Current Doctors News Results

Short pediatric Crohn's disease activity index for quality improvement and observational research.

Inflamm Bowel Dis. 2010 Sep 1;
Kappelman MD, Crandall WV, Colletti RB, Goudie A, Leibowitz IH, Duffy L, Milov DE, Kim SC, Schoen BT, Patel AS, Grunow J, Larry E, Fairbrother G, Margolis P,

BACKGROUND:: Practical and objective instruments to assess pediatric Crohn's disease (CD) activity are required for observational research and quality improvement. The objectives were: 1) to determine the feasibility of completing the Pediatric Crohn's Disease Activity Index (PCDAI) and the Abbreviated PCDAI (APCDAI); and 2) to create a Short PCDAI by retaining and reweighting the most practical and informative components. METHODS:: Physicians in the ImproveCareNow Collaborative for pediatric inflammatory bowel disease (IBD) were asked to record components of the PCDAI and assign a Physician Global Assessment (PGA) of disease severity at each patient encounter. We assessed the feasibility of the PCDAI, the APCDAI, and the individual index components by determining the proportion of visits in which data were recorded. We created a short index by retaining and reweighting components of the PCDAI completed in >/=80% of visits. The feasibility of the Short PCDAI and its ability to discriminate between PGA categories were evaluated using descriptive statistics. RESULTS:: This study population included 1355 subjects with CD (6373 visits). The PCDAI and APCDAI were complete in 16.7% and 44.1% of visits, respectively. A Short PCDAI, including general well-being, abdominal pain, stools, weight, abdominal exam, and extraintestinal manifestations were completed in 66.5% of visits. The correlation between the Short PCDAI and PGA was similar to that of the PCDAI (r = 0.60, P < 0.001 versus 0.61, P < 0.001). CONCLUSIONS:: The Short PCDAI is a practical and valid tool to measure pediatric CD activity. Its use should facilitate quality improvement and observational research. (Inflamm Bowel Dis 2010).

Lived and perceived of their profession by Togolese doctors.

Tunis Med. 2010 Sep; 88(9): 660-5
Viwale Koffi-Tessio A, Oniankitan O, Mijiyawa M

Aim: a study has been carried out by Togolese medical doctors in order to determine the perceived and the real life of their profession. Methods: the study, which was transversal, has taken in account a sample of 52 medical doctors made on the basis of a cautious choice. Most of these medical doctors (15 general practitioners, 23 specialists and 14 hospitalouniversitaires) work in the medical cares centres of Lomé. A sheet of survey has permitted the collection of demographic datas and datas relating to the medical studies and carreer. Results: the 52 medical doctors included in the study (7 women, 45 men) were between 25 and 59 years old; their age of getting their A-level was between 16 and 23 years old, and that of getting the doctorate diploma between 24 and 37. The length of professional experience stands between 8 months and 27 years. The marital status was specified by 47 of the 52 medical doctors: 13 single, one divorced, and 33 married; 5 of the 7 women who took part in the survey were single and without any child. The love of the profession (65%), the social status it confers (37%) and the honour tied to the profession (27%) were the main motives of choosing the profession. The decision of doing medical studies was taken during secondary studies by 45 of the 52 persons. The faculty of medicine of Lomé has been the study frame to general medicine studies of 35 persons (67%). The low payment (83%), the poverty of the patients (83%), the narrowness of the technical platform (79%), the insufficiency of cares structures in paramedical personnel (67%), the insufficiency of continuing education (60%), and the lack or insufficiency of drugs (58%) were the main problems encountered during their professional experience by the people questioned. 22 medical doctors (43%) have estimated that their profession has given them a particular social status. Only 8 medical doctors have found that the real things they have gone trough in the profession matches with the idea they had, while 32 (62%) are ready to choose again the profession if they have to start everything. The little time spent with the family has been stated out by 36 medical doctors (69%), the social and family prestige that came out of it by 32 (62%), and the ability to control the health of one's family by 34 (65%). The psychological impact of the profession on the medical doctors questioned was dominated by the adoption of a philosophical attitude towards life. Conclusion: a better productivity of the Togolese medical doctors needs the improvement of their life conditions (adjustment of texts in force, revision of the salary scale), the renovation of the facilities, the modernization of the technical platform, the continuing education of the medical doctors and the reinforcement of the practical management of the patient on bed.

Profile of a population of consultants in child psychiatry and access to care by Gender.

