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The objective of this study was to assess the use of personal digital assistants (PDAs) among dietitians and dietetic students in Oklahoma and the desire for training in the use of PDAs. A survey was mailed to 648 dietitians and dietetic students to assess their PDA use and interest in PDA training. Frequency and percentage of responses were determined. A total of 320 usable surveys were returned, for a response rate of 49%. Sixteen percent of responders were dietetic students. The responses of students did not differ from those of dietitians, so all responses were combined. Subjects were primarily female, between 21 and 50 yrs of age, and had practiced for 5 yrs or more, similar to the demographics of dietitians nationally. Twenty-four percent of responders currently use a PDA, primarily as an organizational tool. Twenty-eight percent of the users indicated that they had received training in PDA use. Thirty-seven percent of the users were using a PDA for nutrition assessments, and 28% were using it for nutrition support. Of nonusers, 80% indicated that they would use a PDA if training were available. PDAs were used most often as an organizational tool, seldom for nutrition-specific applications. Dietitians and students expressed an interest in receiving training in PDA use, preferably from state and local dietetic associations. PDA training might also be incorporated into academic dietetic programs, and employers could provide training in the workplace. [ABSTRACT FROM AUTHOR]

When ingested, pectin can lower serum cholesterol levels in humans. Pectin is degraded by fecal bacteria in the colon. We examined the release of methanol (MeOH) by this degradation. A 0.2% glucose (2 g/L) mixture was used as the control medium. A pure culture of pectinolytic Erwinia carotovora was the control bacterium. The chief substrates were, in set 1,0.2% pectin (2 g/L) and, in set 2,0.1% glucose (1 g/L) and 0.1% pectin (1 g/L). Cultures of fecal bacteria and E carotovora grew for 72 h in each of the solutions. By 72 h the fecal flora culture in set 1 cleaved 30% of the possible methoxyl groups on pectin. The fecal flora in set 2 cleaved 90.7% of all possible methoxyl groups. Balance studies suggest that all of the free MeOH comes from methoxyl groups on pectin. This study demonstrates that fecal bacteria are capable of degrading pectin to release MeOH. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Breast conservation (BC) rates have been utilized as a quality metric, yet mastectomy rates have been noted to be increasing nationwide. The purpose of this study was to evaluate the factors associated with BC in 437 US breast centers surveyed by the National Accreditation Program of Breast Centers (NAPBC). METHODS: From 2006 to 2010, 437 breast centers across the US were surveyed by the NAPBC. At each center, annual data regarding BC rates were reported in the Survey Application Record (SAR) for patients with Stage 0-II breast cancer. We evaluated characteristics of breast centers including geographic location, volume of patients treated, therapeutic modalities provided, and center organizational relationships. Non-parametric statistical analyses were performed to determine factors associated with BC rates in this cohort. RESULTS: Among the 437 breast centers surveyed from 2006-2011, data on 77,248 patients with Stage 0-II were reported. The median number of Stage 0-II breast cancer patients per center was 149 (range; 10-891). The median proportion of these patients who underwent BC was 64.8% (range; 33-100%). No significant differences in median BC rate was noted over the six years of the study (range; 64.2% in 2006 - 67.1% in 2011, p = 0.788). However, significant regional variations were noted in median BC rates: 62.2% in the West (N = 59 centers), 63.8% in the South (N = 145 centers), 64.1% in the Midwest (N = 118 centers), and 70.8% in the Northeast (N = 104 centers), p < 0.001. There was no difference noted in BC rates between high volume (≥ 150 Stage 0-II cases/yr) and low volume (< 150 Stage 0-II cases/yr) centers (median 65.1% vs. 64.6%, respectively, p = 0.584). No differences in BC rate was noted between centers that referred vs. provided implant-based (p = 0.259), TRAM flap (p = 0.069), latissimus dorsi flap (p = 0.108) or DIEP/free flap (p = 0.324) reconstruction. Similarly, there was no difference noted in BC rates between centers who referred vs. provided whole breast radiation therapy (p = 0.224) and accelerated partial breast irradiation (p = 0.964). Centers that were affiliated with a hospital (N = 195) had a lower rate of BC than those that were not (n = 232); median 63.9% vs. 66.3%, p = 0.037. The majority of centers surveyed were also accredited by the Commission on Cancer (CoC; N=395); however, no differences were noted between these centers and those who were not CoC accredited in terms of BC rates (64.9% vs. 65.8%, respectively, p = 0.748). In a multivariate linear regression model, both region (p = 0.008) and hospital affiliation (p = 0.004) remained significant independent predictors of BC. CONCLUSION: Across 437 US breast centers, data from 77,248 patients demonstrate a national BC rate of 64.8%. While the rate does not seem to be varying significantly over time, variation in BC was noted between regions and between centers associated with hospitals vs. not. Rates of BC do not vary, however, by center volume, availability of reconstruction or radiation, nor by CoC accreditation status. These data suggest that patient choice, rather than the availability of radiation and reconstruction, is the driving force in surgical decision-making. [ABSTRACT FROM AUTHOR]

