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It has been speculated that symptomatic seroma, or seroma requiring needle aspiration, is one of the risk factors for lymphedema symptoms following breast cancer treatment. These symptoms exert tremendous impact on patients' quality of life and include arm swelling, chest/breast swelling, heaviness, tightness, firmness, pain, numbness, stiffness, or impaired limb mobility. Our aim was to explore if symptomatic seroma affects lymphedema symptoms following breast cancer treatment. Data were collected from 130 patients using a Demographic and Medical Information interview tool, Lymphedema and Breast Cancer Questionnaire, and review of medical record. Arm swelling was verified by Sequential Circumferential Arm Measurements and Bioelectrical Impedance Spectroscopy. Data analysis included descriptive statistics, Chi-squared tests, regression, exploratory factor analysis and exploratory structural equation modeling. Thirty-five patients (27%) developed symptomatic seroma. Locations of seroma included axilla, breast, and upper chest. Significantly, more women with seroma experienced more lymphedema symptoms. A well-fit exploratory structural equation model [X2(79) = 92.15, p = 0.148; CFI = 0.97; TLI = 0.96] revealed a significant unique effect of seroma on lymphedema symptoms of arm swelling, chest/breast swelling, tenderness, and blistering (beta = 0.48, p0.01). Patients who developed symptomatic seroma had 7.78 and 10.64 times the odds of developing arm swelling and chest/breast swelling versus those who did not, respectively (p0.001). Symptomatic seroma is associated with increased risk of developing lymphedema symptoms following breast cancer treatment. Patients who develop symptomatic seroma should be considered at higher risk for lymphedema symptoms and receive lymphedema risk reduction interventions.

Due to advances in oncological care, the number of patients exposed to and surviving after anticancer chemotherapy is steadily increasing. Anticancer agents, however, are often associated with side-effects including cardiotoxicity which has been identified as one of the most serious and potentially life threatening complications. Cardiotoxicity manifestations range from asymptomatic alterations of heart and vasculature function to arterial hypertension, myocardial ischemia, arrhythmias (including QT-prolongation) and overt heart failure. Post-chemotherapy cardiovascular impairment has been associated with increased morbidity and may also contribute to increased mortality in these patients, both early and late after chemotherapy. This review article describes pathophysiology, clinical manifestation, diagnostic algorithms, monitoring and therapy of cardiotoxicity caused by anticancer agents. We also outline and discuss a variety of problems associated with patient management from the viewpoint of clinical cardiology according to latest published findings.

To gain an understanding of the environmental factors that affect the growth of the bacterium Sporosarcina pasteurii, the metabolism of the bacterium and the calcium carbonate precipitation induced by this bacterium to optimally implement the biological treatment process, microbial induced calcium carbonate precipitation (MICP), in situ.Soil column and batch tests were used to assess the effect of likely subsurface environmental factors on the MICP treatment process. Microbial growth and mineral precipitation were evaluated in freshwater and seawater. Environmental conditions that may influence the ureolytic activity of the bacteria, such as ammonium concentration and oxygen availability, as well as the ureolytic activities of viable and lysed cells were assessed. Treatment formulation and injection rate, as well as soil particle characteristics are other factors that were evaluated for impact on uniform induction of cementation within the soils.The results of the study presented herein indicate that the biological treatment process is equally robust over a wide range of soil types, concentrations of ammonium chloride and salinities ranging from distilled water to full seawater; on the time scale of an hour, it is not diminished by the absence of oxygen or lysis of cells containing the urease enzyme.This study advances the biological treatment process MICP towards field implementation by addressing key environmental hurdles faced with during the upscaling process.

Methanol oxidation has been used here to study the acid and redox properties of heteropolyacids of the H3+nPVnMo12−nO40, (n = 0, 1, 2, 3) series, both unsupported and supported on the potassium salt K3PMo12O40. Increased vanadium content was found to improve selectivity to formaldehyde by favoring oxidative dehydrogenation at the expense of dehydration. This result is consistent with a reaction mechanism based on HOMO-LUMO interaction. Supported acids generally shown higher activity than the corresponding unsupported catalysts. For unsupported acids, activity was found to be governed mainly by absorption rates and stability of the secondary structure, whereas for supported acids whose structure was stabilized by the support, the influence of vanadium content was found to be a function of the overall proton concentration.

