Spatio-energetic cross talk in photon counting detectors: Detector model and correlated Poisson data generator.
An x-ray photon interacts with photon counting detectors (PCDs) and generates an electron charge cloud or multiple clouds. The clouds (thus, the photon energy) may be split between two adjacent PCD pixels when the interaction occurs near pixel boundaries, producing a count at both of the pixels. This is called double-counting with charge sharing. (A photoelectric effect with K-shell fluorescence x-ray emission would result in double-counting as well). As a result, PCD data are spatially and energetically correlated, although the output of individual PCD pixels is Poisson distributed. Major problems include the lack of a detector noise model for the spatio-energetic cross talk and lack of a computationally efficient simulation tool for generating correlated Poisson data. A Monte Carlo (MC) simulation can accurately simulate these phenomena and produce noisy data; however, it is not computationally efficient. In this study, the authors developed a new detector model and implemented it in an efficient software simulator that uses a Poisson random number generator to produce correlated noisy integer counts. The detector model takes the following effects into account: (1) detection efficiency; (2) incomplete charge collection and ballistic effect; (3) interaction with PCDs via photoelectric effect (with or without K-shell fluorescence x-ray emission, which may escape from the PCDs or be reabsorbed); and (4) electronic noise. The correlation was modeled by using these two simplifying assumptions: energy conservation and mutual exclusiveness. The mutual exclusiveness is that no more than two pixels measure energy from one photon. The effect of model parameters has been studied and results were compared with MC simulations. The agreement, with respect to the spectrum, was evaluated using the reduced χ2 statistics or a weighted sum of squared errors, χred2(≥1), where χred2=1 indicates a perfect fit. The model produced spectra with flat field irradiation that qualitatively agree with previous studies. The spectra generated with different model and geometry parameters allowed for understanding the effect of the parameters on the spectrum and the correlation of data. The agreement between the model and MC data was very strong. The mean spectra with 90 keV and 140 kVp agreed exceptionally well: χred2 values were 1.049 with 90 keV data and 1.007 with 140 kVp data. The degrees of cross talk (in terms of the relative increase from single pixel irradiation to flat field irradiation) were 22% with 90 keV and 19% with 140 kVp for MC simulations, while they were 21% and 17%, respectively, for the model. The covariance was in strong agreement qualitatively, although it was overestimated. The noisy data generation was very efficient, taking less than a CPU minute as opposed to CPU hours for MC simulators. The authors have developed a novel, computationally efficient PCD model that takes into account double-counting and resulting spatio-energetic correlation between PCD pixels. The MC simulation validated the accuracy.


Clinically inapparent meningitis complicating periorbital cellulitis.
Two young children with periorbital (preseptal) cellulitis were found to have meningitis despite having no signs of meningeal irritation and normal cerebrospinal fluid (CSF) cell counts and chemistries. These cases are reported to remind physicians caring for acutely ill children that periorbital cellulitis can have life-threatening complications and that meningitis can occur in the absence of significant clinical signs and in the presence of an initially normal CSF.


Synthesis and characterization of core-shell nanoparticles and their influence on the mechanical behavior of acrylic bone cements.
Core-shell nanoparticles consisting of polybutyl acrylate (PBA) rubbery core and a polymethyl methacrylate (PMMA) shell, with different core-shell ratios, were synthesized in order to enhance the fracture toughness of the acrylic bone cements prepared with them. It was observed by TEM and SEM that the core-shell nanoparticles exhibited a spherical morphology with ca. 120 nm in diameter and that both modulus and tensile strength decreased by increasing the PBA content; the desired structuring pattern in the synthesized particles was confirmed by DMA. Also, experimental bone cements were prepared with variable amounts (0, 5, 10 and 20 wt.%) of nanoparticles with a core-shell ratio of 30/70 in order to study the influence of these nanostructured particles on the physicochemical, mechanical and fracture properties of bone cements. It was found that the addition of nanostructured particles to bone cements caused a significant reduction in the peak temperature and setting time while the glass transition temperature (Tg) of cements increased with increasing particles content. On the other hand, modulus and strength of bone cements decreased when particles were incorporated but fracture toughness was increased.


Oxygen capture by lithiated organozinc reagents containing aromatic 2-pyridylamide ligands.
The sequential reaction of ZnMe2 with a 2-pyridylamine (HN(2-C5H4N)R, R = Ph: 1; 3,5-Xy (=3,5-xylyl): 2; 2,6-Xy: 3; Bz (=benzyl): 4; Me: 5), tBuLi and thereafter with oxygen affords various lithium zincate species, the solid-state structures of which reveal a diversity of oxo-capture modes. Amine 1 reacts to give both dimeric THF [Li(Me)OZn[N(2-C5H4N)Ph]2] (6), wherein oxygen has inserted into the Zn-C bond of a [MeZn[N(2-C5H4N)-Ph]2] ion, and the trigonal Li2Zn complex, bis(OtBu)-capped (THF x Li)2-[[(mu3-O)tBu]2Zn[N(2-C5H4N)Ph]2] (7). The structural analogue of 6 (8) results from the employment of 2, while the use of more sterically congested 3 yields a pseudo-cubane dimer [(THF x [Li(tBu)OZn(OtBu)Me]]2] (9) notable for the retention of labile Zn-C(Me). Amines 4 and 5 afford the oxo-encapsulation products [mu4-O)Zn4[(2-C5H4N)-NBz]6] (10b), and [tBu(mu3-O)-Li3(mu6-O)Zn3[(2-C5H4N)NMe]6] (11), respectively, with concomitant oxo-insertion into a Li-C interaction resulting in capping of the fac-isomeric (mu6-O)M3M'3 distorted octahedral core of the latter complex by a tert-butoxide group.


Occupational hepatitis caused by methylenedianiline.
Four of the six workmen who were engaged in laying an epoxy resin based floor developed an acute hepatic illness; in two of these men, the illness recurred on re-exposure a few months later, and their convalescence period was prolonged. It was concluded that methylenedianiline, which was used as the curing agent for the epoxy resin, was the likely hepatotoxin on the basis of marked similarities of these men's symptoms and signs to those described in other published reports about toxic exposure to this compound. To date, there is no evidence of long-term liver damage caused by this widely used industrial chemical.


Sports Medicine Groups 1994.
The following list of professional organizations and resource groups represents the growing diversity in the field of sports medicine. The list also includes government agencies, sports- related groups, and academic centers that are active in tracking sports Injuries. Several entries have been updated from the list THE PHYSICIAN AND SPORTSMEDICINE published In January 1993. We have also added five new entries. The list Is divided into three sections: 44 sports medicine organizations, 24 groups and committees that generate sports medicine Information, and 14 statistics-gathering groups. Some groups appear more than once; they have been cross-referenced in each instance. Entries in each of the three sections have been arranged alphabetically. When appropriate, we have given the names of directors and other officers. While THE PHYSICIAN AND SPORTSMEDICINE does not endorse any of the groups listed, we do encourage readers to contact the ones that interest them. We have included only the essential information about each group; more detailed descriptions can be obtained by calling or writing to the particular group you are interested in. Readers who would like their organization added to next year's list should contact THE PHYSICIAN AND SPORTSMEDICINE Special Projects, 4530 W 77th St, Minneapolis, MN 55435.


Overdiagnosis problems in the DSM-IV and the new DSM-5: can they be resolved by the distress-impairment criterion?
Criticisms of psychiatry for overdiagnosing, for pathologizing normality, are not new, dating at least from the antipsychiatry critiques in the 1960s. Inevitably, revisions of the diagnostic manuals, the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders (DSM), provide an occasion for renewed criticism, and the revision process of the DSM-IV became a focus for further debates on overdiagnosis. The debates are typically not about the presence or absence of a decisive marker of specific illnesses or of illness in general-a complex matter on which there is hardly a consensus-but rather about the relative medical, psychosocial, and financial harms and benefits that may accrue from overdiagnosis on the one side and underdiagnosis on the other. It is proposed in this In Review paper that a useful and valid principle for use in these debates is the tight conceptual linkage between illness and distress and impairment of day-to-day functioning. This linkage is fundamental to the conceptualization of mental disorder in the DSM-IV and can still serve to reduce overdiagnosis by excluding cases where distress and impairment are absent or minimal. The same conceptual linkage provides a way of understanding how conditions may warrant a diagnosis even though they are not associated with current distress or impairment, namely, if they carry risk for such in the future. For these conditions, assessments of costs and benefits of overdiagnosis and underdiagnosis depend crucially on high-quality, replicated data on the sensitivity and specificity of the early diagnostic test.


[An unusual form of craniofacial dysmorphism with mechanical respiratory disturbances in newborns (author's transl)].
Gross and histologic findings at autopsy of a one week old newborn baby with respiratory distress and mechanical obstacles to adequate intubation revealed a variation of the craniofacial dysmorphy syndrome: hypoplasia of the mandible combined with dysplastic and hypoplastic tongue and complete situs inversus. The tongue consisted of an hypoplastic smooth anterior part and a hypertrophic posterior part with the usual papillae. Both parts were separated by a deep sulcus across the middle of the tongue with a predominantly fibrous amuscular bottom. Because of this anomaly the posterior part of the tongue was retracted covering the orifice of the larynx and thus causing the respiratory distress. The lesion is discussed in context with data of similar syndromes.


Hypoxia-inducible factors in OSCC.
Oral squamous cell carcinoma (OSCC) is a characteristic locally aggressive tumor in which hypoxia levels are very high, causing a low response to chemotherapy and providing basic resistance to anticancer drugs. Tumoral hypoxia directly depends on hypoxia-inducible factors (HIF). The goal of this paper is to describe HIF basic biology and tumor cells (HIF-1α, mainly), analyzing the effects of its expression in OSCC, study its relation with other molecules such as nitric oxide (NO), carbonic anhydrase (CA) or VEGF and assess the possibility of its manipulation as a therapeutic target.


Using a simple equation to predict the microporation-enhanced transdermal drug flux.
The mathematical model describing drug flux through microporated skin was previously developed. Based on this model, two mathematical equations can be used to predict the microporatio-enhanced transdermal drug flux: the complex primal equation containing a variety of experimentally-determined variables, and the simplified straightforward equation. In this study, experimental transdermal fluxes of three corticosteroids through split-thickness human skin treated with a microneedle roller were measured, and the values of fluxes compared with those predicted using both the more complex and simplified equations. According to the results of the study, both equations demonstrated high accuracy in the prediction of the fluxes of corticosteroids. The simplified equation was validated and confirmed as robust using regression analysis of literature data. Further, its capability and ease of use was exemplified by predicting the flux of methotrexate through the skin microporated with laser and comparing with published experimental data.