Neurofibromatosis Type II (NF2) is an autosomal dominant cancer predisposition syndrome in which germline haploinsufficiency at the NF2 gene confers a greatly increased propensity for tumor development arising from tissues of neural crest derived origin. NF2 encodes the tumor suppressor, Merlin, and its biochemical function is incompletely understood. One well-established function of Merlin is as a negative regulator of group A serine/threonine p21-activated kinases (PAKs). In these studies we explore the role of PAK1 and its closely related paralog, PAK2, both pharmacologically and genetically, in Merlin-deficient Schwann cells and in a genetically engineered mouse model (GEMM) that develops spontaneous vestibular and spinal schwannomas. We demonstrate that PAK1 and PAK2 are both hyper activated in Merlin-deficient murine schwannomas. In preclinical trials, a pan Group A PAK inhibitor, FRAX-1036, transiently reduced PAK1 and PAK2 phosphorylation in vitro, but had insignificant efficacy in vivo. NVS-PAK1-1, a PAK1 selective inhibitor, had a greater but still minimal effect on our GEMM phenotype. However, genetic ablation of Pak1 but not Pak2 reduced tumor formation in our NF2 GEMM. Moreover, germline genetic deletion of Pak1 was well tolerated, while conditional deletion of Pak2 in Schwann cells resulted in significant morbidity and mortality. These data support the further development of PAK1-specific small molecule inhibitors and the therapeutic targeting of PAK1 in vestibular schwannomas and argue against PAK1 and PAK2 existing as functionally redundant protein isoforms in Schwann cells., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Cutaneous collagenous vasculopathy (CCV) is a rare benign microangiopathy of the superficial dermal vessels. Clinically, it is characterized by widespread, asymptomatic development of cutaneous telangiectasia in the absence of systemic symptoms. Morphologically, it most resembles generalized essential telangiectasia and other telangiectatic syndromes such as telangiectasia macularis eruptiva perstans (TMEP), ataxia telangiectasia, and hereditary hemorrhagic telangiectasia. It is distinctive in its histology, showing characteristic dilated thick-walled blood vessels in the superficial dermis. The thickened walls of these superficial dermal blood vessels demonstrate reduplication of the basement membrane on PAS staining. We report a 63-year-old man with CCV with this condition for 20 years, starting in 1996. He was diagnosed in the past as having essential telangiectasia. The development of the telangectasias occurred after coronary artery bypass grafting, also performed in 1996. This case not only demonstrates the characteristic clinical and histologic findings, but also suggests a possible mechanism. Moreover, it illustrates that cases of generalized essential telangiectasia may in fact be CCV that are misclassified.