An increasing incidence of invasive aspergillosis is observed in most immunocompromised patients, and especially patients with acute leukemia and after hematopoietic stem cell transplantation. In order to decrease the mortality due to this infection, the clinicians need to optimise their treatment choice. The objective of these guidelines is to summarize the current evidence for treatment of invasive aspergillosis. The recommendations have been developed by an expert panel following an evidence-based search of literature with regard to current recommendation of European Conference in Infections in Leukemia and Infectious Diseases Society of America.

National working group representing clinicians (hematologists, oncologists, infection diseases and ICU specialists), microbiologists, and different special medical societies and working groups prepared evidence-based guidelines for the treatment established fungal infection--invasive candidiasis in the adult hematology and ICU patients. These guidelines updated those published in the Czech Republic in 2003-2004. Evidence criteria of the Infectious Diseases Society of America (IDSA) were used for assessing the quality of clinical trials, and EORTC/MSG Consensus Group for definitions of invasive fungal disease.

Type 1 fimbriae from Actinomyces viscosus T14V, composed of a complex protein of Mr 65,000, mediate the adherence of A. viscosus T14V to the host, whereas type 1 fimbriae-specific antibodies inhibit adherence. Genetic control of the serum IgG response to type 1 fimbriae was evaluated in a series of inbred, hybrid, recombinant inbred, and back-cross mice. Mice were given i.p. injections of 10(8) A. viscosus T14V cells in saline on days 0 and 14, and IgG anti-type 1 fimbriae in sera obtained on day 26 were measured by ELISA. Segregation analysis of the responses of (BALB/cJ x A/J)F1 x A/J backcross mice suggested polygenic control. Linkage analysis in (BALB/cJ x A/J)F1 x A/J backcross and SWXL recombinant inbred mice suggested control by genes linked with H-2 and with Ly-17 and Akp-1. In several F1 hybrid strains derived from H-2-disparate high and low responder parental strains, low responsiveness was dominant. The F1 derived from the H-2-identical high and low responder strains CBA/J and C3H/HeJ was a low responder, suggesting that dominant low responsiveness was mediated by non-H-2-linked genes. A three-gene model is proposed for regulation of the type 1 fimbriae response, including an MHC-linked gene, a gene linked with Ly-17 and Akp-1 on the telomeric portion of chromosome 1, and a background gene whose linkage is unknown.

A bilateral oophorectomy at the time of elective hysterectomy is often performed to prevent ovarian cancer. The assumption that endogenous estrogen can be easily replaced with supplemental medication fosters the decision for routine oophorectomy. Published reports on the use of postmenopausal estrogen indicate that compliance is less than perfect. This fact could affect the overall outcome. Decision analysis techniques with Markov cohort modeling were used to evaluate the policy of elective bilateral oophorectomy. Results from studies judged methodologically sound were combined to determine values representing the influence of estrogen on coronary heart disease, breast cancer, and osteoporotic fracture. The decision tree also explicitly incorporated patient compliance. When compliance with estrogen therapy is assumed to be perfect, oophorectomy yields longer life expectancy than retaining the ovaries. When actual drug-taking behavior is considered, retaining the ovaries results in longer survival. This analysis highlights the importance of including the effects of patient compliance with treatment recommendations when the impact of a health policy decision such as prophylactic surgery is assessed.

An optical-fiber crossbar switch has been constructed using fully integrated GaAs optoelectronic receivers, custom monolithic GaAs laser drivers, and an electrical 32*32 silicon crossbar switch. 470 Mb/s operation has been achieved with a bit error rate of less than 10/sup -12/. The approach uses a monolithic GaAs optoelectronic integrated receiver to convert optical signals into electrical signals that are fed into an Si 32*32 electronic crossbar switch. The switch outputs are used to drive laser transmitters consisting of a custom monolithic GaAs IC laser driver and a 0.85 mu m GaAs/AlGaAs laser. The system could be reconfigured in 1 mu m, limited by the control logic, with the switch chip capable of reconfiguration in 35 ns. No errors are induced by reconfiguration. >

Interns are expected to teach medical students, yet there is little formal training in medical school to prepare them for this role. To enhance the teaching skills of our graduating students we initiated a 4-hour “teaching to teach” course as part of the end of the fourth-year curriculum. Course evaluations demonstrate that students strongly support this program (overall ratings 2000 to 2005: mean = 4.4 [scale 1 to 5], n = 224). When 2004 course participants were surveyed during the last month of their internship, 84%“agree” or “strongly agree” with the statement: “The teaching to teach course helped prepare me for my role as a teacher during internship” (2005: mean 4.2 [scale 1 to 5], n = 45, response rate 60%). A course preparing fourth-year students to teach during internship is both feasible and reproducible, with a minimal commitment of faculty and resident time. Participants identify it as an important addition to their education and as useful during internship.