Tunis Med. 2010 Sep; 88(9): 646-50
Othman S, Bouden A, Halayem S, Abbes Z, B Halayem M

Background: Access to care in mental health is a fundamental element in the monitoring and care of children and adolescents. Aim: The objective of this work was to draw up the demographic and clinical characteristics of a population of consultants in child psychiatry and to investigate possible gender inequalities in access to care. Methods: This is a descriptive cross-sectional study concerning a sample of 730 children and adolescents having consulted child psychiatry department in Tunis and Monastir during a period of 4months (April- July on 2006). Data were collected through a questionnaire administered to the relatives of patients consulting these various structures. Results: 66 % of consulting were boys. In 55 % of cases, the mother, alone, accompanied the child to the consultation. The request of care emanated in the majority of the cases from parents and doctors. On average ran out 18 months before the first medical visit and 26 months before the first psychiatric consultation. Multiple medical consultations precede the meeting with the child psychiatrist. We have not found difference in the care of children and adolescents according to gender. Only the period preceding the first medical consultation for psychiatric symptoms was longer in girls compared to boys. Conclusion: Access to care structures was easy and even in cases of geographical remoteness parents did not seem to privilege boys over girls.

Who Are the Opinion Leaders? The Physicians, Pharmacists, Patients, and Direct-to-Consumer Prescription Drug Advertising.

J Health Commun. 2010 Sep; 15(6): 629-55
Lee AL

A popular perception holds that physicians prescribe requested drugs to patients influenced by mass mediated direct-to-consumer prescription drug advertising. The phenomenon poses a serious challenge to the two-step flow model, which emphasizes the influence of opinion leaders on their followers and their legitimating power over the informing power of the mass media. This study investigates a 2002 Food and Drug Administration (FDA) survey and finds that patients searching for drug information through mass and hybrid media in newspapers and magazines' small print, the Internet, and toll-free numbers are more likely to seek information through interpersonal communication channels like health care providers. Patients using small print, toll-free numbers, one's own physician, and other physicians are associated with influencing their physicians with various drug-requesting behaviors. But physicians only prescribe requested drugs to patients who are influenced by other health care providers, such as pharmacists and other physicians, not the mass media. The influence of expert opinion leaders of drugs is so strong that the patients even would switch from their own unyielding physicians who do not prescribe drugs as advised by the pharmacists. Physicians and patients all are influenced more by other expert opinion leaders of drugs than by the mass media and therefore still uphold the basic tenet of the two-step model.

Quantifying word use to study health literacy in doctor-patient communication.

J Health Commun. 2010 Sep; 15(6): 590-602
Koch-Weser S, Rudd RE, Dejong W

Most health literacy research to date has assessed health literacy using either general reading tests or text-based appraisals of reading and numeracy skills, yet the definition of health literacy includes domains beyond reading ability. Effective oral communication between doctor and patient is an important component of health literacy, but only recently have efforts been made to develop measures that tap into domains beyond those that can be assessed with text-based measures. Focusing on oral exchange, this article describes computer-assisted approaches to quantifying word use and the development of three word-use measures that can be used to study health literacy in transcripts of clinical encounters. The measures can be used to assess either the expressed literacy level of patients or the aural literacy demands made by doctors. Importantly, the computer-assisted quantitative measures described here make it possible for word use to be analyzed at a level of detail that human raters would be hard pressed to attain.

The Utility and Limitations of FRAX: A US Perspective.

Curr Osteoporos Rep. 2010 Sep 2;
Silverman SL, Calderon AD

The FRAX calculator is a major achievement in terms of our understanding of measuring fracture risk. Along with being an easily accessible web-based tool, it is the only model based on extensive data on multiple cohorts. FRAX will help clinicians identify individuals who need osteoporosis treatments, while also screening out those who do not require osteoporosis treatments. However, FRAX is limited by a number of factors. Although it is web based, few physicians have the means to access it. It also assumes that body mass index and mortality are constant across different racial and ethnic groups. FRAX is further limited by the exclusion of variables known to be associated with fracture risk, lack of dose-response relationships for variables, increased subsequent fracture risk after initial fracture, restriction to only one bone mineral density site, racial and ethnic differences that may influence fracture risk, and availability of racial and ethnic fracture risk data to be used in the FRAX calculator. Finally, the values obtained from FRAX should not take the place of good clinical judgment.