Linker histone function in chromatin: dual mechanisms of action.
Aspects pertaining to linker histone structure and function are discussed, including the extent to which these proteins are essential, their ability to regulate specific gene expression, and recent structural data that provides a potential molecular basis for understanding how linker histones can have both repressive and stimulatory effects on genomic functions in vivo.


Fatal systemic nocardia infection revealed by cardiac tamponade.
We report the case of a 50-year-old man admitted for cardiac tamponade. He was diagnosed with acute pneumonia. He had no previous medical history, but exhibited a body mass index of 41. Two days before admission, he complained of chest pain irradiating to the neck lateral side. Massive cardiac tamponade developed over 48 hours. There was no obvious cause for immunodepression. Pericardial puncture was ineffective, due to obesity and fluid high viscosity. Surgery was undertaken (Marfan intervention). Pericardial fluid was found to be purulent; direct examination revealed nocardia as bacteria with typical filamentous, branching rods. Despite adapted antibiotic treatment the patient died within a few hours. Acute pericarditis due to Nocardia is discussed.


The effect of cadmium on the collagen solubility of embryonic chick bone in tissue culture.
The effect of cadmium (Cd) on the solubility of bone collagen was examined in cultured tibiae from 9-day chick embryos. The solubility of collagen was not significantly increased by 8.9 microM Cd, but showed a significant increase at 13.4 microM Cd. As the [3H]hydroxyproline (Hyp) formation was inhibited by Cd at 8.9 and 13.4 microM [3H]Hyp formation and collagen solubility were investigated in the presence of 200 microM Fe2+, a metal which is known to prevent the inhibitory effects of Cd on prolyl hydroxylase in vitro. Fe affected neither a decrease in [3H]Hyp formation nor an increase in collagen solubility caused by Cd. This suggests that a Cd-induced increase in collagen solubility may be due to the decrease of lysyl oxidase activity, not to the formation of underhydroxylated collagen. Zn at 48 and 134 microM depressed the Cd-induced increase in collagen solubility, but caused no increase in collagen solubility. Our present and previous results suggest that Zn can protect the disturbance of both the collagen synthesis and the collagen cross linking caused by Cd.


Duration of methicillin-resistant Staphylococcus aureus carriage, according to risk factors for acquisition.
To examine the duration of methicillin-resistant Staphylococcus aureus (MRSA) carriage and its determinants and the influence of eradication regimens. Retrospective cohort study. A 1,033-bed tertiary care university hospital in Bern, Switzerland, in which the prevalence of methicillin resistance among S. aureus isolates is less than 5%. A total of 116 patients with first-time MRSA detection identified at University Hospital Bern between January 1, 2000, and December 31, 2003, were followed up for a mean duration of 16.2 months. Sixty-eight patients (58.6%) cleared colonization, with a median time to clearance of 7.4 months. Independent determinants for shorter carriage duration were the absence of any modifiable risk factor (receipt of antibiotics, use of an indwelling device, or presence of a skin lesion) (hazard ratio [HR], 0.20 [95% confidence interval {CI}, 0.09-0.42]), absence of immunosuppressive therapy (HR, 0.49 [95% CI, 0.23-1.02]), and hemodialysis (HR, 0.08 [95% CI, 0.01-0.66]) at the time MRSA was first MRSA detected and the administration of decolonization regimen in the absence of a modifiable risk factor (HR, 2.22 [95% CI, 1.36-3.64]). Failure of decolonization treatment was associated with the presence of risk factors at the time of treatment (P=.01). Intermittent screenings that were negative for MRSA were frequent (26% of patients), occurred early after first detection of MRSA (median, 31.5 days), and were associated with a lower probability of clearing colonization (HR, 0.34 [95% CI, 0.17-0.67]) and an increased risk of MRSA infection during follow-up. Risk factors for MRSA acquisition should be carefully assessed in all MRSA carriers and should be included in infection control policies, such as the timing of decolonization treatment, the definition of MRSA clearance, and the decision of when to suspend isolation measures.


An empirical basis for the competition by dexamethasone to progesterone receptors as estimated with the synthetic progestin R5020.
Normal mammary glands of mice contain both progesterone and glucocorticoid receptors and the levels of both these receptors are modulated as a function of development. Measurement of progesterone receptors using the synthetic progestin, R5020, has led to conflicting data both with regard to the presence of progesterone receptor during certain developmental stages of the mammary gland and the ability of the glucocorticoids to compete for specific R5020 binding sites. In this report we have identified experimental conditions which allow for the separate measurements of the progesterone and glucocorticoid receptors in the same cytosol. If sulfhydryl reducing agents such as dithiothreitol are excluded from the assay buffer, R5020 binds to only a single class of high affinity sites in mammary cytosol of virgin mice and these binding sites exhibit a strict steroid specificity characteristic of progesterone receptors. In contrast, if dithiothreitol is included in the buffers, R5020 binds not only to the high affinity sites but also to certain saturable lower affinity sites; these lower affinity sites for R5020 also bind glucocorticoids such as dexamethasone. These findings should facilitate more accurate quantitation of both progesterone and glucocorticoid receptors in normal and neoplastic tissues and also be applicable to studies on the mechanism(s) of progesterone action.


Early infarct FLAIR hyperintensity is associated with increased hemorrhagic transformation after thrombolysis.
Absence of FLAIR hyperintensity within an acute infarct is associated with stroke onset <4.5 h. However, some patients rapidly develop FLAIR hyperintensity within this timeframe. We hypothesized that development of early infarct FLAIR hyperintensity would predict hemorrhagic transformation (HT) in patients treated with tissue plasminogen activator (tPA) < 4.5 h after onset. Consecutive acute stroke patients treated with intravenous tPA <4.5 h after onset who had MRI before and 1 day after thrombolysis were included. Two raters (blind to HT) independently identified FLAIR hyperintensity with reference to the diffusion-weighted image (DWI) lesion. HT was assessed using T2* MRI at 24 h. Hemorrhagic infarction (HI) was defined as petechial HT without mass effect, and parenchymal hematoma (PH) as HT with mass effect. Multivariable logistic regression analysis for HT included FLAIR status, baseline National Institutes of Health Stroke Scale and DWI lesion volume, leukoaraiosis (Wahlund score), serum glucose and reperfusion. Of 109 patients, 33 (30%) had acute FLAIR hyperintensity. HT occurred in 17 patients (15.6%; 15 HI, 2 PH). HT was more common in FLAIR-positive patients than FLAIR-negative patients (33.3% vs. 9.2%, P = 0.009). Median time-to-scan and median time-to-thrombolysis did not differ significantly between patients with HT and without [97 IQR(68, 155) vs. 90 IQR(73, 119), P = 0.5; 120 IQR(99, 185) vs. 125 IQR(95, 150), P = 0.6, respectively]. In multivariable analysis, only FLAIR hyperintensity was independently associated with HT after thrombolysis (OR 18; 95% CI 2-175, P = 0.013). Early development of FLAIR hyperintensity within the area of diffusion restriction is associated with increased risk of HT after thrombolysis in acute stroke patients.


A 90-day toxicity study of L-asparagine, a food additive, in F344 rats.
L-asparagine is an amino acid listed as an existing food additive in Japan. The present 90-day toxicity study in F344/DuCrlCrj rats was conducted for safety assessment and to determine a no observed adverse effect level (NOAEL) of L-asparagine. Groups of 10 males and 10 females were given the material at dose levels of 0%, 1.25%, 2.5% or 5% in diet for 90 days. During the experiment, there were no remarkable changes in general conditions and no deaths occurred in any group. Final body weights of male 5% and 1.25% groups were significantly decreased. There were also significant increases in relative organ weights of the brain, kidney and testis in 5% males. On serological examination, GLU, PL, K and ALT were increased significantly in 5% females, and GLU was increased significantly and CRN was decreased significantly in the female 1.25% group. However, histopathological examination did not reveal any significant variation in development of lesions among the groups. Changes in body and organ weights, as well as other parameters, were concluded to be due to treatment with 5% L-asparagine. The NOAEL was determined to be 2.5% in the diet (males, 1.65 g/kg body weight/day; females, 1.73 g/kg body weight/day).


Amisulpride Augmentation in Acute Catatonia.
Benzodiazepines are the first-line treatment of catatonia, but a substantial number of patients do not respond to them. Amisulpride is one of the atypical antipsychotic that has been effective for negative symptoms of schizophrenia. We examined the effect of augmentation of oral low doses of amisulpride with lorazepam on resolution of catatonic symptoms. Fifteen patients with catatonia were treated with a combination of oral lorazepam (2-4 mg) with amisulpride (100 mg). Catatonic symptoms were rated using the Bush Francis Catatonia Rating Scale at the baseline and daily thereafter. There was complete resolution of catatonic symptoms on the third day in all patients. There was significant reduction of the total Bush Francis Catatonia Rating Scale score over time (F = 181.38, P < 0.001) with a strong effect size (partial η = 0.96). Augmentation of lorazepam with low-dose amisulpride can be a reliable strategy for management of catatonia.


Effectiveness of a vegetable dental chew on periodontal disease parameters in toy breed dogs.
Sixteen toy breed dogs completed a parallel, 70-day two-period, cross-over design clinical study to determine the effect of a vegetable dental chew on gingivitis, halitosis, plaque, and calculus accumulations. The dogs were randomly assigned into two groups. During one study period the dogs were fed a non-dental dry diet only and during the second study period were fed the same dry diet supplemented by the daily addition of a vegetable dental chew. Daily administration of the dental chew was shown to reduce halitosis, as well as, significantly reduce gingivitis, plaque and calculus accumulation and therefore may play a significant role in the improvement of canine oral health over the long-term.