Purpose: The definition of a "breast center" varies significantly, ranging from hospital-based or free-standing comprehensive programs to private subspecialty practices with patient resources in close proximity. This study analyzes the 2-year data of the National Accreditation Program for Breast Centers (NAPBC) to assess the demographics of the types of programs seeking breast center (BC) accreditation. The results of a postaccreditation survey are also analyzed., Materials and Methods: All data (ie, Survey Application Record, on-site surveyors' reports, postaccreditation survey) for programs applying for accreditation between October 31, 2008, and October 31, 2010, were entered into a database at the American College of Surgeons headquarters. Analysis was conducted with SPSS v.19 and Microsoft Excel 2007., Results: During the initial 2-year period, 238 centers were surveyed across 41 states. With regard to the 27 standards and 17 BC components, 68% of centers had no deficiencies, 28% had ≤ 10% deficiencies, 3% had deficiencies in 11% to 29% of standards, and 2% had ≥ 30% deficiencies. The most common standards with noncompliance were accreditation for ultrasound-guided biopsy (standard 11), stereotactic biopsy (standard 10), and accrual onto clinical trials (standard 3.2). The only BC component found to be absent was survivorship program (1%). Desciptive categories were as follows: 81.5% were hospital-based centers, 13.5% were free-standing facilities, 2.5% were group practices, and 3% were "other." There were no significant associations between descriptive category and full accreditation versus contingency or failure, or deficiencies in any one standard (all Ps > .05). On the basis of responses to the postaccreditation survey, 76% admitted making significant changes before the survey process., Conclusion: This initial analysis of the NAPBC 2-year data suggests that a wide variety of BC models adequately provide a high level of care and services for patients across the nation.

Objectives: The aim of the present study was to compare the diagnostic accuracy of F-speed conventional film, unenhanced digital images and inversion-enhanced digital images for the detection of osseous defects in patients with vertical bone defects., Methods: 23 vertical osseous defects in the mandible were evaluated. Intrasurgical measurements were made from the cementoenamel junction (CEJ) to the deepest extension of the osseous defects by one of the researchers. Radiographic measurements were obtained on conventional F-speed film, unenhanced digital images and inversion-enhanced digital images by six examiners. From each measure the corresponding probe measure was subtracted to form a difference score., Results: Significant differences in means of difference scores were found among examiners within each imaging modality, and among the modalities within five of the six examiners. A significant (P<0.001) interaction term for the ANOVA indicated that differences among modality means were not the same across all examiners. The difference means were significantly different from zero for five of the six examiners with conventional F-speed film, four of six with inversion enhanced digital images, but for only one of six for unenhanced digital images. The reliability coefficient computed on a per examiner basis was 0.90 for conventional F-speed film, 0.94 for unenhanced digital image and 0.79 for inversion-enhanced digital image., Conclusions: In this study, unenhanced digital imaging was found to be superior to conventional F-speed film and inversion-enhanced digital images for accurately imaging periodontal osseous defects in patients.

Children and adolescents with obesity are increasingly referred to the pediatric endocrinology clinic at OU Children's Hospital for evaluation and initiation of preventive measures. During the summer of 2004 we conducted a retrospective review of cases to determine the prevalence of fasting insulin resistance and dyslipidemia; to study associations and differences due to ethnic background; and compare values with similar patients seen at four Indian Health Service clinics. We observed the highest prevalence of dyslipidemia in Caucasian youth. The prevalence of high fasting glucose and mean glucose values were higher in the obese Native American youth than in African Americans or Caucasians. The elevated glucose levels in young Native Americans may be associated with their increased risk for type 2 diabetes compared to other races; but Caucasians are more prone to dyslipidemia. Effective methods are needed to detect, prevent and treat diabetes and cardiovascular risk in children and adolescents.

Objective: It is controversial whether acanthosis nigricans is an independent marker of insulin resistance. In this study, we evaluated whether insulin resistance (as reflected by HOMA) was associated with acanthosis nigricans, Native American heritage, BMI, fasting insulin, and plasma lipids in Native American children and adolescents., Design/methods: Retrospective chart review of Native American children (3.6 to 17.8 yrs) seen in 4 tribal or Indian Health Service clinics after referral for exceptionally high type 2 diabetes risk (family history, extreme obesity, and/or severe acanthosis nigricans)., Results: All but 2 had a family history of type 2 diabetes in at least one first or second degree relative, all but 3 had acanthosis nigricans (12 severe and 11 mild/not severe), and all but 2 were obese (BMI Z score of +3 to +8). Those with severe acanthosis nigricans had higher BMI and fasting insulin levels and lower HDL-C (p < 0.05) than those with acanthosis nigricans that was not severe. HDL-C correlated with BMI Z-score (p = 0.046) and approached significance with fasting insulin. HOMA correlated with BMI (p = 0.0005), with 82.4% of males and 33.3% of females having a HOMA greater than the 90th percentile for normal children. A multiple regression model indicated that acanthosis nigricans severity remained a predictor (p = 0.015) of HOMA after association of BMI Z score, Native American blood quantum, and gender were removed., Conclusions: These data indicate that among Native American children at high risk for developing type 2 diabetes, acanthosis nigricans is an independent marker of insulin resistance (as reflected by HOMA).