Response to the Letter to the Editor from Gustavo Cartaxo Patriota, M.D., M.Sc., on "Clinical Grading Scales in Intracerebral Hemorrhage"

Neurocrit Care. 2010 Sep 2;
Hwang BY, Appelboom G, Kellner CP, Connolly ES

Patient Care Outside of Office Visits: A Primary Care Physician Time Study.

J Gen Intern Med. 2010 Sep 2;
Chen MA, Hollenberg JP, Michelen W, Peterson JC, Casalino LP

BACKGROUND: Patient care provided by primary care physicians outside of office visits is important for care coordination and may serve as a substitute for office visits. OBJECTIVES: To describe primary care physicians' ambulatory patient care activities outside of office visits ("AOVs") and their perceptions of the extent to which AOVs substitute for visits and may be performed by support staff. DESIGN: Cross-sectional direct observational study. PARTICIPANTS: Thirty-three general internists in 20 practices in two health care systems (one public, one private) in the New York metropolitan area. MAIN MEASURES: Duration of AOVs by type of activity and whether they pertain to a patient visit on the study day (visit specific) or not (non-visit specific). Physician perceptions of the: (1) extent that non-visit-specific AOVs substitute for visits that would have otherwise occurred, (2) extent that visits that occurred could have been substituted for by AOVs, and (3) potential role of support staff in AOVs. KEY RESULTS: Physicians spent 20% of their workday performing AOVs, 62% of which was for non-visit specific AOVs. They perceived that a median of 37% of non-visit-specific AOV time substituted for visits, representing a potential five visits saved per day. They also perceived that 15% of total AOV time (excluding charting) could be performed by support staff. Forty-two percent of physicians indicated that one or more visits during the study day could be substituted for by AOVs. CONCLUSIONS: Though time spent on AOVs is generally not reimbursed, primary care general internists spent significant time performing AOVs, much of which they perceived to substitute for visits that would otherwise have occurred. Policies supporting physician and staff time spent on AOVs may reduce health care costs, save time for patients and physicians, and improve care coordination.

The Import of Trust in Regular Providers to Trust in Cancer Physicians among White, African American, and Hispanic Breast Cancer Patients.

J Gen Intern Med. 2010 Sep 1;
Kaiser K, Rauscher GH, Jacobs EA, Strenski TA, Estwing Ferrans C, Warnecke RB

BACKGROUND: Interpersonal trust is an important component of the patient-doctor relationship. Little is known about patients' trust in the multiple providers seen when confronting serious illness. OBJECTIVES: To characterize breast cancer patients' trust in their regular providers, diagnosing physicians, and cancer treatment team and examine whether high trust in one's regular provider confers high trust to cancer physicians. DESIGN: In-person interviews. PARTICIPANTS: 704 white, black, and Hispanic breast cancer patients, age 30 to 79, with a first primary in situ or invasive breast cancer who reported having a regular provider. MEASURES: We measure trust in: (1) regular provider, (2) diagnosing doctors, and (3) cancer treatment team. Other variables include demographic variables, preventive health care, comorbidities, time with regular provider, time since diagnosis, cancer stage, and treatment modality. RESULTS: Sixty-five percent of patients reported high trust in their regular provider, 84% indicated high trust in their diagnosing doctors, and 83% reported high trust in their treatment team. Women who reported high trust in their regular provider were significantly more likely to be very trusting of diagnosing doctors (OR: 3.44, 95% CI: 2.27-5.21) and cancer treatment team (OR: 3.09, 95% CI: 2.02-4.72 ). Black women were significantly less likely to be very trusting of their regular doctor (OR: 0.58, 95% CI: 0.38-0.88) and cancer treatment team (OR: 0.45, 95% CI: 0.25-0.80). English-speaking Hispanic women were significantly less trusting of their diagnosing doctors (OR: 0.29, 95% CI: 0.11-0.80). CONCLUSIONS: Our results suggest that patients are very trusting of their breast cancer providers. This is an important finding given that research with other populations has shown an association between trust and patient satisfaction and treatment adherence. Our findings also suggest that a trusting relationship with a regular provider facilitates trusting relationships with specialists. Additional work is needed to increase interpersonal trust among black women.

Design and Development of EMR Supporting Medical Process Management.