Migration and activation of antigen-specific CD8+ T cells upon in vivo stimulation with allogeneic tumor.
The response of CD8+ T cells to allogeneic tumor was studied by adoptive transfer of cells from TCR transgenic 2C mice specific for Ld alloantigen. Transferred cells were monitored during the course of a response to i.p. challenge with live P815 (H-2d) using the 1B2 mAb specific for the 2C TCR. Tumor was present in the draining LN and spleen within 3 to 4 days of challenge. The first changes in 1B2+ cells occurred in the spleen on day 4; VLA-4 expression increased in an Ag-specific manner and L-selectin expression decreased in an Ag-nonspecific manner. The number of 1B2+ cells in the spleen declined over days 4 to 6. The first detectable increase in CD25 expression and blast transformation was in the peritoneal cavity beginning days 5 and 6. Clonal expansion was largely limited to this site and was maximal on day 8. As expansion occurred in the peritoneal cavity; the number of 1B2+ cells in the draining LN and spleen also increased. These cells had an activated phenotype (CD44(high), VLA-4(high)) but most did not express CD25 and were not blasts. These results suggest that initial Ag recognition in the spleen results in altered expression of adhesion receptors so that cells gain access to the peritoneal cavity where they undergo clonal expansion and differentiation. Following the response, 1B2+ cells decline in number but a memory population (CD44(high), L-selectin(high and low)) persists for long times in the spleen and LN.


[Complications and management of percutaneous femoral arterial access].
Vascular access complications following endovascular procedures remain an important cause of morbidity when using a femoral approach. In this review, we describe the risk factors, clinical presentation and management of hematoma, retroperitoneal bleeding, pseudoaneurysms, arteriovenous fistulae and arterial thrombosis.


Temporal trends in overweight and obesity among Nicobarese adults in Nicobar Islands, India, 1960s-1999.
The aim of the present study is to assess the change in the prevalence of overweight and obesity among Nicobarese adults from 1960s to 1999 using WHO recommendations for the classification of overweight and obesity. The sample includes 774 individuals (424 men and 350 women) during 1960s and 484 individuals (259 men and 225 women) during 1999, aged 20-64 years from Nicobar Islands, India. Height (cm), weight (kg) and sitting height (cm) were measured and BMI (kg/m(2)) was calculated. Overweight and obesity were defined as BMI ≥ 25 kg/m(2) and BMI ≥ 30 kg/m(2), respectively. There was significant increase of height, weight and BMI among both the men and women of 20-39, and 40 and above years age groups. However, the higher magnitude of increment was observed in 20-39 years. The prevalence of overweight increased from 5.42% to 22.01% among men and from 4% to 21.78% among women, while obese individual was absent during 1960s and the prevalence of obesity increased to 2.70% in men and 8.89% in women. The magnitude of increment was higher among women compared to men. The results indicate remarkable increase in the prevalence of both overweight and obesity among Nicobarese adult in Nicobar Islands.


Paediatric sunburn: the experience of an Australian paediatric burns unit.
The number of hospital presentations and admissions for treatment of sunburn remains significant, despite efforts to educate the public regarding sun protection. Current literature chiefly examines public health campaigns and sun protection behaviours and attitudes. There are very few articles that explore paediatric sunburn requiring hospital presentation. This study was therefore undertaken to provide a snapshot of this issue and to identify patterns and causative factors in the development of severe sunburn requiring hospital presentation. Data were collected for retrospective analysis from case records of patients who presented with sunburn and were registered on the Burns Service database at the Women's and Children's Hospital in South Australia. This study includes patients who presented during the period of October 2006 to March 2011. There were 81 cases identified over the period of 2006-2011 from the Burns database that had sufficient information for the purpose of this study. Factors such as outdoor activity and water sports were predictably apparent, with patients being burned on days with extremely high ultraviolet ratings. Key patterns that emerged were location of sunburn and sun protection use, which were gender and age specific. Larger-scale studies are warranted to further delineate the contributing factors and to identify the specific populations of children at risk of sunburn. Future educational programmes can therefore target these subgroups and behaviours for effective prevention of sunburn. Tailored campaigns that address these factors may be of greater impact in reducing hospital presentations and admissions of significant sunburn.


Technical Approach to Antegrade Femoral Access.
The number of endovascular procedures for treatment of peripheral arterial disease continues to increase as minimally invasive procedures have become the first-approach solution for lower extremity arterial lesions of any complexity, including Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease (TASC) II category C and D. Although the usual treatment strategy has been to access the contralateral common femoral artery (CFA), an ipsilateral, antegrade CFA approach has certain advantages. The greatest advantages are the decrease in the access-to-lesion distance, which in turn improves the mechanical advantage and responsiveness of the tools used to perform the intervention. In certain clinical situations such as prior endovascular aneurysm repair, aortobifemoral surgical bypass, iliac kissing stents, and aortoiliac occlusive disease, an antegrade approach may be mandatory. In this article, we describe our institutional thought process and techniques for performing a successful antegrade puncture of the CFA, as well as highlight some pitfalls and the associated complication rates of which to be aware.


Enhanced synthesis of factor B induced by tumor necrosis factor in human skin fibroblasts is decreased by IL-4.
IL-4 is a T cell-derived lymphokine that has multiple biologic functions, affecting B cells, T cells, mast cells, monocytes, macrophages, and hematopoietic progenitor cells. We report that IL-4 also affects human skin fibroblasts. These effects were primarily in modulating the effects of other mediators of inflammation on these cells, with IL-4 producing little or no effects by itself. Synthesis of C proteins in human skin fibroblasts is modulated by TNF and other mediators of inflammation. TNF increased synthesis of factor B by 18.6-fold; IL-4 reduced the TNF effect on factor B synthesis by 83%. This effect started with concentrations of IL-4 as low as 0.1 ng/ml. The effect of IL-4 on the TNF-induced increase in synthesis of factor B occurred after 2 h incubation, the time when the effects of TNF alone were first observed. IL-4 also abrogated the effects of IL-1 and LPS on factor B synthesis, but did not affect the increase in synthesis of factor B induced by IFN-gamma. In contrast to the pattern for effect of IL-4 on factor B synthesis, the TNF-induced rate of synthesis of C3 was augmented by IL-4. The specificity of the IL-4 effect was also apparent when comparing the effect of IL-4 on the TNF-induced synthesis of factor B to the effects on total protein synthesis (increased 1.5-fold) and the TNF-induced increases in synthesis in C1r, C1s, C1 inhibitor, C2, and factor H (no changes). The IL-4-induced decrease in synthesis of factor B was mediated at a pretranslational level and was dependent on synthesis of a new protein. This interaction between IL-4 and mediators of inflammation can potentially modulate the inflammatory response in the setting of activation of Th cells.


Drechmeria panacis sp. nov., an endophyte isolated from Panax notoginseng.
An endophytic strain (designated as strain SYPF 8335T) was isolated from a root of Panax notoginseng in Wenshan district, Yunnan province of China. Strain SYPF 8335T grew very slowly and formed white colonies. Phylogenetic analysis of four loci indicated that strain SYPF 8335T was placed in the Drechmeria clade with Drechmeria campanulata as its closest phylogenetic neighbour. The nucleotide differences between strain SYPF 8335T and D. campanulata are 30 substitutions in the internal transcriber region region. A key morphological feature that differentiates the two fungi is that D. campanulata produces campanulate conidia. Combined with the morphology and molecular analyses, a new species named Drechmeria panacis sp. nov., is proposed.


Back to the future: teaching anatomy by whole-body dissection.
To evaluate the 2010 "Anatomy by whole body dissection" course, a 7-week elective course offered to senior medical students at the University of Sydney at the end of their third year. In the 2010 course, 29 students divided into eight groups carried out whole-body dissections on eight cadavers over a 34-day period. Surgical trainees acted as demonstrators, and surgeons and anatomists as supervisors. The students were assessed by practical tests involving the identification of 20 tagged structures in four wet specimens before, during, at the end of, and 1 month after the course. In addition, students were asked to complete an anonymous feedback questionnaire about the course. Acquisition of topographical anatomical knowledge, and student feedback on the usefulness of the course. A significant increase in topographical clinical anatomical knowledge was demonstrated among the participants and was maintained in the short term. The median pre-course assessment score was 8/20 (interquartile range [IQR], 4) and the median post-course assessment score was 19/20 (IQR, 1). This difference was statistically significant (P<0.001). All students rated the course as "very good", and unanimously recommended that the course be available to all students as part of the medical curriculum. Students' knowledge of anatomy improved significantly between the pre-course and post-course assessments, and all students rated the course very favourably. This supports our view that dissection anatomy should be an integral component of medical education.


Codon-optimized Gaussia luciferase cDNA for mammalian gene expression in culture and in vivo.
Photoproteins have played a major role in advancing our understanding of biological processes. A broader array of biocompatible, nontoxic, and novel reporters can serve to expand this potential. Here we describe the properties of a luciferase from the copepod marine organism Gaussia princeps. It is a monomeric protein composed of 185 aa (19.9 kDa) with a short coding sequence (555 bp) making it suitable for viral vectors. The humanized form of Gaussia luciferase (hGLuc) was efficiently expressed in mammalian cells following delivery by HSV-1 amplicon vectors. It was found to be nontoxic and naturally secreted, with flash bioluminescence characteristics similar to those of other coelenterazine luciferases. hGLuc generated over 1000-fold higher bioluminescent signal intensity from live cells together with their immediate environment and over 100-fold higher intensity from viable cells alone (not including secreted luciferase) or cell lysates, compared to humanized forms of firefly (hFLuc) and Renilla (hRLuc) luciferases expressed under similar conditions. Furthermore, hGLuc showed 200-fold higher signal intensity than hRLuc and intensity comparable to that of hFLuc in vivo under standard imaging conditions. Gaussia luciferase provides a sensitive means of imaging gene delivery and other events in living cells in culture and in vivo, with a unique combination of features including high signal intensity, secretion, and ATP independence, thus being able to report from the cells and their environment in real time.


Laparoscopic management of intentional and unintentional cystotomy.
We assessed the laparoscopic closure of intentional or unintentional bladder lacerations during operative laparoscopy. Retrospective review of operative reports revealed 19 women who required bladder repair. The defect was repaired laparoscopically in 1 layer using interrupted absorbable polyglycolic suture (17 patients) or polydioxanone suture (2) and followed by 7 to 14 days of transurethral drainage. Complications were limited to 1 vesicovaginal fistula that required reoperation. After 6 to 48 months of followup all patients were well with a good outcome. In select cases the bladder can be repaired safely and effectively during operative laparoscopy by an experienced laparoscopic surgeon.