Effects of paroxetine treatment of comorbid depression and posttraumatic stress disorder (PTSD) on subjective symptoms, autonomic reactivity, and diurnal salivary cortisols were assessed prospectively. Cross-sectional baseline psychophysiologic assessments of 22 patients with depression + PTSD, 21 with depression alone, and 20 asymptomatic, previously traumatized controls found that comorbid patients had higher blood pressure and heart rate reactivity to individualized trauma scripts than purely depressed and control groups. On discriminant analyses comparing comorbid patients with each other group, combined autonomic variables correctly classified 55% of comorbid patients (sensitivity) and 75% of traumatized, healthy subjects (specificity) as well as 55% of comorbid patients (sensitivity) and 86% of purely depressed patients (specificity). Although baseline AM and PM salivary cortisol levels were within reference range and did not differ significantly across groups, depression + PTSD patients differed from the other 2 groups in having a flattened diurnal pattern. After 10 weeks of open-label paroxetine, comorbid patients significantly improved in all PTSD symptom evaluations and physiologic reactivity measures but did not change cortisol levels or acquire a robust diurnal cortisol pattern. Ten treated depressed patients did not change in physiologic or cortisol measures. Results demonstrate that sampled comorbid patients had autonomic reactivity patterns similar to PTSD that responded to selective serotonin reuptake inhibitor treatment but had diurnal cortisol secretion patterns different from depression or that expected for PTSD, which did not change with treatment. Results suggest a complexity in the neurobiology of comorbid PTSD and major depression and its response to treatment.

Effects of double-blind treatment of chronic posttraumatic stress disorder (PTSD) with 2 SSRIs and placebo on emotional symptoms and autonomic reactivity were assessed prospectively. PTSD subjects received citalopram (n=25), sertraline (n=23), or placebo (n=10) for 10 weeks, with psychophysiologic assessments performed before and after treatment. Intent-to-treat analysis showed that all treatment groups improved significantly in total symptoms of PTSD (as measured by the Clinician Administered PTSD Scale), all 3 PTSD symptom clusters, and sleep time. However, subtle differences in improvements in PTSD symptom clusters, physiologic reactivity, and reported adverse events were identified. Citalopram treated subjects significantly lowered systolic and diastolic blood pressures, while sertraline and placebo treated patients significantly lowered only systolic blood pressure reactivity to individualized trauma scripts. The sertraline group showed significantly more improvement in avoidance/numbing symptoms than both other groups. Considering side effects, subjects on sertraline reported more gastrointestinal problems, with early terminators having more insomnia. Early terminators on citalopram reported more fatigue and appetite changes than other treatment groups, with completers reporting more sexual dysfunction. Results support a class effect of SSRIs in treating PTSD symptoms, but suggest a possible differential effect of drugs on symptom clusters, physiologic parameters, and side effects that may have clinical relevance. Implications of symptom reduction noted in the smaller placebo group are discussed relative to recent concerns about increasing placebo response in clinical trials.

The stability of an analyte can have an important influence on its diagnostic performance and therefore should be documented before an analyte is introduced into routine practice. The stability of creatine kinase MB isoenzyme (CK-MB), troponin I and troponin T was studied by incubating samples at temperatures between 26 degrees C and 39 degrees C for periods up to 5400 min. Arrhenius plots were made which showed that all three proteins demonstrated a rapid decrease in stability between 15 degrees C and 20 degrees C. The activation energies for CK-MB, troponin I and troponin T were 7.7, 6.34 and 6.34 cal/mol, respectively.