J Med Syst. 2010 Sep 2;
Li JS, Zhang XG, Chu J, Suzuki M, Araki K

Current EMR system benefits physicians by facilitating order entry and reducing errors. It can improve the safety and effectiveness of medical services, but cannot manage the whole medical process and the quality of medical services. In addition to physicians, EMR should be designed for all medical professionals because medical services cannot be accomplished by physicians alone, but also requires the involvement of other medical professionals. Therefore, we applied PDCA, the famous quality management cycle to design a comprehensive and coherent EMR system which can be used throughout the entire treatment process. EMR with the PDCA Cycle can record every order state and every treatment procedure in order to monitor the whole medical process. This extends the safety from planning the treatment to fulfilling it. By analyzing the records, doctors and hospital managers can perfect the medical process and improve healthcare quality. The EMR we designed with the PDCA Cycle provides a record entry interface for physicians and a worksheet interface for nurses and other professionals. Every treatment procedure and every change of orders or tasks will be fed back to medical professionals. So information generated from the beginning to the end of treatment will link with each other to avoid any information islands. Furthermore, the EMR can display the additional information intuitively and real-timely without increasing the burden of medical professionals' work.

[Chance for young electrophysiologists : The continuing education program "Fellowship heart rhythm"]

Herzschrittmacherther Elektrophysiol. 2010 Sep 2;
Neuzner J, Willems S, Klein HU, Block M

Increasing workloads, growing economical pressure and developments on the German job market for young physicians create a background which threatens an adequate education and training of physicians in many places. The"Fellowship heart rhythm" program focuses on training in clinical electrophysiology complementary to established educational initiatives, such as courses for competence in pacemaker and ICD therapy of the German Cardiac Society. Participants have to be residents with a minimum of 3 years clinical experience and should be younger than 36 years old. They should be actively involved with a long-term perspective in clinical electrophysiology. Activity in the fields of pacing, defibrillator and cardiac resynchronization therapy is required. The hospital has to be able provide the possibility of invasive electrophysiology and catheter ablation including a 3-dimensional mapping system. In 6 face-to-face meetings of 3 days each, the state of the art is presented in the topics electrophysiological studies, sudden cardiac death and defibrillation, health economy/management, catheter ablation, atrial fibrillation and heart failure and arrhythmias. The first 4 years with 2 fellowship programs have demonstrated that this project enables education at a high level, strongly supporting advances in scientific interest, individual development and medical orientation. The fellowship program facilitates the development of a network of young electrophysiologists in Germany.

The use of protein array to identify targetable receptor tyrosine kinases for treatment of human colon cancer.

Int J Oncol. 2010 Oct; 37(4): 829-35
Morishita A, Gong J, Nomura T, Yoshida H, Izuishi K, Suzuki Y, Kushida Y, Haba R, D'Armiento J, Masaki T

Several studies have reported that activated receptor tyrosine kinases (RTKs) are highly expressed in colon cancer and may promote tumor growth and survival. However, there is little information available as to the function and signaling of RTKs in colon cancers. In the present study, we performed protein array technology to determine the expression status of various RTKs that are activated in colon cancer compared to normal colonic cells and tissues. Of the 42 different phospho-RTKs, 5 (ErbB2, FGFR1, FGFR2a, FGFR3 and MSPR) were activated in Caco-2, SW480, WiDr, Lovo colon cancer cell lines and cancerous tissues. In order to determine the effect of inhibition of RTKs, especially ErbB2, athymic nude mice bearing xenograft tumors were treated with the ErbB2-targeting drug trastuzumab alone, or in combination with 5-Fluorouracil (5-FU). Similar to the treatment of 5-FU alone, trastuzumab suppressed the growth of colon cancer. Combination therapy of trastuzumab and 5-FU inhibited tumor growth significantly compared to the treatment of 5-FU alone or trastuzumab alone. In addition, xenograft tumors were also analyzed by phospho-MAPK protein array. The activity of Akt3/PKBgamma was inhibited with 5-FU alone and trastuzumab, indicating that trastuzumab may inhibit colon cancer growth through ErbB2-Akt3/PKBgamma signaling. These data demonstrate that ErbB2 could be an important candidate for colon cancer therapy and the addition of trastuzumab to 5-FU therapy might augment the clinical response in colon cancer patients. Therefore, the analysis of phospho-RTK expression by protein array as a useful tool might identify novel therapies for individual patients with colon cancer.

Biological markers and Alzheimer disease: a canadian perspective.