[Comparison between OPD-Scan results and visual outcomes of Tecnis ZM900 and Restor SN60D3 diffractive multifocal intraocular lenses].
Comparison of the visual performance and wavefront analysis between patients with Tecnis ZM900 aspheric and AcrySof ReStor SN60D3 spheric diffractive multifocal intraocular lenses (IOL). This prospective comparative study included 78 eyes of 39 patients. The performed ophthalmologic evaluation included near, intermediate and distance corrected and uncorrected visual acuity, contrast sensitivity measurement (under photopic and mesopic conditions) and wavefront analysis with the OPD-Scan aberrometrer. Uncorrected near and distance visual acuity and aberrometry analysis were similar with both intraocular lenses; nevertheless, intermediate visual acuity and contrast sensitivity under photopic conditions were statistically better with Tecnis ZM900. Both studied intraocular lenses promoted excellent near and distance postoperative visual acuity, in high contrast situations. Tecnis ZM900 IOL provided good quality of vision with high contrast condition in low luminosity with reduction in spherical aberration and improvements in intermediate visual acuity when compared to Restor IOL.


Thyroid dysfunction in antiviral therapy of chronic hepatitis C.
Thyroid disorders are common dysfunctions during HCV infection and IFN-therapy. The aim of the study was to evaluate the general risk of thyroid disorders' development in chronic HCV-infected patients and their possible relationship with HCV genotype, type of used IFN-alpha and viral response. A study was performed in 89 patients with chronic hepatitis C (57 males, 32 females) and 25 healthy subjects. All HCV-infected patients were treated by IFN-alpha and RBV for a period depending on the HCV genotype. Hematological parameters, liver and thyroid function tests were analyzed. Serum Tpo-Ab and TG-Ab were detected by semiquantitative ELISA. In statistical analyses U Mann-Whitney and Spearman correlation tests were used. Ap value < 0.05 was considered significant. Twelve (13.5%) CHC patients developed thyroid disorders during IFN-alpha therapy. Thyroid disorders were more often detected in females, in 3a-genotype-infection and in patients treated with natural leukocyte IFN-alpha. Seven (7.6%) Tpo-Ab and/or TG-Ab positive patients were noticed. Four of them (57.1%) developed hypothyroidism during IFN-alpha therapy. This study demonstrated low effect of IFN-alpha therapy on thyroid disorders development and on TPO-Ab and TG-Ab serum level in chronic HCV-infected patients.


Synergistic effect of [1H-[1,2,4]Oxadiazole[4,3-a]quinoxalin-1-one] and antidepressant drugs in the mouse forced swimming test: possible involvement of serotonergic pathway.
To augment the effects of classical antidepressant drugs by combination therapies in drug-resistant patients has been an emerging treatment strategy. In the present study, the potential synergistic effect of [1H-[1,2,4]Oxadiazole[4,3-a]quinoxalin-1-one] (ODQ) and antidepressant drugs in the forced swimming test was evaluated. While 5mg/kg intraperitoneal administration of imipramine, fluoxetine or desipramine caused no effect in the duration of immobility in the forced swimming test (sub-effective doses), higher doses (20, 10 and 10mg/kg, respectively) reduced the immobility period (effective doses). When sub-effective doses of ODQ (15mg/kg) and imipramine (5mg/kg) were applied, there was a significant reduction in the immobility time compared with those of each drug alone. Similarly the reduction seen with the effective dose of imipramine (20mg/kg) was also augmented by the co-administration of ODQ (15mg/kg). By its sub-effective dose, ODQ exerted statistically significant augmentations in the responses to either sub-effective (5mg/kg) or effective dose (10mg/kg) of fluoxetine. By contrast, desipramine was not influenced by the co-administration of ODQ (15mg/kg). None of the drugs used in the present study had any effects on the locomotor activity test over the dose range applied. The results show that co-administration of imipramine/fluoxetine and ODQ exhibits a supra-additive effect and that serotonergic rather than noradrenergic pathway may be involved in the synergistic effect of ODQ.


Computed tomography of renal lymphoma.
The CT studies of 29 patients with renal or perirenal lymphoma were retrospectively reviewed. Four patterns of disease were identified. Seventeen of 29 patients (59%) had bilateral renal masses. Only seven of these patients had associated enlarged retroperitoneal lymph nodes. Eight patients (28%) had single renal or perirenal lesions adjacent to or contiguous with bulky retroperitoneal lymphadenopathy. Three patients had infiltration of the perirenal space without significant renal parenchymal involvement, and one patient had a solitary renal mass. No patients in this series had diffuse involvement of the kidney without a focal mass. Renal involvement with lymphoma should be considered in any patient who develops multiple homogeneous solid renal or perirenal masses, even in the absence of other retroperitoneal disease.


[Complications of cosmetic skin bleaching in Africa].
Use of cosmetic products to bleach or lighten the skin is common among dark-skinned women in some sub-Saharan African countries. Long-term use of some pharmacologic compounds (e.g. hydroquinone, glucocorticoids and mercury) can cause adverse effects including dermatologic disorders such as dyschromia, exogenous ochronosis, acne and hypertrichosis, prominent striae, tinea corporis, pyoderma, erysipelas, scabies, and contact dermatitis and systemic complications such as hypertension, hypercorticism or surrenal deficiency, and mercurial nephropathy.


C5aR and C3aR antagonists each inhibit diet-induced obesity, metabolic dysfunction, and adipocyte and macrophage signaling.
Mammalian survival depends on metabolizing nutrients, storing energy, and combating infection. Complement activation in blood triggers energy-depleting immune responses to fight infections. Here we identify surprising energy-conserving roles for complement proteins C5a and C3a and their receptors, C5aR and C3aR, roles that are contraindicated in complement biology. Rats fed a high-carbohydrate high-fat diet developed obesity, visceral adiposity, adipose inflammation, glucose/insulin intolerance, and cardiovascular dysfunction that correlated with increased plasma C3a, adipose C5aR, and C3aR. These in vivo changes were dramatically attenuated by receptor-selective antagonists of either C5aR (5 mg/kg/d p.o.) or C3aR (30 mg/kg/d p.o.), which both reduced proinflammatory adipokines and altered expression of inflammatory genes in adipose tissue. In vitro C5a and C3a (100 nM) exhibited novel insulin-like effects on 3T3-L1 adipocytes, promoting energy conservation by increasing glucose and fatty acid uptake while inhibiting cAMP signaling and lipolysis, and induced PGE(2) release from macrophages, effects all blocked by each respective antagonist (10 μM). These studies reveal important new links between complement signaling and metabolism, highlight new complement functions on adipocytes and in adipose tissue, demonstrate how aberrant immune responses may exacerbate obesity and metabolic dysfunction, and show that targeting C3aR or C5aR with antagonists is a new strategy for treating metabolic dysfunction.


Hybrid total hip arthroplasty for multiple epiphyseal dysplasia.
Multiple Ephiphyseal Dysplasia (MED) is a rare autosomal dominant skeletal dysplasia that causes deformation of the epiphysis of the involved joints. The hips are invariably affected and symptoms due to incapacitating early onset degenerative hip disease often begin between the second and fourth decade of life. Literature regarding the clinical and radiographical outcomes after total hip arthroplasty in this young population are very scarce. Hypothesis in patients with multiple epiphyseal dysplasia and early onset degenerative hip disease, hybrid total hip arthroplasty is a safe and reliable procedure. We followed 10 hybrid total hip arthroplasties in 6 patients with respect to the early and medium term complications. The average age at surgery was 32 years old (17 to 41). All stems were cemented polished straight tapered stems, all cups were porous coated uncemented cups. The mean duration of follow-up was 10.3 (7-14, SD2.8) years. Clinical outcomes were measured using the Charnley modification of the Merle d'Aubigné-Postel grading system and VAS-scores. No early complications and no revisions occurred and patients significantly improved for pain, function and mobility. The Charnley, Merle d'Aubigné and Postel hip scores significantly improved from 9.6 points pre-operatively (range: 8-11 points) to 17 points (range: 16-18 points) and the VAS-score significantly improved after surgery from respectively 7 at rest and 8.5 during activity preoperatively to 1 at rest and 1.5 during activity postoperatively. Radiographic evaluation showed no cases of radiolucency around the cemented femoral components. No migration or subsidence of the components was noted. With regard to the acetabular component, osteolysis was noted in 4 hips, but serial radiographs showed no progression or migration of the component and the patients were completely pain free. Hybrid total hip arthroplasty is a viable treatment option in multiple epiphyseal dysplasia patients, with excellent mid-term clinical and radiographical outcomes. Level IV, retrospective study.


A microbiological assay for the quantitative determination of glutathione.
Based on the requirement of a glutathione-deficient mutant strain of Saccharomyces cerevisiae to take up external glutathione for growth on synthetic media, a simple agar diffusion test for quantitative detection of total glutathione from various sources was established. Glutathione concentrations can be reliably detected in a less expensive way, requiring less technical effort compared to enzymatic or biochemical detection methods.


Fecal glucocorticoid metabolites of experimentally stressed captive and free-living starlings: implications for conservation research.
Fecal glucocorticoid metabolite (FGM) analysis has received considerable attention in conservation biology because it has potential to be used as a noninvasive measure of stress in animals. There has been a recent and extensive literature describing the importance of technical, physiological, and biological validations of this technique, yet surprisingly little is known about how FGM concentrations change during chronic stress. Therefore, we experimentally induced chronic stress in both captive and free-living European starlings (Sturnus vulgaris). Chronic stress was elicited using a rotation of four different 30 min acute stressors for 16 days in the laboratory and 8 days in the field. Exogenous ACTH, the primary glucocorticoid secretagog, significantly increased FGM concentrations in approximately 2 h, and our assay detected endogenous diel glucocorticoid rhythms similar to those of other birds. Thus, our assay was both physiologically and biologically validated. However, experimentally induced chronic stress did not alter daytime or nighttime FGM concentrations in captive starlings. In contrast, chronically stressed adult female starlings had higher FGM concentrations than unstressed female starlings in the field. Our field data support the general assumption that higher FGM concentrations indicate chronic stress, but our captive data do not. Overall, our results suggest that more research is need before FGM analysis can be used as a reliable measure of stress in animals, especially those kept in captivity.


