in heart rate and blood pressure were greater in COREXIT EC9500A-exposed than in air-exposed rats at 1 d but not 7 d after the exposure. COREXIT EC9500A exposure also induced a rise in basal tone and reduced responsiveness of tail arteries to acetylcholine-induced vasodilation at 1 d but not 7 d following the exposure. These findings demonstrate that an acute exposure to COREXIT EC9500A exerts transient effects on cardiovascular and peripheral vascular functions.

Objective: The current frequency weighting proposed in the International Standards Organization-5349 standard may underestimate the risk of injury associated with exposure to vibration >100 Hz. The goal of this study was to assess the frequency-dependent responses of the peripheral vascular system to repeated bouts of vibration., Methods: The effects of exposure to vibration at 62.5, 125, or 250 Hz (constant acceleration of 49 m/s2) on vascular morphology, oxidative stress, inflammation, and gene expression were examined in the ventral tail artery of rats., Results: Vascular responses indicative of dysfunction (eg, remodeling and oxidative activity) became more pronounced as the frequency of the exposure increased., Conclusion: Exposure to vibration frequencies that induce the greatest stress and strain on the tail (ie, >100 Hz) result in vascular changes indicative of dysfunction.

The End of Life Care Strategy takes as inclusive an approach as possible, but can it make a difference for people with learning disabilities who are dying? Therefore we must ask ourselves 'Does one size fit all?'

Vibration-induced white finger (VWF) is a disorder seen in workers exposed to hand-transmitted vibration, and is characterized by cold-induced vasospasms and finger blanching. Because overweight people with metabolic syndrome are pre-disposed to developing peripheral vascular disorders, it has been suggested that they also may be at greater risk of developing VWF if exposed to occupational vibration. We used an animal model of metabolic syndrome, the obese Zucker rat, to determine if metabolic syndrome alters vascular responses to vibration. Tails of lean and obese Zucker rats were exposed to vibration (125 Hz, 49 m/s(2) r.m.s.) or control conditions for 4 h/d for 10 d. Ventral tail arteries were collected and assessed for changes in gene expression, levels of reactive oxygen species (ROS) and for responsiveness to vasomodulating factors. Vibration exposure generally reduced the sensitivity of arteries to acetylcholine (ACh)-induced vasodilation. This decrease in sensitivity was most apparent in obese rats. Vibration also induced reductions in vascular nitric oxide concentrations and increases in vascular concentrations of ROS in obese rats. These results indicate that vibration interferes with endothelial-mediated vasodilation, and that metabolic syndrome exacerbates these effects. These findings are consistent with idea that workers with metabolic syndrome have an increased risk of developing VWF.

Background: Type 1 pseudohypoaldosteronism (PHA1) is a salt-wasting syndrome caused by mineralocorticoid resistance. Autosomal recessive and dominant hereditary forms are caused by Epithelial Na Channel and Mineralocorticoid Receptor mutation respectively, while secondary PHA1 is usually associated with urological problems., Methods: Ten patients were studied in four French pediatric units in order to characterize PHA1 spectrum in infants. Patients were selected by chart review. Genetic, clinical and biochemistry data were collected and analyzed., Results: Autosomal recessive PHA1 (n = 3) was diagnosed at 6 and 7 days of life in three patients presenting with severe hyperkalaemia and weight loss. After 8 months, 3 and 5 years on follow-up, neurological development and longitudinal growth was normal with high sodium supplementation. Autosomal dominant PHA1 (n = 4) was revealed at 15, 19, 22 and 30 days of life because of failure to thrive. At 8 months, 3 and 21 years of age, longitudinal growth was normal in three patients who were given salt supplementation; no significant catch-up growth was obtained in the last patient at 20 months of age. Secondary PHA1 (n = 3) was diagnosed at 11, 26 days and 5 months of life concomitantly with acute pyelonephritis in three children with either renal hypoplasia, urinary duplication or bilateral megaureter. The outcome was favourable and salt supplementation was discontinued after 3, 11 and 13 months., Conclusions: PHA1 should be suspected in case of severe hyperkalemia and weight loss in infants and need careful management. Pathogenesis of secondary PHA1 is still challenging and further studies are mandatory to highlight the link between infection, developing urinary tract and pseudohypoaldosteronism.