Int J Alzheimers Dis. 2010; 2010:
Schipper HM

Decreased beta-amyloid(1-42) and increased phospho-tau protein levels in the cerebrospinal fluid (CSF) are currently the most accurate chemical neurodiagnostics of sporadic Alzheimer disease (AD). A report (2007) of the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (2006) recommended that biological markers should not be currently requisitioned by primary care physicians in the routine investigation of subjects with memory complaints. Consideration for such testing should prompt patient referral to a specialist engaged in dementia evaluations or a Memory Clinic. The specialist should consider having CSF biomarkers (beta-amyloid(1-42) and phospho-tau) measured at a reputable facility in restricted cases presenting with atypical features and diagnostic confusion, but not as a routine procedure in all individuals with typical sporadic AD phenotypes. We submit that developments in the field of AD biomarker discovery since publication of the 3rd CCCDTD consensus data do not warrant revision of the 2007 recommendations.

Propofol-Based Sedation Does Not Increase Rate of Complication during Percutaneous Endoscopic Gastrostomy Procedure.

Gastroenterol Res Pract. 2011; 2011:
Amornyotin S, Chalayonnavin W, Kongphlay S

Objectives. To evaluate and compare the complication rate of sedation with or without propofol regimen for percutaneous endoscopic gastrostomy (PEG) in a hospital in Thailand. Subjects and Methods. A total of 198 patients underwent PEG procedures by using intravenous sedation (IVS) from Siriraj Hospital, Thailand from August 2006 to January 2009. The primary outcome variable was the overall complication rate. The secondary outcome variables were sedation and procedure related complications, and mortality rate. Results. After matching ASA physical status and indications of procedure, there were 92 PEG procedures in propofol based sedation group (A) and 20 PEG procedures in non-propofol based sedation group (B). All sedation was given by residents or anesthetic nurses directly supervised by staff anesthesiologist in the endoscopy room. There were no significant differences in patients' characteristics, sedation time, indication, complications, anesthetic personnel and mortality rate between the two groups. All complications were easily treated, with no adverse sequelae. Mean dose of fentanyl and midazolam in group A was significantly lower than in group B. Conclusion. Propofol-based sedation does not increase rate of complication during PEG procedure. Additionally, IVS of PEG procedure is relatively safe and effective when performed by physicians in training. Serious complications are none.

Referral practices and perceived barriers to timely obstetric care among Ugandan traditional birth attendants (TBA).

Afr Health Sci. 2010 Mar; 10(1): 75-81
Keri L, Kaye D, Sibylle K

OBJECTIVES: To assess current beliefs, knowledge and practices of Ugandan traditional birth attendants (TBAs) and their pregnant patients regarding referral of obstructed labors and fistula cases. METHODS: Six focus groups were held in rural areas surrounding Kampala, the capital city of Uganda. RESULTS: While TBAs, particularly those with previous training, appear willing to refer problematic pregnancies and labors, more serious problems exist that could lessen any positive effects of training. These problems include reported abuse by doctors and nurses, and seeing fistula as a disease caused by hospitals. CONCLUSIONS: Training of TBAs can be helpful to standardize knowledge about and encourage timely emergency obstetric referrals, as well as increase knowledge about the causes and preventions of obstetric fistula. However, for full efficacy, training must be accompanied by greater collaboration between biomedical and traditional health personnel, and increased infrastructure to prevent mistreatment of pregnant patients by medical staff.

Waiting time for emergency abdominal surgery in Zaria, Nigeria.

Afr Health Sci. 2010 Mar; 10(1): 46-53
Adamu A, Maigatari M, Lawal K, Iliyasu M

BACKGROUND: Management of surgical emergencies in Nigeria is characterised by mismatch between supply of facilities and demand for care. This study aimed to evaluate the waiting time between presentation at hospital with acute abdominal disease and operative intervention. PATIENTS AND METHOD: We prospectively studied adult patients with abdominal diseases requiring emergency operation. The interval between presentation and first contact with emergency room doctors was defined as T1; time from contact to decision to operate as T2; time taken to resuscitate patient T3 and to commencement of operation T4. Causes of delay and its impact on outcome of treatment were noted. RESULTS: There were 488 patients, mean age 32 +/-1.7SD years. TT ranged between 0.8 and 79.0 hours, mean 22.3 +/- 10.0 hours. In 81.6% operative intervention was delayed beyond 6 hours of which financial constraints accounted for 53.8%. T3 accounted for the longest delay (0.5 -53.0hours). Patients of lower socio-economic class had longer T3 (p<0.005). Waiting for complementary investigations caused delay in 22.1%. Post-operative complications (p=0.0001) and their severity were higher in patients with longer TT. Prolonged TT (p<0.001), ASA grade (0.005) and time from onset of symptoms to admission (p=0.009) were associated with mortality. Patients whose operations were delayed beyond 24 hours had a longer hospital stay. CONCLUSION: Emergency abdominal operations were delayed in our patients mainly because of scarce financial resources. Delayed interventions were associated with higher morbidity and mortality.