Magnetic resonance imaging of syringocystadenoma papilliferum of the external auditory canal.
Syringocystadenoma papilliferum (SCAP) usually occurs on the face or the scalp and is very rare in the external auditory canal (EAC). There has been no information on magnetic resonance (MR) imaging of this tumor irrespective of its site. We report here a case of 57-year-old man having this tumor, which was surgically removed and its histopathology was confirmed. MR imaging demonstrated a lobulated 4-cm mass with clearly defined margins in the EAC. Although the tumor was bulky, these MR findings were different from the malignancies. The mass lesion showed intermediate signal intensity both on T1- and T2-weighted MR images and showed slight enhancement on gadolinium-enhanced T1-weighted images. Signal intensities on T2-weighted images of this tumor were low compared to those of pleomorphic adenoma. All ceruminous gland tumors including SCAP are thought to be potentially malignant; therefore, pre-operative biopsy should not be performed. Even though incisional biopsy is sometimes needed as in our case, the current MR features would be helpful for differential diagnosis of this rare condition and assessing the extension of the tumor.


Chronic renal failure: a significant risk factor in the development of acquired renal cysts and renal cell carcinoma. Case reports and review of the literature.
Three male patients with end-stage renal disease on chronic hemodialysis presented with gross hematuria and were subsequently found to have acquired renal cyst disease and progressive bilateral renal cell carcinoma. There are now more than 84 similar cases in the literature, but the precise roles that renal failure and hemodialysis play in the development of renal cysts and renal neoplasms remain unclear. The high incidence of acquired renal cyst disease (45%) and the development of renal tumors (9%, with a 5% to 7% metastatic rate) in patients with end-stage renal failure clearly underscores the need for more intense radiologic monitoring.


Purification and properties of aminoendopeptidase from rat epidermis.
An aminoendopeptidase isolated from 2-day-old rat epidermis was purified to apparent homogeneity by the procedures of ammonium sulfate fractionation, DE-52 column chromatography, Sephadex G-200 gel filtration, and CM-52 and DEAE-Sepharose 6B column chromatography. Enzymatic activity was exhibited only in the presence of sulfhydryl compounds and further enhanced by addition of 5 mM EDTA. It was inhibited by p-chloromercuribenzoate, other sulfhydryl blocking reagents, and o-phenanthroline. The monomer form of the enzyme is Mr = 52,000 +/- 2,300 by sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis, but a native form was considered to be Mr = 400,000 +/- 26,000 having an isoelectric point of pH 5.25. Among synthetic substrates the enzyme hydrolyzed amino acid 2-naphthylamide derivatives and L-leucine amine (L-LeuNH2) most effectively. N-alpha-benzoyl-DL-arginine-2-naphthylamide (BANA) was the only endopeptidase substrate for the enzyme and a competitive inhibitor for its aminopeptidase activity. Protein substrates have not yet been found. The pH optimum is 7.5 and in a range of pH 6.5-7.5 it is stable at 37 degrees C for 30 min but loses about 50% of its activity at 50 degrees C.


The contribution of different frequency bands of fMRI data to the correlation with EEG alpha rhythm.
Alpha rhythm is a prominent EEG rhythm observed during resting state and is thought to be related to multiple cognitive processes. Previous simultaneous electroencephalography (EEG)/functional magnetic resonance imaging (fMRI) studies have demonstrated that alpha rhythm is associated with blood oxygen level dependent (BOLD) signals in several different functional networks. How these networks influence alpha rhythm respectively is unclear. The low-frequency oscillations (LFO) in spontaneous BOLD activity are thought to contribute to the local correlations in resting state. Recent studies suggested that either LFO or other components of fMRI can be further divided into sub-components on different frequency bands. We hypothesized that those BOLD sub-components characterized the contributions of different brain networks to alpha rhythm. To test this hypothesis, EEG and fMRI data were simultaneously recorded from 17 human subjects performing an eyes-close resting state experiment. EEG alpha rhythm was correlated with the filtered fMRI time courses at different frequency bands (0.01-0.08 Hz, 0.08-0.25 Hz, 0.01-0.027 Hz, 0.027-0.073 Hz, 0.073-0.198 Hz, and 0.198-0.25 Hz). The results demonstrated significant relations between alpha rhythm and the BOLD signals in the visual network and in the attention network at LFO band, especially at the very low frequency band (0.01-0.027 Hz).


Pathway analysis of genetic markers associated with a functional MRI faces paradigm implicates polymorphisms in calcium responsive pathways.
Several lines of evidence suggest that common polygenic variation influences brain function in humans. Combining high-density genetic markers with brain imaging techniques is constricted by the practicalities of collecting sufficiently large brain imaging samples. Pathway analysis promises to leverage knowledge on function of genes to detect recurring signals of moderate effect. We adapt this approach, exploiting the deep information collected on brain function by fMRI methods, to identify molecular pathways containing genetic variants which influence brain activation during a commonly applied experiment based on a face matching task (n=246) which was developed to study neural processing of faces displaying negative emotions. Genetic markers moderately associated (p<10(-4)) with whole brain activation phenotypes constructed by applying principal components to contrast maps, were tested for pathway enrichment using permutation based methods. The most significant pathways are related to post NMDA receptor activation events, driven by genetic variants in calcium/calmodulin-dependent protein kinase II (CAMK2G, CAMK2D) and a calcium-regulated nucleotide exchange factor (RASGRF2) in which all are activated by intracellular calcium/calmodulin. The most significant effect of the combined polygenic model were localized to the left inferior frontal gyrus (p=1.03 × 10(-9)), a region primarily involved in semantic processing but also involved in processing negative emotions. These findings suggest that pathway analysis of GWAS results derived from principal component analysis of fMRI data is a promising method, to our knowledge, not previously described.


Chromosomal location of the octamer transcription factors, Otf-1, Otf-2, and Otf-3, defines multiple Otf-3-related sequences dispersed in the mouse genome.
Chromosomal locations have been assigned for the octamer transcription factor, Otf, gene family (previously named the octamer-binding protein, Oct, gene family) using an interspecific backcross of [(C57BL/6J x Mus spretus)F1 x C57BL/6J] mice and the BXH recombinant inbred strains. Molecular probes for Otf-1 and Otf-2 recognized single loci on mouse chromosomes 1 and 7, respectively, whereas probes for Otf-3 recognized a minimum of eight independently segregating loci (designated Otf-3a through Otf-3h). Members of the Otf-3 family mapped to mouse chromosomes 1, 2, 3, 6, 14, 17, and the X chromosome, indicating that the Otf family has become widely dispersed during evolution. Several Otf loci mapped near developmental mutations, raising the possibility that these mutations result from defects in Otf family members.


Non-radioactive localization of substance P binding sites in rat brain and spinal cord using peptides labeled with 1.4-nm gold particles.
We present here a new method for non-radioactive labeling of substance P (SP) to demonstrate the distribution of its binding sites in histological sections. The peptide was labeled at the primary amino group with a 1.4-nm gold particle. In Western blots of membrane fractions of rat spinal cord, specific binding occurred at 38 and 58 KD. This binding was competitively suppressed by adding the native peptide. In addition, the SP-gold conjugate was able to displace the corresponding 125I-labeled peptide from binding proteins. In histological sections, binding sites could be shown in various parts of rat brain and spinal cord. The distribution patterns were comparable to those found in studies using autoradiographic methods. Adding the native peptide or a neurokinin 1 receptor agonist markedly reduced labeling of the tissue, whereas only a slight reduction was obtained after adding neurokinin A. Therefore, SP could be specifically labeled with a 1.4-nm gold particle to demonstrate its binding sites. This new method combines the advantages of receptor-ligand affinity binding with a non-radioactive detection system. It can be used for labeling peptides in general and therefore offers an alternative or addition to other methods used in study of the distribution of membrane receptors.


The vascular arrangement of the sinus mucosa. A study in rabbits.
Seventy-seven New Zealand White rabbits, with an average weight of 3 kg, were used in studies on the paranasal sinus. Replica moulds of the sinus revealed a sinus cavity composed of three compartments with a total volume of 2-3 ml. The sinus cavity was connected with the nasal cavity through an ostium. By intravascular injection of silicone rubber for dissection and of methacrylate for production of corrosion casts, the vascular bed and the vessels passing to and from the sinus cavity were studied. The main arterial supply and venous drainage takes place through the ostium, which is surrounded by a dense venous plexus. Compared with the nasal mucosa, the number of vessels per volume unit is about the same in the sinus mucosa. Many vessels perforating through the osseous walls, both arteries and veins, were found, however, indicating that the blood supply is not derived exclusively from vessels coming through the ostium.


Spatial shifts in visual attention in normal ageing and dementia of the Alzheimer type.
Using a spatial-cueing paradigm, we assessed the ability of Alzheimer's disease patients, age-matched controls and younger participants to use cues to guide attention to the location indicated by the cue. In separate experiments, we attempted to isolate cues that attract attention automatically (exogenous cueing) and those that require the wilful movement of attention (endogenous cues). We found significant cueing effects for all three groups of participants for both types of cue. However, the group with Alzheimer's disease showed far greater cueing effects when using an exogenous cue, whilst no difference between group's ability to use the cue was found for the endogenous cue. No differences in cueing were found for either cue type as a function of normal ageing. We further tested whether the differences in cueing found in the group with Alzheimer's disease was due to a generalised slowing of function. After transforming the data to take account of the overall slowing of all responses in this group, we still found significant differences between this group and the control groups. We conclude that patients with Alzheimer's disease have an abnormality in automatic, but not controlled visuospatial attention.