We describe six cases of head and neck or upper limb cancer palliative care patients with refractory pain, treated with an intrathecal catheter placed at cervical or upper thoracic spinal levels with a non-implanted, externalized and tunnelled delivery system. In these cases, this system was safe and effective.

Decisions about cardiopulmonary resuscitation (CPR) continue to cause difficulties for healthcare professionals. Current UK guidelines provide information on the underlying principles, but do not include a clear decision framework. The resulting confusion about when and who to ask about CPR can result in an inappropriate burden being placed on patients, partners or families. A simple clinical decision framework is presented, together with the underlying principles. This framework is offered as an aid for clinicians and patients in understanding the current ethical, clinical and legal guidance on decisions about CPR.

Background/purpose: This article is an anatomic, clinical, therapeutic, and prognostic assessment of 56 children 16 years of age or younger, who underwent a surgical operation for thyroid papillary carcinoma from April 1988 to December 2001 in the Department of General Surgery at the University of Pisa. Of these 56 patients, 22 are Belarus children (39%) in whom carcinoma developed after the nuclear accident in Chernobyl in April 1986, whereas 34 (61%) are children with differentiated nonirradiated tumors. The purpose of this work was to compare the group of children who had radiation-induced thyroid carcinoma with the group affected by non-radiation-induced carcinoma to evaluate if there are significant clinical, anatomic, and prognostic differences between them and to identify the best surgical strategy to adopt., Results: At the time of clinical presentation, the tumor was limited to the thyroid gland in 28 cases (50%), whereas in the others, in 24 cases (43%) metastases in the neck lymph nodes were present or had infiltrated the extrathyroid tissues as was seen in 4 cases (7%). The surgical operation was a total thyroidectomy in 37 cases (66%), whereas in 19 patients with radiation-induced carcinoma it was a hemithyroidectomy followed by a completion of thyroidectomy in Pisa (34%). The histologic examination showed multifocal sites of papillary adenocarcinoma in the gland in 23% of cases, and both lobes of the thyroid gland were involved with tumor in 23% of patients. The postsurgical follow-up showed a mortality rate of 0% and a recurrence rate of 33.5% (64% radiation-induced carcinoma v 3% non-radiation-induced carcinoma; P < .0001). At the moment, 8 of 22 cases (36%) with radiation-induced carcinoma are free of disease versus 33 of 34 (97%) with non-radiation-induced carcinoma (P < .0001)., Conclusions: These findings show carcinoma of the thyroid in children has a low risk of mortality but a high risk of recurrence. Children with radiation-induced thyroid carcinoma are more likely to have a recurrence of the disease. Total thyroidectomy for the treatment of both radiation-induced and non-radiation-induced carcinomas appears to represent, on the basis of these results, the best therapeutic option.

Intraspinal analgesia can be helpful in some patients with intractable pain. Over 15 years palliative care professionals evolved their spinals policy through a repeated series of evaluations, discussions and literature reviews. One hundred intraspinal lines were then reviewed. Notable changes in policy were the switch from epidurals to intrathecals, and the insertion of lines during working hours rather than as emergencies. Our efficacy, and frequency of adverse effects, is equal or better to published studies. Key issues in reducing adverse effects were the improved care of the spinal line exit site, a change from bolus administration to continuous infusions, and modifying line insertion techniques. Current policy is to use continuous infusions of diamorphine and bupivacaine in a 1:5 ratio through externalized intrathecal lines. The lines are effective in approximately two thirds of patients and can be kept in place for up to 18 months. The policy continues to be updated and common documentation is now in place.

