Characteristics of Esophageal Cancer Cases in Tanzania.

PurposeAge-standardized incidence rates for esophageal cancer (EC) in East Africa have been reported as disproportionately high compared with the worldwide incidence of nine per 100,000 population. This study aimed to characterize EC cases seen at Muhimbili National Hospital and Ocean Road Cancer Institute in Dar es Salaam, Tanzania.MethodsDemographic, clinical, and treatment variables were abstracted from charts of patients who received care for a diagnosis of EC at one or both institutions between 2011 and 2013. Categorical data were summarized as frequency counts and percentages. Continuous data were presented as medians and ranges. To compare men and women, Pearson's χ2 and two-sample t tests were applied.ResultsSeven hundred thirty-eight unique cases of EC were identified, of whom 68% were men and the median age was 60 years (range, 19 to 95 years). Notably, 93 cases (13%) were ≤ 40 years old at diagnosis. Squamous cell carcinoma was the dominant histology, comprising 90% of cases with documented histopathology. However, 34% of cases with a diagnosis of EC were not pathologically confirmed. The stage was documented as locoregional in 4% of cases, locally advanced in 20% of cases, metastatic in 14% of cases, and unknown in 63% of cases. Of 430 patients who received treatment at Ocean Road Cancer Institute, 76% were treated with radiation, 44% were treated with chemotherapy, 3% underwent a cancer-related surgical procedure, and 10% of cases received no cancer-directed therapy. The median overall survival for all patients was 6.9 months (95% CI, 5.0 to 12.8), regardless of stage at presentation.ConclusionBetween 2011 and 2013, cases of EC represented a large clinical burden at both institutions

Selection Factors in Housing Among Rural Low-To-Moderate Income Residents

Growth in rural areas has increased the need to examine more closely the quality and acceptability of different types of existing housing. This study focuses on the reasons rural residents moved to their housing and whether their needs were satisfied by their selections. Comparisons of reasons for moving among conventional home, mobile home, and apartment residents indicated similar motivations for housing choices. Comparisons of present housing satisfaction revealed that a large majority of all respondents selected housing that met their needs. The results suggest that despite the predominant preference for single-family conventionally built homes, a substantial portion of future housing demand for low-to-moderately priced housing in rural areas could be accommodated quite adequately with nonconventional housing such as mobile homes and apartments

Measurement and monitoring of electrocardiogram belt tension in premature infants for assessment of respiratory function

Background: Monitoring of the electrocardiogram (ECG) in premature infants with conventional adhesive-backed electrodes can harm their sensitive skin. Use of an electrode belt prevents skin irritation, but the effect of belt pressure on respiratory function is unknown. A strain gauge sensor is described which measures applied belt tension. Method: The device frame was comprised of an aluminum housing and slide to minimize the device weight. Velcro tabs connected housing and slide to opposite tabs located at the electrode belt ends. The slide was connected to a leaf spring, to which were bonded two piezoresistive transducers in a half-bridge circuit configuration. The device was tested for linearity and calibrated. The effect on infant respiratory function of constant belt tension in the normal range (30 g–90 g) was determined. Results: The mechanical response to a step input was second order (f_n = 401 Hz, ζ = 0.08). The relationship between applied tension and output voltage was linear in the range 25–225 gm of applied tension (r² = 0.99). Measured device sensitivity was 2.18 mV/gm tension using a 5 V bridge excitation voltage. When belt tension was increased in the normal range from 30 gm to 90 gm, there was no significant change in heart rate and most respiratory functions during monitoring. At an intermediate level of tension of 50 gm, pulmonary resistance and work of breathing significantly decreased. Conclusion: The mechanical and electrical design of a device for monitoring electrocardiogram electrode belt tension is described. Within the typical range of application tension, cardiovascular and respiratory function are not substantially negatively affected by electrode belt force

Interaction between Insecticide Exposure and Trematode Infection across Four Wood Frog Populations

Amphibian populations are declining worldwide due to a number of stressors including pesticides and parasites. Conservation of these animals can be complicated because populations can differ dramatically in response to the same stressor. When consistently exposed to pesticides, some populations evolve tolerance through the process of natural selection acting across multiple generations. Alternatively, populations that are intermittently exposed to pesticides induce tolerance within a single generation. To date, however, there have been few studies examining the costs associated with these different stress tolerance mechanisms. In this study, we examined how difference in stress tolerance influence susceptibility to parasitic infections. We collected wood frog tadpoles from four different populations: two with evolved tolerance to pesticides and two with the ability to induce pesticide tolerance. We exposed tadpoles from each population to sublethal doses of carbaryl (0 and 5 ppm) for 5 days. Tadpoles were allowed to acclimate in pesticide-free water for 2 days. After this acclimation period, we then exposed tadpoles to 0 or 50 trematode parasites (Echinostoma trivolvis) for 2 days and counted the number of parasites encysted within the body. Exposure to sublethal carbaryl decreased susceptibility to trematodes for tadpole populations with evolved pesticide tolerance. In contrast, exposure to sublethal carbaryl increased susceptibility to trematodes for tadpole populations with induced pesticide tolerance. This suggests that populations with the ability to induce pesticide tolerance incur the cost of increased disease risk. This has important conservation implications for understanding a population’s history and defending against disease