Surgical treatment of brachiocephalic vessel involvement in Takayasu's arteritis.
Takayasu's arteritis (TA) is a chronic idiopathic inflammatory disease that affects large and medium size arteries. The brachiocephalic trunk is the most frequently involved site in TA, and multi-vessel lesions are common. Surgical treatment includes vessel reconstruction surgery and percutaneous transluminal angioplasty (PTA). Herein, we report our preliminary experience with surgical treatment of cerebral ischemia caused by cervical arterial lesions due to TA. From January 2000 to December 2007, 38 patients with cerebral ischemia caused by cervical arterial occlusive lesions due to TA were treated surgically. There were three males and 35 females, with an age range of 15 - 42 years (mean 26.5 years). All patients had operative repairs undertaken. Twenty eight patients received bypass operation and 10 patients received percutaneous transluminal angioplasty. One case with coronary stenosis received coronary artery bypass simultaneously. Patients were followed up for 11 months to eight years. There were no peri-operative deaths in cerebrovascular reconstruction patients. Symptoms of cerebral ischemia were improved or cured in 25 of 38 patients. There was a low incidence of cerebral reperfusion syndrome. Two patients died at five and seven years after surgery due to heart failure. Another 8 patients (20%) required further surgery for stenosis (5 patients) or anastomotic aneurysms (3 patients). Percutaneous transluminal angioplasty was performed successfully for treatment of aortic and renal lesions. Repeated angioplasty for revascularization was performed in six PTA cases with restenosis after 5 - 24 months. When cerebral perfusion has potential to be affected by TA, a definitive corrective procedure is advised when the patient is relatively stable. Although the recurrence rate is very high, percutaneous transluminal angioplasty is the first choice procedure. Bypass operation is optimal for brachiocephalic-vessel involvement in TA. Cerebral reperfusion syndrome can be avoided by careful selection of the operation method and improved post-operative treatment.


Reversible Light-Controlled Cargo Release in Hydrogen-Bonded Dimeric Capsules.
We describe the synthesis of three tetraureacalix[4]arenes having four appended terminal azobenzene groups. In CD2Cl2 solution and at millimolar concentration, the thermally equilibrated all-trans-tetraureas dimerize quantitatively, encapsulating one Me4P(+) cation. The light-induced isomerization of the all-trans encapsulation complexes produced a plethora of isomeric cis-enriched counterparts displaying a reduction in cavity size. cis-enriched dimers not suitable for the encapsulation of the cation or a solvent molecule are also produced, leading to partial release of the cargo (Me4P(+)) to the bulk solution. The substitution of the terminal phenyl in the azobenzene groups plays a key role in controlling the amount of released cargo in quantities up to 70%. The switching between the two states (all-trans and cis-enriched capsules) proceeds with no detectable photodegradation, even when it is repeated multiple times.


[M. sternocleidomastoideus mechanical stimulation produces lateralized effect on body schema perception].
Neck muscles play important role in body schema perception, pose and motor control. The mechanical neck muscles stimulation can influence these processes. On present investigation the kinesiology tape (KT) application was used as a local mechanical stimulation for M. sternocleidomastoideus. The results confirmed the influence of the KT application on the body schema perception. Moreover, the influence effect was lateralized in dependence on the side of the KT application. In most of the subjects the KT left application diminished the reaction time in the body schema mental rotation task. The right the KT application has not shown this effect. The possible causes of the KT application lateralized effect can be the proprioceptive asymmetry in neck muscles or the hemispheric functional asymmetry of the body schema perception process. The results may be useful for understanding the neurological nature of asymmetric body schema perception impairments as well as for the development of sport training methods.


Avascular necrosis of the humeral head treated by core decompression. A retrospective review.
Thirty shoulders, in 20 patients, which had undergone core decompression for symptomatic avascular necrosis of the humeral head were reviewed 2 to 14 years later (average 5.6). Twenty-two showed good or excellent clinical results; the other eight shoulders had required arthroplasty. All 14 shoulders with stage I or II radiological changes (Ficat and Arlet 1980) at operation had good or excellent results. We advocate early core decompression for symptomatic avascular necrosis of the humeral head.


Collaborative Value Creation Framework: The Potential for Strengthening Intersectoral Partnerships in Chronic Disease Prevention.
There is considerable theoretical appeal and investment in intersectoral partnerships for chronic disease prevention, yet there is limited understanding of pathways for creating collaborative value. The purpose of this paper was to discuss the Collaborative Value Creation Framework in terms of its potential to understand how value is created in prevention partnerships. The framework holds promise for a) studying the significance of all types of collaborative value and in what contexts, b) examining how sources of collaborative value can be enhanced, c) surfacing how mindsets advance or hinder collaborative efforts, and d) establishing interdependent links with and between other elements of the framework such as collaborative processes, stages, and outcomes to increase value creation potential. Mapping the interdependence of all elements would be an innovation to the application of the framework to discover leverage points to increase collaborative value and strengthen prevention partnerships.


Toxicity of malathion at early life stages of the Senegalese sole, Solea senegalensis (Kaup, 1858): notochord and somatic disruptions.
The toxicity of malathion to Solea senegalensis was studied in a static renewal bioassay for 24, 48 and 72 h, with toxicant concentrations ranging from 1.56 until 100 µgL⁻¹. The LC₅₀ values of malathion for 48 and 72 h was 63.5 (95% C.I: 50.83-79.34) and 22.94 (95% C.I: 17.16-30.68) µgL⁻¹ respectively. The survival of larvae was non-affected by exposure to malathion at concentrations up to 25 µgL⁻¹ (24 h NOEC), 6.25 µgL⁻¹ (48 h NOEC) and <1.6 µg⁻¹ (72 h NOEC). At the end of the experiment, surviving larvae from concentrations smaller than the 72h-LC₅₀ were chosen to study morphological changes during malathion exposure. Results revealed a strong disruption in the notochord and trunk musculature integrity as a result of toxicant exposure. Noticeable changes in the composition and reduction of collagen fibers from the perinotochordal connective sheath and perimysium were clearly detected. The trunk musculature was also altered, showing a general disorganization of fibers. Moreover, malathion exposure provoked pericardial and yolk-sac oedemas and histopathological alterations in some other organ- systems and tissues (i.e. liver, pancreas, intestine).


Microbial purification technique of mineral dressing plants reject waters.
Earlier investigations on laboratory and pilot plant scale have shown the resort to microorganisms to be a practicable approach to the problem of purifying mineral dressing plant reject waters from residual flotation reagents and/or metal ions. In spite of the proven effectiveness of this method, one major drawback, namely the pathogenicity of some microorganisms, has so far hampered its application on a commercial scale. A research programme, aimed at developing a microbial reject water purification technique utilizing non-pathogenic strains was thus drawn up and is currently being implemented. Strains such as Bacillus subtilis, Saccharomyces cerevisiae, Bifidobacterium bifidum, Lactobacillus acidophilus and Acinetobacter calcoaceticus, which are not harmful to human health, some of them being commonly found in the human intestine, have been successfully tested for removing alkylsulphates, alkylamines and fatty acids from solutions simulating flotation plant tailings waters. Removals as high as 90% in less than 48 h can be easily achieved with no nutrient requirements, since in most cases the flotation reagent residue to be removed is metabolized by the microorganisms themselves.


Repair of abdominal aortic aneurysms in patients with renal, iliac, or distal arterial occlusive disease.
Appropriate preoperative vascular assessment of patients presenting with aortic aneurysms and arterial occlusive disease is essential to obtain the optimal results from aneurysm repair. The renal arteries should be evaluated in patients with hypertension or renal dysfunction, and stenosis must be addressed when seen on arteriograms. Hemodynamically significant lesions are candidates for bypass concomitant with aortic replacement. The stump pressure of a patent inferior mesenteric artery should be assessed intraoperatively, and bypass or reimplantation should be performed if colon ischemia might result from internal mesenteric artery ligation. If vasculogenic impotence is suggested by preoperative studies, meticulous nerve-sparing dissection and revascularization of the internal iliac arteries may result in recovery of erectile function in some patients. In all cases of aneurysm repair, the hypogastric circulation must be maintained through either direct revascularization or bypass to major collateral arteries. Iliac occlusive disease may be evaluated with several modalities, including physical examination, noninvasive laboratory testing, arteriography, and the papaverine test, to determine whether critical or subcritical stenoses are present. Aortic bifurcation grafts should be used to construct the distal anastomoses beyond areas of significant disease. The extent of lower-extremity occlusive disease directly affects the long-term patency of aortic replacement, and diligent follow-up is necessary for timely intervention to maintain patency of vascular reconstructions.


Clinical study of choledochocele: is it a risk factor for biliary malignancies?
We aimed to clarify the clinical characteristics of choledochocele and to evaluate the possibility of choledochocele as a risk factor for biliary malignancies. The clinical feature, the configuration of the pancreatobiliary ductal system, coexistent pancreatobiliary lesions, and amylase level in bile in 21 patients with choledochocele were reviewed. The correlation between the configuration, comorbid diseases, and amylase level in the bile was investigated. There was a female predominance, and 57% of the patients showed abdominal pain. Quite a few patients showed elevation of the levels of hepatobiliary enzymes. The configuration of the pancreatobiliary ductal system and choledochocele was classified into two categories: type I, where the choledochocele and pancreatic duct were visualized independently or simultaneously (90.5%); and type II, where the pancreatic duct was visualized after filling of the choledochocele (9.5%). Among coexistent bilio-pancreatic diseases, biliary stone diseases were the most frequent. Biliary malignancy was seen in 3 patients (14.3%). The amylase level in the bile was high in 50% (4/8) of the patients examined. The rate of abnormal elevation of amylase level in the bile in the two types of pancreatobiliary ductal system and choledochocele was 3/7 and 1/1, respectively. The prevalence of organic abnormal arrangement of the pancreatobiliary ductal system in which the choledochocele serves as a common channel is low. However, there are patients with suspected functional abnormal arrangement of the pancreatobiliary ductal system, who may possibly be a high-risk group for biliary malignancy.


Using health technology assessment to support optimal use of technologies in current practice: the challenge of "disinvestment".
Health systems face rising patient expectations and economic pressures; decision makers seek to enhance efficiency to improve access to appropriate care. There is international interest in the role of HTA to support decisions to optimize use of established technologies, particularly in "disinvesting" from low-benefit uses. This study summarizes main points from an HTAi Policy Forum meeting on this topic, drawing on presentations, discussions among attendees, and an advance background paper. Optimization involves assessment or re-assessment of a technology, a decision on optimal use, and decision implementation. This may occur within a routine process to improve safety and quality and create "headroom" for new technologies, or ad hoc in response to financial constraints. The term "disinvestment" is not always helpful in describing these processes. HTA contributes to optimization, but there is scope to increase its role in many systems. Stakeholders may have strong views on access to technology, and stakeholder involvement is essential. Optimization faces challenges including loss aversion and entitlement, stakeholder inertia and entrenchment, heterogeneity in patient outcomes, and the need to demonstrate convincingly absence of benefit. While basic HTA principles remain applicable, methodological developments are needed better to support optimization. These include mechanisms for candidate technology identification and prioritization, enhanced collection and analysis of routine data, and clinician engagement. To maximize value to decision makers, HTA should consider implementation strategies and barriers. Improving optimization processes calls for a coordinated approach, and actions are identified for system leaders, HTA and other health organizations, and industry.