An overview concerning different types of kidney involvement associated with monoclonal gammapathy (MG) is given, focused on light-chain deposition disease (LCDD). Pathophysiologic basis of LCDD remains in the light-chain tissue deposition (resp. in tissue deposition of immunoglobulin's stable domain). This mechanism is typical for monoclonal immunoglobulin's overproduction as found in MG. Clinical picture of LCDD reflects multiorgan character of disorder, while renal lesions rank among the most frequent, serious and best documented ones. Clinical data referring to a group of six patients, treated in our nephrologic department are presented. Diagnosis of LCDD was established on basis of the renal biopsy finding. Renal functions were decreased at the time of diagnosis in all patients, whereas haemodialysis treatment was started in one patient. On conclusion therapeutic possibilities of LCDD are discussed, in which number symptomatic therapy of renal failure is combined with corticosteroids therapy and cytostatic therapy; prognosis of most patients remains serious.

The STEREO (Solar TErrestrial RElations Observatory) mission is being developed for NASA by The Johns Hopkins University Applied Physics Laboratory. The mission will employ two identical satellite observatories to observe solar phenomena, providing the first-ever 3-D stereoscopic images to study the nature of coronal mass ejections. The STEREO Interface Board, which is part of the integrated electronics module (IEM), contains electronics that handle the digital portion of the uplink and downlink communications. The functions of the Interface Board include decoding critical commands, Storing and encoding downlink information, and generating system interrupts. In addition, the Interface Board processes a variety of discrete interfaces. The STEREO IEM makes use of a Compact PCI backplane to provide communication between constituent boards. Rather than using a flight-qualified PCI chipset, the STEREO Interface Board uses a commercial PCI Intellectual Property (IP) core, integrated with a custom backend bus interface, implemented in an Actel field-programmable gate array (FPGA). An IP core is a synthesizable hardware description of a digital logic block that can be implemented in an application specific integrated circuit (ASIC) or an FPGA. The advantages of using a PCI IP core include lower expense, lower power, future reusability with smaller form factors, future reusability with increased integration, and greater customization. This will be one of the first commercial IP cores to be flown by The Johns Hopkins University Applied Physics Laboratory. This paper will explore the advantages and disadvantages of choosing the commercial IP core over a flight-qualified PCI chipset and will detail the lessons learned from the implementation, integration, and testing of the core.

Background Sexual harassment has become a national concern and one that is increasingly recognized in the field of medicine. Although there are reports of the sexual harassment of medical trainees, there is little information on the prevalence of this problem and whether it is adequately addressed by training institutions. Methods Surveys with descriptions and examples of sexual harassment were mailed to 133 internal medicine residents in a university training program. The residents were asked to report anonymously whether they had encountered sexual harassment during medical school or residency, the frequency and type of harassment, its effect on them, whether they chose to report it to a person in authority, and the factors that influenced this decision. Results Surveys were returned by 82 residents (response rate, 62 percent) -- 33 women and 49 men. Twenty-four women (73 percent) and 11 men (22 percent) reported that they had been sexually harassed at least once during their training. The women were mo...

Spectrum of antimycotics used in treatment of systemic mycoses is comparatively poor. The oldest and till present received "golden standard" is polyen amphotericin B (AmB). It has the widest spectrum of effects and has the lowest incidence of resistances. However, the therapy can be accompanied by manifestations of toxicity, namely that of nephrotoxicity. "Lipoid" form of AmB (Abelcet, Amphocil, AmBisome) with only 20% risk of nephrotoxicity partly solved the problem. Wider use of these drugs is hindered by their high price. The azoles group (ketoconazole, fluconazole, itraconazole) today represents the most frequently used group of antimycotics; triazols of the 3rd generation (variconazole, posaconazole, ravuconazole) broaden the spectrum of effects namely to aspergil infections. In the future substances with a different target structure will be used. According the mechanism of effect they can be classified as echinocandins (inhibition of beta-glucane synthesis), echinocandins (inhibition of chitin synthesis), sordarines (selective inhibitors of proteosynthesis), pradimicines (cell lysis by binding on manoproteins). The rising occurrence of resistance should be coped with inhibitors of the efflux pump (milbemycine). Clinical testing of all these substances is already in progress, in some of them already in phase III.