Stroke: Sedation and anesthesia during endovascular stroke therapy.

Nat Rev Neurol. 2010 Sep; 6(9): 474-5
Meyers PM, Heyer EJ

Tenofovir nephrotoxicity: acute tubular necrosis with distinctive clinical, pathological, and mitochondrial abnormalities.

Kidney Int. 2010 Sep 1;
Herlitz LC, Mohan S, Stokes MB, Radhakrishnan J, D'Agati VD, Markowitz GS

Tenofovir, a widely prescribed antiretroviral medication for treatment of HIV-1 infection, is infrequently associated with renal dysfunction and biopsy findings of acute tubular necrosis. We examined the clinical and pathological findings in 13 cases of tenofovir nephrotoxicity (7 men and 6 women, mean age of 51.1+/-9.6 years). Patients received tenofovir therapy for a mean of 19.6 months (range, 3 weeks to 8 years; median 8 months). Nine patients presented with acute kidney injury, and four had mild renal insufficiency with subnephrotic proteinuria. Mean baseline serum creatinine was 1.3+/-0.3 mg/dl, reaching 5.7+/-4.0 mg/dl at the time of biopsy, with mean proteinuria of 1.6+/-0.3 g/day. Glycosuria was documented in seven patients, five of whom were normoglycemic. Renal biopsy revealed toxic acute tubular necrosis, with distinctive proximal tubular eosinophilic inclusions representing giant mitochondria visible by light microscopy. Electron microscopy showed mitochondrial enlargement, depletion, and dysmorphic changes. Clinical follow-up after tenofovir discontinuation was available for 11 of 13 patients (mean duration 13.6 months). Significant recovery of renal function occurred in all patients, including four who required transient hemodialysis. Our study shows that tenofovir nephrotoxicity is a largely reversible form of toxic acute tubular necrosis targeting proximal tubules and manifesting distinctive light microscopic and ultrastructural features of mitochondrial injury.Kidney International advance online publication, 1 September 2010; doi:10.1038/ki.2010.318.

Occupational Exposure to Ethylene Oxide and Risk of Lymphoma.

Epidemiology. 2010 Aug 31;
Kiran S, Cocco P, Mannetje A, Satta G, Dʼandrea I, Becker N, de Sanjosé S, Foretova L, Staines A, Kleefeld S, Maynadié M, Nieters A, Brennan P, Boffetta P

BACKGROUND:: Ethylene oxide, a high-volume commodity, is an established human carcinogen, although the relevant epidemiologic evidence is limited. METHODS:: We explored the association between occupational exposure to ethylene oxide and risk of lymphoma in a case-control study, including 2347 lymphoma cases first diagnosed in 1998-2004 and 2463 controls, from 6 European countries. The diagnosis of lymphoma was based on the 2001 World Health Organization Classification of lymphoma. Occupational exposure to ethylene oxide was retrospectively assessed by industrial hygienists and occupational physicians based on detailed self-reported information. We modeled risk of lymphoma with unconditional logistic regression analysis as a function of various exposure measures, adjusting for age, sex, and participating center. RESULTS:: Thirty-one cases and 27 controls (1.2% of the total study population) were defined as ever having been exposed to ethylene oxide (odds ratio = 1.3 [95% confidence interval [CI] = 0.7-2.1]). Lymphoma risk showed a 4.3-fold increase associated with mediumhigh frequency of exposure to ethylene oxide (95% CI = 1.4-13). Among major subtypes, chronic lymphocytic leukemia was consistently associated with ethylene oxide exposure, related in a doseresponse manner to probability, frequency, and duration of exposure, as well as to cumulative exposure and (less definitively) with exposure intensity. CONCLUSIONS:: Our results add to the evidence that ethylene oxide is a human carcinogen.