Seizure possibly associated with fluvoxamine.
To inform clinicians of the possibility that seizures due to therapeutic doses of fluvoxamine may not be as rare as previously considered. A 49-year-old white man with schizoaffective disorder and a past history of seizures secondary to head trauma had been seizure-free for approximately 10 years. Fluvoxamine therapy was begun due to increasing obsessive-compulsive behavior. Despite receiving anticonvulsants for his mood disorder, the patient had a breakthrough seizure. There were no underlying medical conditions that might have induced this seizure. No further seizures occurred after he was placed on a higher dosage of the anticonvulsants. The obsessive-compulsive behavior improved considerably as a result of fluvoxamine treatment. The patient presented here developed a seizure with a therapeutic dosage of fluvoxamine; seizures associated with this agent have occurred more often with overdose. Multiple factors such as a prior history of seizures, head trauma, and concurrent treatment with other psychotropic agents are considered in this case report. Despite the relatively safe and benign adverse effect profile of the selective serotonin-reuptake inhibitors such as fluvoxamine, clinicians should be cautious about seizures as an adverse effect, especially when the patient has even a remote history of seizure or head trauma.


Entrainment from the para-Hisian region for differentiating atrioventricular node reentrant tachycardia from orthodromic atrioventricular reentrant tachycardia.
The difference between the stimulus-atrial and ventriculo-atrial intervals (SA-VA) and between the post-pacing interval and the tachycardia cycle length (PPI-TCL) during entrainment from the right ventricular apex distinguishes atrioventricular node reentrant (AVNRT) from orthodromic atrioventricular reentrant tachycardia (AVRT). We hypothesized that these features still apply when entrainment is performed from the para-Hisian region. Forty-seven supraventricular tachycardias (34 AVNRT/13 AVRT) were included. The SA-VA and PPI-TCL were obtained in all patients by using two right-sided diagnostic catheters. In 24 of them, these measurements were also performed upon His-bundle capture during entrainment. A paced QRS widening of >or=40 ms during entrainment, when compared with the tachycardia QRS width, identified absence of His-bundle capture, P < 0.001. A SA-VA >75 ms distinguished AVNRT from AVRT, P < 0.001 (sensitivity/specificity 97%/100%). A PPI-TCL >100 ms was diagnostic of AVNRT, P < 0.001 (sensitivity/specificity 97%/92%). Upon His-bundle capture, the SA-VA and PPI-TCL shortened in AVNRT (121 +/- 23 to 66 +/- 24 ms; 139 +/- 30 to 85 +/- 31 ms, respectively, P < 0.001) and no longer differentiated AVNRT from AVRT. Para-Hisian entrainment without His-bundle capture distinguishes AVNRT from AVRT with the advantage of using only two diagnostic catheters.


An investigation of dento-alveolar trauma and its treatment in an adolescent population. Part 1: The prevalence and incidence of injuries and the extent and adequacy of treatment received.
To measure the prevalence and incidence of dental trauma and to assess the extent and success of treatment provided. Cross-sectional and one-year incremental study. 2022 11-14-year-old pupils were examined in schools for clinical evidence of trauma of anterior teeth. 1891 were examined 15 months later. A history of the trauma and treatment provided were obtained together with some social data. Radiographs were taken of affected teeth. Degree of trauma, whether treatment was provided and its quality, ACORN classification. 34% had suffered trauma but only 12% needed treatment for 332 teeth. 47% of these teeth had received treatment, of which 59% was inadequate. After 15 months 4% had experienced new injuries. 42% of boys and 28% of girls (P < 0.01) had sustained injuries, as had 38% from ACORN group III and 30% from groups I and II. 67% of those with pain and 40% of those without attended for treatment (P < 0.01), while 69% who were unhappy with the appearance and 35% who were not (P < 0.01) attended. The primary care services currently available for the treatment of dental trauma are inadequate.


Serologic responses of dogs naturally exposed to or vaccinated against Borrelia burgdorferi infection.
To characterize the serologic responses of dogs naturally exposed to or vaccinated against Borrelia burgdorferi and to assess responses at intervals after antibiotic treatment. Prospective, controlled clinical trial. 19 dogs of various breeds and ages with narrowly defined clinical criteria of limb/joint borreliosis and 10 control dogs of equivalent age were used to determine serologic responses following natural exposure to the organism. Eight seronegative dogs were used to determine serologic responses following vaccination. Serologic responses to B burgdorferi and recombinant outer surface protein (Osp)A, flagellin, and P39 were assessed by means of ELISA and western immunoblot. Passive protective activity was assessed by use of a mouse protection assay. Naturally exposed dogs were seropositive, but had variable ELISA titers and immunoblot profiles. Immunoblot analysis did reveal consistent reactions to flagellin, P39, and a 22 kd protein, but not to OspA. Antibody responses did not change appreciably up to 13 weeks after antibiotic treatment. Vaccinated dogs had strong reactions to OspA and OspB, but not to P39. Dogs with clinical borreliosis are seropositive and remain seropositive after antibiotic treatment, emphasizing that serologic testing is not a useful means of measuring clinical response. Serologic responses of infected dogs can be discriminated from those of vaccinated dogs by means of immunoblot analysis, and recombinant P39 is a potentially useful antigen for that purpose.


Slow axoplasmic transport: a fiction?
Ribosomes have not been observed in axoplasm. This had led to the notions that the perikaryon is the only source of neuronal proteins and that the axoplasm is supplied by a (slow) transport mechanism. However, we question these two notions because they are unable to give an account of real neurones in accordance with the body of biological knowledge. We point out, for example, that the synthetic rate of perikarya or the life span of axoplasmic proteins should be beyond known ranges for animal cells and that a uniform axon is unlikely to result if it is fed from one end. We propose an alternative view for the maintenance of the axon which accepts the controversial idea of axoplasmic synthesis of proteins; as a result, the slow transport becomes unnecessary. Our view gives a qualitative account of the observations dealing with the maintenance of the axoplasm. To account for the phenomenology in a more quantitative fashion, a computer simulation was carried out where the equations of the program provided only for axoplasmic synthesis of proteins; the set of curves retrieved were in good agreement with experimental findings believed so far to support the notion of slow transport. In conclusion, we think that the notion of "slow axoplasmic transport" has been a misinterpretation of good observations because the frame of reference was incomplete in not providing for axoplasmic synthesis of proteins.


Bond strength of self-adhesive resin cements to dry and moist dentin.
This study evaluated the effects of humidity conditions and evaluation times on the dentin bond strength (DBS) of two self-adhesive resin cements (RC). The RC used were: RelyX Unicem (3M ESPE) and Clearfil SA Cement (Kuraray Med.). One hundred and twenty coronal portions of bovine incisors (n = 10) were used. Buccal surfaces were abraded in order to expose a flat dentinal surface (180-grit SiC) and to standardize the smear layer formation (600-grit SiC). The humidity conditions tested were: dry (air-dried for 10 s), slightly moist (water application with disposable applicator on dried dentin and water excess removed with absorbent paper), and moist (same application without water removal). The RC were used according to the manufacturers' recommendations and were applied to prepolymerized resin discs (2 mm thick; Sinfony, 3M ESPE), which were subsequently bonded to the dentin surfaces. After 24 h, half of the teeth were prepared for the microtensile bond strength test, while the other half were stored in water for 6 months and tested in tension (0.5 mm/min) until failure. A 3-way analysis of variance and the Tukey test were performed (preset alpha of 0.05). No RC showed any reduction of DBS after 6 months, and no significant difference was observed between them. The moist dentin increased the bond strength of Clearfil SA Cement for both periods of time. Humidity conditions can change the DBS; however, the study's results were product-dependent.


An intragenic duplication in guanosine triphosphate cyclohydrolase-1 gene in a dopa-responsive dystonia family.
Autosomal dominant dopa-responsive dystonia is commonly caused by mutations in the guanosine triphosphate cyclohydrolase-1 gene. We report a British family that has been followed for more than 20 years in which no mutations were previously identified. Reanalysis of this pedigree detected a duplication of guanosine triphosphate cyclohydrolase-1 exon 2 in affected family members. mRNA analysis showed a mutant transcript with a tandem exon 2 duplication. Four family members developed dopa-responsive dystonia, with onset in their late teens, and subsequently developed restless leg syndrome and migraine. This is the first report of an intragenic guanosine triphosphate cyclohydrolase-1 duplication in a dopa-responsive dystonia family.


Anatomical study on the morphology and blood supply of the falciform ligament and its clinical significance.
The purpose of this study was to understand the clinical significance of the morphology and blood supply of the falciform ligament in laparoscopic surgery. The structure, blood vessel distribution and anastomoses of the falciform ligament were observed in 20 cases of living laparoscopy, 30 cadaveric specimens injected with latex and five cadaveric specimens with Indian ink and hyaline. The falciform ligament was formed by two sides of peritoneum and its length, largest and smallest width were 8.3+/-1.6 cm, 4.9+/-0.8 cm and 1.1+/-0.3 cm, respectively. The left inferior phrenic artery and middle segment artery of the liver formed a vessel that arched and gave off 6-12 branches to the falciform ligament. The veins of the falciform ligament drained into the left inferior phrenic vein, and were not accompanied by any artery. In conclusion, the vessels of the falciform ligament anastomose with multiple vessels and form a significant pathway of the collateral circulation in the liver. The falciform ligament is an important landmark in laparoscopic surgery.