The objective of the paper is to draw attention to the not very frequent and thus omitted form of sideropenic anaemia in selective iron malabsorption as the only manifestation of malabsorption syndrome in coeliac sprue. This type should be suspected when examination of blood losses is futile and oral iron administration which is usually administered empirically produces no effect. The authors present the example of two patients with severe sideropenic anaemia where the diagnosis of malabsorption was confirmed only several years after the diagnosis of sideropenic anaemia was established. Evidence of a correct conclusion was permanent normalization of haemoglobin values when the patients adhered to a gluten-free diet.

Injection drug users frequently present to emergency departments with fever. A careful history and physical examination with attention to anatomic localization of symptoms and signs are often necessary to unmask unusual underlying medical conditions. We report a case of a woman with recent injection drug use who presented with fever, a palpable neck mass, and Pancoast's syndrome. She had been seen recently at the ED of another hospital and discharged with oral antibiotics for presumed cellulitis. A mycotic aneurysm of the subclavian artery causing Pancoast's syndrome was later diagnosed by using computed tomography and angiography. A high index of suspicion for anatomically localized infective processes should always be maintained with febrile injection drug users.

Strain P14 of facultative methylotrophic bacteria that synthetisizes poly-beta-hydroxybutyrate has been isolated. The cells are gram-negative motile rods with a polar flagellum. They do not form spores or capsules, but do have a caretenoid pigment. Predominant in the fatty acid composition of the cells is cis-vaccenic acid (cis 18:1: omega 7)--72%. In the phospholipid composition phosphatidylcholine predominates (45%), along with phosphatidylenthanoloamine (27%) and phosphatidylglycerol (17%). The main biquinone is Q-10; other ubiquinones (Q-8, Q-9, Q-11) are present in minor quantities. The cells accomplish the icl-variant of serine pathway. The GC content of DNA (Tm) is 65 mole%. A high level DNA-DNA homology with representatives of the genus Methylobacterium was observed. The strain has been identified as Methylobacterium extorquens strain P14.

Many different models for the behavior of interest rates have been proposed and investigated over the years. We have made progress in the sense that some formerly popular models have been eliminated from serious consideration, but there is still no general agreement on which model is the best. The uncertainty leads to substantial model risk in pricing and hedging interest rate derivatives. This article presents a different approach: rather than specifying a particular stochastic process for the short-term interest rate, Epstein, Haber, and Wilmott simply place bounds on its behavior, in the form of maximum and minimum feasible values and a constraint on its rate of change, while permitting any movement of the rate within the constraints. This general approach leads to an acceptable range for the interest rate and for financial instruments based upon it. Model dependence is greatly reduced in this way. The next challenge will be to develop models in this framework that produce tight enough bounds to be useful for traders and investors.

A group of workers exposed to elemental mercury was monitored over a period of 14 years (1983-1996) at the Institute of Occupational Medicine and Environmental Health, Sosnowiec. Mercury was used as a catalyst in the synthesis of acetic aldehyde and obtaining of chlorine. Every year medical examination was performed in the group of 163-277 persons. During the first four years of monitoring, excessive absorption of Hg was found in 32.1-45.1% of workers. The highest percentage (46.1-65.0%) was observed in persons engaged in technological processes of acetic aldehyde synthesis. From 1987 workers employed in this department were systematically (every six months) removed from the contact with Hg. Due to preventive removal a gradual decrease in the percentage of those with high Hg absorption (32.0-9.2%) was observed. As the authors point out, it is important to select properly workers to be employed under conditions of mercury exposure, and to determine every six months their urine mercury level. It is also desirable to remove workers temporarily from the most hazardous workposts and to incorporate a wide spectrum of specialistic examinations into periodical checkups.

Divers are exposed to dense gases under hyperbaric and hyperoxic conditions and, therefore, may be at risk of developing respiratory disease. Long-term effects on respiratory function have been found in commercial divers who perform deep dives. This study was conducted to detect possible lung function changes in scuba divers who dive in shallow water using compressed air or oxygen as a breathing gas. A cross-sectional sample of 180 healthy male divers (152 air divers and 28 oxygen divers) and 34 healthy male controls underwent a diving medical examination including body plethysmography, diffusion capacity measurement and a cold-air isocapnic hyperventilation test (CAIH). Air divers and oxygen divers had a lower mid-expiratory flow at 25% of vital capacity (MEF25) than controls (p