The purpose of this study was to compare the effects of a hyperlipidemic diet on three different rodent models to evaluate them on how their responses simulate human serum lipid diseases. Forty hamsters, 40 gerbils, and 20 guinea pigs were given either a chow diet or a modified high-fat, high-cholesterol diet (HF/HC) for 7 days. Food was withheld from half of the animals on each diet for 12 hours prior to collecting the blood for analysis of total cholesterol and triglyceride concentration. In all species, HF/HC feeding resulted in at least a 370% increase in total cholesterol concentration. Withholding food significantly decreased total cholesterol concentration in hamsters and gerbils fed HF/HC but had no effect on animals fed chow diet. Triglyceride concentrations were increased by the HF/HC in the hamster and the gerbil. As with total cholesterol, triglyceride concentration was decreased after food was withheld in these two animal groups. We suggest that the guinea pig is the most appropriate model for studying hypercholesterolemia because of its moderate plasma cholesterol response and normal triglyceride response to a HF/HC. We also suggest that the hamster is a good model for studying hypertriglyceridemia since increased serum triglyceride concentrations can be easily maintained on a HF/HC.

An assay for the evaluation of antiviral and immunomodulator potency was developed using pure populations of cultured human monocytes. The assay involved culturing of human monocytes until they were fully susceptible (15-20 days) to lytic infection with HSV-1. When susceptible cells were cultured with recombinant interferon-alpha or a synthetic interferon inducer such as polyinosinic:polycytidylic acid prior to infection, a significant enhancement in resistance to the cytopathic effects of HSV-1 was observed. Likewise, a dose dependent reduction in cell lysis was observed when acyclovir was added immediately after virus infection. Monocyte resistance to HSV-1 was determined by the retention of pinocytic activity as determined by the uptake of neutral red dye. Relative pinocytic activity was quantitated using a simple colorimetric procedure. This antiviral assay can be completed in 48 h; is easy to perform, highly sensitive and reproducible.

There is substantial evidence that natural vitamin B-6 exists largely in a bound form. It has been shown that the principal modes of binding represents an interaction of pyridoxal and/or pyridoxal phosphate with protein moieties. The nature and extent of binding of different forms of the vitamin in orange juice was investigated. Studies employing ultracentrifugation, ultrafiltration and, membrane dialysis of this food product suggested binding to a molecule of less than 3,500 daltons molecular weight. Binding was resistant to protease treatment although susceptible to heat-acid hydrolysis. Separation of pyridoxal, pyridoxine, and pyridoxamine species of the vitamin by ion exchange chromatography was followed by fluorometric analysis with and without preparative hydrolysis. Extensive and equal binding of both pyridoxal and pyridoxine was observed by this method. Thus, the binder(s) of vitamin B-6 in orange juice is a small dialyzable molecule which is heat stable, binds both pyridoxal and pyridoxine and is non-protein in nature.

Studies were carried out to evaluate the comparative effectiveness of cholestyramine and pectin as hypocholesterolemic agents. Circulating levels of serum cholesterol and lipoprotein-associated cholesterol were measured in rats fed high cholesterol diet supplemented with either cholestyramine or pectin. When compared with controls, a significant decrease in the level of total cholesterol was observed in rats fed either cholestyramine or pectin (p less than 0.001, 43% reduction in cholesterol, and p less than 0.04, 25% reduction in cholesterol, respectively) and this was due exclusively to the lowering of low density lipoprotein. Further statistical evaluation of data revealed no significant difference between the cholesterol levels of rats fed either cholestyramine or pectin (p greater than 0.07). The data acquired in this study suggest that both cholestyramine and pectin are comparable and effective hypocholesterolemic agents and the observed hypocholesterolemic effect of these agents is mediated through lowering of cholesterol associated with the low density lipoprotein.

The influence of dietary pectin on iron absorption and retention was studied in rats. Basal diet with low and normal iron levels were fed with and without addition of 2% citrus pectin. After 40 days rats were fasted for 24 hours and were given 59Fe in dilute HCl with or without 2% pectin by gavage. Whole-body counting techniques were employed to monitor 59Fe absorption and turnover. Rats maintained on low iron diet absorbed and retained a much higher proportion of 59Fe than rats maintained on normal level of iron. Dietary pectin at the level fed in this study had no influence on iron uptake and/or turnover in rats.