Bioprinting is coming of age: report from the International Conference on Bioprinting and Biofabrication in Bordeaux (3B'09).

Biofabrication. 2010 Mar; 2(1): 010201
Guillemot F, Mironov V, Nakamura M

Abstract The International Conference on Bioprinting and Biofabrication in Bordeaux (3B'09) demonstrated that the field of bioprinting and biofabrication continues to evolve. The increasing number and broadening geography of participants, the emergence of new exciting bioprinting technologies, and the attraction of young investigators indicates the strong growth potential of this emerging field. Bioprinting can be defined as the use of computer-aided transfer processes for patterning and assembling living and non-living materials with a prescribed 2D or 3D organization in order to produce bio-engineered structures serving in regenerative medicine, pharmacokinetic and basic cell biology studies. The use of bioprinting technology for biofabrication of in vitro assay has been shown to be a realistic short-term application. At the same time, the principal feasibility of bioprinting vascularized human organs as well as in vivo bioprinting has been demonstrated. The bioprinting of complex 3D human tissues and constructs in vitro and especially in vivo are exciting, but long-term, applications. It was decided that the 5th International Conference on Bioprinting and Biofabrication would be held in Philadelphia, USA in October 2010. The specially appointed 'Eploratory Committee' will consider the possibility of turning the growing bioprinting community into a more organized entity by creating a new bioprinting and biofabrication society. The new journal Biofabrication was also presented at 3B'09. This is an important milestone per se which provides additional objective evidence that the bioprinting and biofabrication field is consolidating and maturing. Thus, it is safe to state that bioprinting technology is coming of age. 1. Back to Europe The International Conference on Bioprinting and Biofabrication in Bordeaux (3B'09), France, 6-8 July 2009, was held after several international meetings which had been organized previously. The First International Workshop on Bioprinting and Biopatterning [1] was held at the University of Manchester (UK) in September 2004 and was organized by Professor Brian Derby (University of Manchester), Douglas B Chrisey (Naval Research Laboratory, Washington, USA), Richard K Everett (ONR Global, London) and Nuno Reis (Universidade de Beira Interior, Covilha, Portugal). The Second International Workshop on Bioprinting, Biopatterning and Bioassembly was chaired by Vladimir Mironov in 2005 in Charleston (USA) [2]. The Third International Symposium on Bioprinting and Biofabrication was held in Kawasaki (Japan) in November 2006 and was organized by Professor Makoto Nakamura (University of Toyama, Japan). After three years without an international meeting, Fabien Guillemot (INSERM, University of Bordeaux, France) and Professor Makoto Nakamura decided to organize the International Conference on Bioprinting and Biofabrication (3B'09) [3] in Bordeaux, the wine capital of the world. This 4th international meeting on bioprinting was endorsed by TERMIS (Tissue Engineering and Regenerative Medicine International Society) and sponsored by the clusters Advanced Materials in Aquitaine, Materials in Bordeaux and Route des Lasers, INSERM and the Aquitaine Regional Council. It took place at the Burdigala Hotel in a very pleasant and friendly atmosphere where new players, especially the young, were welcome and were given the opportunity to discuss their work. The balanced geographical representation was another important feature of the 3B'09 conference. Indeed, more than 65 scientists and engineers from 11 countries (Belgium, France, Germany, Italy, Japan, Poland, Portugal, Romania, The Netherlands, UK, USA) attended this conference, which included five oral presentation sessions, one poster session and social events organized at the Bordeaux City Hall and at the Château Giscours. 2. Scientific program The scientific program was established to highlight the latest developments associated with bioprinting technologies and biofabrication approaches. Indeed, since the early pioneering works of Thomas Boland (Clemson University, USA) and Vladimir Mironov [4], the bioprinting scientific community has been evolving, bringing together physicists, biologists and physicians [5, 6]. Consequently, the oral presentation sessions covered: (1) the latest developments in bioprinting technologies; (2) the potential to combine the bioprinting process with other biofabrication and rapid prototyping methods; (3) matrices and biomaterials for bioprinting and biofabrication; (4) methods for designing, modeling and biomechanically evaluating 3D constructs; (5) developmental biology and tissue engineering. This scientific schedule emphasized some of the main areas that have to be connected prior to envisaging real applications in regenerative medicine, pharmacokinetic and toxicological studies, where