Introduction: The risk of thromboembolic events related to travel is not exclusively due to air travel. We report the case of a patient who presented pulmonary embolism after prolonged train travel., Observation: An 82 Year-old patient had a significant past history of ischemic heart disease. He traveled by train, in a sitting position, for around 12 hours from Barcelona (Spain) to Paris (France). Approximately 24 hours after the journey, he presented pain in the right leg and dyspnea, which increased during the following 48 hours. Ultrasonographic cardiac examination revealed pulmonary arterial hypertension (54mm Hg), acute right ventricular failure and showed a thrombus located in the pulmonary artery, confirming the diagnosis of pulmonary embolism. Ultrasonography diagnosed deep venous thrombosis of the right leg. Treatment with heparin and oral anticoagulant was initiated. Evolution was favorable and the patient was discharged home 14 days later. No further medical event occurred during the Year that followed., Discussion: The mechanisms that precede the development of a venous thrombosis are not specific to the method of transport. Blood vessel wall lesions, venous stasis and blood clotting component abnormalities, principle elements in the development of thrombosis according to Virchow's triad, are enhanced by prolonged sitting position, during travel, whether in planes or not. The role of other risk factors, personal or depending on the condition of travel, remains unknown. Simple prophylactic measures should be widely proposed during long travel, whatever the mode of transport., Conclusion: The development of a venous thrombosis, enhanced by prolonged sitting position, can occur whatever the form of travel. Prophylactic measures should be widely prescribed for prolonged travel, taking in consideration personal thromboembolic risk factors and circumstances of travel.

As part of a four-year study into the use of videoconferencing in palliative care, the delivery of workshops on palliative care to community nurses was evaluated by the Open University. Twenty nurses were randomly allocated to alternating videoconferencing and face-to-face modes of presentation. The quantitative study measured the amount of learning that occurred in each workshop with pre-tests and post-tests, and the mode of presentation. Forty-nine workshop attendances were analysed. The qualitative study used observation and analysis of videorecordings to assess the activity and attention spans in interactive communication during workshops, while a combination of interviews and questionnaires was used to assess the participants' level of satisfaction with presentation. The results showed that the nurses' level of satisfaction with the instructional presentation was high in both modes of presentation. Despite difficulties at the start of the project in the videoconferencing presentation, there was little difference between the modes of presentation in achievement scores or the gain in achievement scores. Although the learners preferred face-to-face workshops, they learnt as much from a videoconferenced workshop. Videoconferencing was less suitable for psychological or emotional discussions, but this may have been due to the time constraints on the workshops. Some features of videoconferencing suggest it could be used effectively in helping learners discuss sensitive issues. The Current Learning in Palliative Care (CLiP) worksheets were found to be an effective means of delivering learning.

p73 is the first identified homolog of p53, but its function has not been established. Our study investigated the expression of p73 in liver tissue of patients with hepatitis C virus (HCV)-associated hepatocellular carcinoma (HCC). RT-PCR was performed on RNA extracted from tumorous and nontumorous liver tissue of HCV-associated HCC, and control tissue and the cDNA were sequenced. Anti-p73 polyclonal antibodies were used for protein analysis and immunohistochemistry, and patients' sera were analyzed for anti-p73 antibodies by radioimmunoassay. Analysis of the p53 gene was performed by SSCP and RFLP-PCR. The p73 mRNA and protein were highly expressed and accumulated in HCC tissues. Immunohistochemical studies revealed significant immunoreactivity in the nuclei of HCC cells. No mutations were detected in the p73 gene or in p53, and no loss of heterozygosity of the p53 gene was found. Anti-p73 antibodies were detected in sera of HCC patients, but were not significantly different from that occurring in non-HCV or non-HCC patients. In conclusion, p73 protein is overexpressed and accumulates in the nuclei of HCV-associated HCCs and may play a role in HCC development.