Phenotypic Transition of the Collecting Duct Epithelium in Congenital Urinary Tract Obstruction

Epithelial-mesenchymal transition (EMT) has emerged in recent years as an important process in the development of organ fibrosis in many human diseases. Our previous experience in a nonhuman primate model of obstructive nephropathy suggested that EMT of collecting duct epithelium contributes to the development of interstitial fibrosis. In this study we demonstrate for the first time in humans that obstructed fetal collecting duct epithelium undergoes transition to mesenchymal phenotype, characterized by decreased expression of epithelial markers, de novo expression of mesenchymal markers with subsequent loss of cell-cell interaction, disruption of the basement membrane, and increased deposition of extracellular matrix into the expanded interstitium of the obstructed kidney. The results of this study therefore support the previous findings from animal studies and suggest that EMT of the collecting duct epithelium might contribute to the development of interstitial fibrosis in human fetal obstructive nephropathy

Insights on the Role of Diabetes and Geographic Variation in Patients with Criticial Limb Ischaemia

AbstractBackgroundPatients with critical limb ischaemia (CLI) unsuitable for revascularisation have a high rate of amputation and mortality (30% and 25% at 1 year, respectively). Localised gene therapy using plasmid DNA encoding acidic fibroblast growth factor (NV1FGF, riferminogene pecaplasmid) has showed an increased amputation-free survival in a phase II trial. This article provides the rationale, design and baseline characteristics of CLI patients enrolled in the pivotal phase III trial (EFC6145/TAMARIS).MethodsAn international, double-blind, placebo-controlled, randomised study composed of 525 CLI patients recruited from 170 sites worldwide who were unsuitable for revascularisation and had non-healing skin lesions was carried out to evaluate the potential benefit of repeated intramuscular administration of NV1FGF. Randomisation was stratified by country and by diabetic status.ResultsThe mean age of the study cohort was 70 ± 10 years, and included 70% males and 53% diabetic patients. Fifty-four percent of the patients had previous lower-extremity revascularisation and 22% had previous minor amputation of the index leg. In 94% of the patients, the index leg had distal occlusive disease affecting arteries below the knee. Statins were prescribed for 54% of the patients, and anti-platelet drugs for 80%. Variation in region of origin resulted in only minor demographic imbalance. Similarly, while diabetic status was associated with a frequent history of coronary artery disease, it had little impact on limb haemodynamics and vascular lesions.ConclusionsClinical characteristics and vascular anatomy of CLI patients with ischaemic skin lesions who were unsuitable for revascularisation therapy show little variations by region of origin and diabetic status. The findings from this large CLI cohort will contribute to our understanding of this disease process.This study is registered with ClinicalTrials.gov, number NCT00566657

Physical and mental quality of life in patients with end-stage liver disease and their informal caregivers

Background & Aims Management of end-stage liver disease (ESLD) has implications for not only patients’ quality of life (QOL), but also their caregivers’. We aimed to identify characteristics of patients with ESLD and their caregivers that are associated with QOL. Methods We obtained cross-sectional baseline data from patients and their caregivers (132 dyads; 62% were married or partners), recruited from outpatient hepatology clinics within 2 healthcare centers. Patients were included if their model for end-stage liver disease score was 15 or more; caregivers were identified by the patient as the primary informal caregiver. QOL was measured by the SF-36 and relationship quality using the mutuality scale. We measured uncertainty using the uncertainty in illness scales for patients and caregivers. Multilevel modeling was used to analyze the data. Results Refractory ascites was associated with worse physical QOL for patients (unstandardized beta [B], –9.19; standard error [SE], 2.28) and caregivers (B, –5.41; SE, 2.33); history of hepatic encephalopathy was associated with worse patient physical QOL (B, –3.86; SE, 1.65). High levels of uncertainty were associated with worse physical and mental QOL for both members of the dyads; relationship quality was significantly associated with patient mental QOL (B, 2.73; SE, 1.19). Conclusions Clinicians and researchers should consider the effects of ESLD on caregivers as well as their patients to optimize the QOL for both

“Dial Up and Lock In”: Asymmetric organo-Brønsted acid catalysis incorporating stable isotopes

An operationally simple organo-Brønsted-acid-catalyzed asymmetric and regioselective “dial up and lock in” of one or more stable isotopes into organic compounds is unknown. Here, we describe a newly designed, chemically versatile protocol mediating single- or multiple-isotope incorporation into aziridines via a one-pot, three-component, two-step process. By exploiting easy-to-generate isotope-derived starting materials, it allows complete control of isotope positioning, affords >95 atom % isotope incorporation, and generates cis-aziridines with excellent optical activities and regioselectivities. Demonstrating a “low entry point,” and thus easy access to a broad range of researchers, it requires no specialist laboratory equipment and employs readily attainable reaction conditions. Demonstrating their utility, the aziridines are easily transformed into sought-after chiral non-racemic α-amino acids appended with one to three (or more) identical or different isotopes. The widespread use of these compounds ensures that our methodology will be of interest to biological, medicinal, pharmaceutical, agrochemical, biotechnology, materials, and process chemists alike