high throughput and high-resolution bioprinting technologies are required. Thus, it is now obvious that, in addition to core bioprinting technologies, biomaterial and bioink properties, rapid prototyping approaches and basic cell biology have to be taken into account within a single perspective. Consequently, while the initial definition of our burgeoning field was formulated at the First International Workshop on Bioprinting and Biopatterning in Manchester (UK) as 'the use of material transfer processes for patterning and assembling biologically relevant materials, molecules, cells, tissues, and biodegradable biomaterials with a prescribed organization to accomplish one or more biological functions', we propose to enlarge this definition to 'the use of computer-aided transfer processes for patterning and assembling living and non-living materials with a prescribed 2D or 3D organization in order to produce bio-engineered structures serving in regenerative medicine, pharmacokinetic and basic cell biology studies'. Regarding the poster session, three young scientists were awarded a bottle of Château Giscours wine for their impressive work. Laureates were Virginie Kériquel in vivo high-throughput biological laser printing of nano-hydroxyapatite in mice calvaria critical sized defects: preliminary results) [7], Kayo Sakaue (Integration of 3D-micro tissue models for creation of tissue chip) [8] and Alberto Rainer (Regeneration of osteochondral segment via mesenchymal stem cells culturing on 3D rapid prototyped scaffolds) [9]. 3. On bioprinting technologies The 3B'09 conference was an excellent opportunity to perform an in-depth review of bioprinting technologies (jet-based and extrusion methods) through a number of exciting talks given by both academics and industrialists. Recent advances in ink-jet bioprinting technologies were reviewed by Professor Thomas Boland and supplemented mainly by the presentations given by Professor Makoto Nakamura [10, 11] and Professor Brian Derby. Regarding laser-based technologies, a series of talks dealing with experimental and modeling approaches of laser-assisted bioprinting (LAB) [12] were given by members of Fabien Guillemot [13] and Boris Chichkov's groups [14] from The University of Bordeaux and Lazer Zentrum in Hannover (Germany), respectively. Utkan Demirci (Harvard University, USA) introduced a new ultrasonic wave-based bioprinting technology, the so-called layer-by-layer 3D tissue epitaxy by cell-laden hydrogel droplets [15] while Hedges and Wirth from Germany presented an aerosol jet bioprinting technology and its applications in surface biofunctionalization [16]. Besides the above-mentioned jet-based bioprinting techniques, many presentations were related to 3D plotting by extrusion processes. Giovani Vozzi's group (University of Pisa, Italy) presented several talks dealing with the micro-fabrication of two- and three-dimensional structures by pressure-assisted micro-syringe (PAM) [17]. Moreover, processing considerations for the 3D plotting of thermoplastic scaffolds were presented by Kim Ragaert (Ghent University, Belgium) [18] and Hendrik John (Sys-Eng, Germany) while Kentaro Iwami (Tokyo University, Japan) described for the first time rapid prototyping by extruding/aspirating/refilling thermoreversible hydrogel [19]. Finally, additional 3D biofabrication methods were presented. Matsusaki et al (Japan) introduced possible, layer-by-layer, short-term applications of bioprinting for biofabrication of tissue chips. Frasca et al (University of Paris-Diderot, France) demonstrated how nanotechnology (magnetic nanoparticles) can be employed in magnetic force-driven tissue engineering. In summary, while each of these technologies displays specific properties such as high resolution, high throughput, low price, bio-safety, etc, it seems obvious that achieving more advanced applications in tissue engineering will require a combination of these tools, and thus a combination of their performances. Moreover, to print human organs, highly integrative approaches should be set up; these should include the development of new biomaterials, the improvement of reverse-engineering and rapid prototyping methods, intensification of scientific gateways between developmental biology and tissue engineering [20] (as introduced by Gabor Forgacs, University of Missouri, USA) [21], in particular with the help of numerical modeling. All these perspectives were discussed during the conference and are reported in the following sections. 4. Scaffold or not scaffold, that is the question! One of the controversial topics of discussion during the conference was the definition of 'scaffold'. Synthetic biodegradable scaffold is considered to be a fundamental principle of the traditional scaffold-based or 'top down' tissue engineering approach [22]. The emerging modular or 'bottom-up' approach is sometimes called 'scaffold-free' [23] or 'scaffold-less'. Some participants insisted that scaffold according to definition is a temporal and removable support. (ABSTRACT TRUNCATED)