Anemia is common complication in multiple myeloma (MM). Its etiology is multifactorial-bone marrow infiltration, cytokines production, renal failure and effect of chemotherapy are main contributing factors. The red cell substitution therapy, which is administrated in 34 - 53% of patients, is frequently associated with the risk of well-known side effects. The use of recombinant erythropoietin (r-HuEPO) is a novel therapy in patients with MM.We have investigated the effect of r-HuEPO (Eprex. Cilag) in the group of 8 patients with MM. The growth factor was administrated in the dose of 150 U/kg. 3 times/ week s.c. The criterium of response was the increase of Hb levels of 20 g/L. All patients responded to r-HuEPO treatment. The medium period of response was 6,5 weeks. In two patients the doses of r-HuEPO could be reduced due to excellent effect of therapy. The energy level, ability to daily activities and overall quality of life significantly improved during the course of therapy. Neither effect of growth factor on thrombopoiesis and/or leukopoiesis nor serious adverse events due to r-HuEPO therapy were observed. The activity of underlying disease did not seem to be affected by r-HuEPO. In one patient the disease rapidly progressed after the end of study. The progression had some features of plasmablastic leukemia and leads to the death of patient.According to our experience, r-HuEPO is highly effective in the treatment of anemia in MM. The stimulation of erythropoiesis was associated with significant improvement of quality of life of patients. The effect of r-HuEPO treatment on activity of MM was not found, however, in one patient rapid progression of disease was observed after the end of study.

The etiology of anaemia associated with tumours is multifactorial. One of the mechanisms of development of anaemia in tumours are so-called chronic diseases anaemias, the main feature of which is inadequate production of endogenous erythropoietin (EPO). The objective of the investigation was to test the effect of recombinant human erythropoietin (rHuEPO) in the treatment of anaemia (rise of haematocrit, Hb) in patients with chronic lymphatic leukaemia (CLL) and multiple myeloma (MM) and the effect of this treatment on the quality of life. The authors evaluated at the same time the impact of the endogenous EPO level before treatment and its predictive value as regards the therapeutic response.The investigation comprised a total of 14 patients (6 CLL, 8 MM). The basic criterion for inclusion in the group was a Ht value lower than 0.32 and Hb less than 105 g/l. The examination protocol was focused on elimination of other causes of anaemia. During the 12-week investigation the patients completed a questionnaire "Quality of life" which reflected their subjective evaluation of the effect of treatment. The patients themselves administered r-HuEPO three times a week by the s.c. route--an initial dose of 150 U/kg with the possibility to increase the dose to 300 U/kg.A therapeutic response was obtained in four patients with CLL and eight patients with MM. Respondents with CLL had endogenous EPO values lower than 300 U/l, seven MM respondents lower than 200 U/l, one 400 U/l. The Hb level of the patients rose and the quality of life improved. All patients tolerated treatment very well and the authors did not observe any serious undesirable effects.The investigation confirmed the therapeutic effect of r-HuEPO in patients with a lower baseline value of EPO. Subjective evaluation (questionnaire) correlated with objective evaluation (Ht, Hb). Assessment of the endogenous EPO level before treatment is according to the authors one of the important primary predictive parameters and EPO values between 200 and 300 U/l are the upper range where a therapeutic effect can be expected with the highest probability. The authors conclude also that a secondary predictive criterion of the response is evaluation of the therapeutic effect after 4-5 weeks treatment when a rise of Hb by at least 20 g/l is an argument for further treatment.

We report here the failure of the Synchron LX (Beckman) and Vitros 950 (Johnson & Johnson) assays to detect HDL-cholesterol (HDL-C) in the presence of a paraprotein. HDL-C was repeatedly undetectable (

This paper outlines strategies for all nurses to participate in nursing's research agenda, which aims to enhance the scientific basis of nursing practice. The emphasis here is on generating data for the outcomes movement as a tool for transforming the American health care delivery system.

Cigarette smoking is a risk factor for many diseases, and recent evidence indicates that it adversely affects periodontal health. A number of epidemiologic studies have shown strong associations between smoking and the prevalence and severity of periodontitis, as well as interproximal bone loss. Although the pathogenesis of periodontitis in smokers is poorly understood, there are data suggesting that smoking causes defects in neutrophil function, impaired serum antibody responses to periodontal pathogens, and potentially diminished gingival fibroblast function. The prevalence and severity of periodontitis in former smokers is decreased compared to current smokers, providing evidence that smoking cessation is beneficial. Smoking markedly influences response to treatment, and a subset of smokers predominates among refractory periodontitis patients who are resistant to conventional treatment. A patient's smoking history is a useful clinical predictor of future disease activity. Current estimates suggest that smoking is associated with a large proportion of periodontitis cases and constitutes a major public dental health problem.