[Sustained upgaze in a patient who ingested high doses of bupropion. Report of one case].
Upgaze or sustained elevation of the eyes, is an alteration of ocular motility initially described in hypoxic coma. We report a 65-year-old woman admitted with hypotension and alteration of sensorium due to the ingestion of 9.5 g of Bupropion. She presented two seizures of short duration, without epileptic activity on the EEG. She had a persistent asynchronous myoclonus in extremities, tachycardia and prolonged Q-t. She suffered a cardiac arrest caused by asystole, which recovered quickly in five minutes. At that moment, upgaze appeared, associated with a persistent ocular opening, which persisted for days, but finally disappeared, without remission of coma. A magnetic resonance imaging done at the eighth day, showed hyperintensity of the oval center and corpus callosum which disappeared in a new imaging study done 30 days later, where images of hypoxia in the basal nuclei and cortex appeared. The patient died forty seven days after admission. Up-gaze is an ominous oculomotor alteration linked to an important but incomplete damage in the cerebral cortex, a condition that perverts some sequences of the ocular opening, reversing the Bell phenomenon and producing eyelid retraction.


The incidence of error in young children's Wh-questions.
Many current generativist theorists suggest that young children possess the grammatical principles of inversion required for question formation but make errors because they find it difficult to learn language-specific rules about how inversion applies. The present study analyzed longitudinal spontaneous sampled data from twelve 2-3-year-old English speaking children and the intensive diary data of 1 child (age 2;7 [years;months] to 2;11) in order to test some of these theories. The results indicated significantly different rates of error use across different auxiliaries. In particular, error rates differed across 2 forms of the same auxiliary subtype (e.g., auxiliary is vs. are), and auxiliary DO and modal auxiliaries attracted significantly higher rates of errors of inversion than other auxiliaries. The authors concluded that current generativist theories might have problems explaining the patterning of errors seen in children's questions, which might be more consistent with a constructivist account of development. However, constructivists need to devise more precise predictions in order to fully explain the acquisition of questions.


Comprehensive assessment of the association between miRNA polymorphisms and gastric cancer risk.
Single nucleotide polymorphisms (SNPs) in pri- or pre-microRNAs (miRNAs) were found to be associated with gastric cancer risk. The aim of this study was to systematically review with update meta-analysis for the association of miRNA SNPs with gastric cancer risk. We systematically reviewed a total of 31 SNPs in the precursor genes of 29 miRNAs associated with overall cancer risk. Meanwhile, 13 case-control studies with a total of 9044 gastric cancer cases and 11,762 controls were included in a meta-analysis of five highly studied pre-miRNA SNPs (miR-146a rs2910164, miR-196a2 rs11614913, miR-499 rs3746444, miR-149 rs2292832 and miR-27a rs895819). Our results show both the homozygous miR-27a rs895819 and the miR-149 rs2292832 heterozygote genotype were associated with a decreased risk of gastric cancer when compared with wild type. In the stratified analysis, in some subgroup, heterozygous miR-146a rs2910164 was associated with a decreased risk of gastric cancer; and the variant genotype of miR-196a-2 rs11614913 was associated with an increased risk. No association was found between miR-499 rs3746444 and gastric cancer risk. In summary, miR-27a rs895819 and miR-149 rs2292832 are of potential forewarning ability for gastric cancer risk.


Carbamazepine-related hyponatremia following cardiopulmonary bypass.
A 67-year-old man on long-term carbamazepine therapy underwent elective coronary artery bypass grafting. Following an initially uncomplicated recovery, he developed symptomatic hyponatremia. The symptoms and biochemical abnormality improved after gradual discontinuation of carbamazepine. We discuss the association between carbamazepine and hyponatremia and the causes of hyponatremia after cardiopulmonary bypass. Surgeons should consider stopping carbamazepine before operations with cardiopulmonary bypass.


Mesh erosion in robotic sacrocolpopexy.
This study aimed to compare the incidence of mesh erosion after robotic sacrocolpopexy between women undergoing total and those undergoing supracervical hysterectomy (SH). This is a retrospective cohort study of women who underwent sacrocolpopexy and concomitant hysterectomy using the DaVinci surgical robot between May 2007 and December 2010 at 2 sites. Baseline data were gathered before surgery. The primary outcome was mesh erosion identified during 3 months of follow-up. A total of 102 women underwent sacrocolpopexy, of whom 45 were with concomitant SH and 57 were with total hysterectomy (TH). Their mean age was 58 years, mean body mass index was 26.8 kg/m, 98% were white, 6% smoked, and 25% were on systemic hormone replacement therapy. Mean preoperative Ba = +1.4, C = -2.2. These were not different between the 2 groups or by site. Within 3 months of surgery, mesh erosion was diagnosed in 8 women, all of whom had TH. No mesh erosions occurred in the SH group (14% vs 0%). Total hysterectomy mesh erosion rate at site 1 was 37% compared with 3% [corrected] at site 2. Mesh type was the only identifiable difference between sites: self-cut polypropylene at site 1, precut polypropylene at site 2. Two women in the SH had abnormal uterine pathology: 1 endometrial adenocarcinoma and 1 focus of hyperplasia with atypia. No mesh erosions were associated with SH within the first 3 months. In TH, the graft material used may be a modifiable factor needing further investigation. Unexpected abnormal uterine pathologic diagnosis remains a possibility with SH. Longer-term follow-up and a randomized trial are warranted to answer these questions.


Anatomic and histologic studies of lateral collateral ligament complex of the elbow joint.
We studied the gross and histologic anatomic characteristics of the lateral collateral ligament complex of the elbow joint from 15 cadavers to demonstrate its cross-sectional anatomy. The lateral ulnar collateral ligament adheres closely to the supinator, the extensor muscles, its intermuscular fascia, and the anconeus muscle and lies posterior to the radial collateral ligament. The lateral ulnar collateral ligament itself was identified with microscopy as a slender, poor structure consisting of the thick area of the posterolateral capsuloligamentous layer and a poorer structure than the anterior bundle of the medial collateral ligament as the primary stabilizer of the elbow joint. We believe that the lateral ulnar collateral ligament contributes to rather than is a major constraint to the posterolateral rotatory instability as part of the lateral collateral ligament complex with the surrounding tissues.


Role of the medial parieto-occipital cortex in the control of reaching and grasping movements.
The medial parieto-occipital cortex is a central node in the dorsomedial visual stream. Recent physiological studies in the macaque monkey have demonstrated that the medial parieto-occipital cortex contains two areas, the visual area V6 and the visuomotor area V6A. Area V6 is a retinotopically organized visual area that receives form and motion information directly from V1 and is heavily connected with the other areas of the dorsal visual stream, including V6A. Area V6A is a bimodal visual/somatosensory area that elaborates visual information such as form, motion and space suitable for the control of both reaching and grasping movements. Somatosensory and skeletomotor activities in V6A affect the upper limbs and involve both the transport phase of reaching and grasping movements. Finally, V6A is strongly and reciprocally connected with the dorsal premotor cortex controlling arm movements. The picture emerging from these data is that the medial parieto-occipital cortex is well equipped to control both proximal and distal movements in the online visuomotor guidance of prehension. In agreement with this view, selective V6A lesions in monkey produce misreaching and misgrasping with the arm contralateral to the lesion in visually guided movements. These deficits are similar to those observed in optic ataxia patients and suggest that human and monkey superior parietal lobules are homologous structures, and that optic ataxia syndrome is the result of the lesion of a 'human' area V6A.


Selection and characterization of an L-thiazolidine-4-carboxylic acid resistant callus culture of Vigna radiata (L.) Wilczek var. radiata.
Callus cultures were established from seedling root tips of mungbean (Vigna radiata (L.) Wilczek var. radiata) cv. K 851. The growing calli were exposed to increasing concentrations of thioproline - an analog of proline, in the medium. A concentration of 3.0 mM thioproline completely inhibited the growth of the cells. However, after 25 days incubation 5 cell clones were obtained which could grow on this concentration of thioproline. Out of them one vigorously growing cell clone was further characterized. This selected clone contained higher endogenous levels of free proline (5 fold) and K(+) (1.5 fold) and exhibited elevated tolerance, not only to thioproline but also to exogenously applied NaCl in the growth medium, as compared to the normal sensitive callus cells. Higher endogenous levels of free proline and K(+) appear to impart dual resistance to thioproline and NaCl to the selected cell strain.


Premature ovarian insufficiency and neurological function.
Premature ovarian insufficiency (POI) involves loss of ovarian function before age 40. POI has been associated with neurological dysfunction and an increased risk of dementia, perhaps due to depletion in estrogen levels. The present review discusses the effects of POI caused by genetic disorder, natural premature menopause, surgical menopause, breast cancer treatment and gonadotropin-releasing hormone (GnRH) agonist treatment. Overall, data suggest an increased risk of neurological disorder where POI is due to premature menopause or induced from surgery. This increased risk appears to be most apparent on domains of global cognitive and verbal memory tests. Where POI is caused by genetic disorder, observed cognitive deficiencies may be more likely to have a genetic basis rather than being due to the effects of sex steroids on the brain. Findings related to loss of cognitive function after chemotherapy or GnRH treatments are mixed. There are also discrepant data related to use of hormone therapy after POI (particularly after surgical menopause). After surgery, hormone treatment appears to be most beneficial if initiated close to the average natural age of menopause.


Verb subcategorization frequencies: American English corpus data, methodological studies, and cross-corpus comparisons.
Verb subcategorization frequencies (verb biases) have been widely studied in psycholinguistics and play an important role in human sentence processing. Yet available resources on subcategorization frequencies suffer from limited coverage, limited ecological validity, and divergent coding criteria. Prior estimates of verb transitivity, for example, vary widely with corpus size, coverage, and coding criteria This article provides norming data for 281 verbs of interest to psycholinguistic research, sampled from a corpus of American English, along with a detailed coding manual. We examine the effect on transitivity bias of various coding decisions and methods of computing verb biases.


The Laparoscopic Versus Open Approach for Reduction of Intussusception in Infants and Children: An Updated Institutional Experience.
We have previously demonstrated successful laparoscopic management after failed enema reduction of children with intussusception. The purpose of this study is to assess the effectiveness of our mature experience with laparoscopic reduction by evaluating operative success, duration of hospital stay, postoperative complications, and hospital readmission rates. After IRB approval, a retrospective review was conducted on children (age 0-18 years) who failed enema reduction of intussusception between 2008 and 2017. Cases were classified as either open or laparoscopic. Demographic data, incidence of bowel resection, postoperative length of stay, complications, and hospital readmission rates were abstracted from patient medical records. Comparative analysis was performed in STATA with a P value <.05 determined as significant. A total of 81 children were included in our study with 63 patients (78%) undergoing a laparoscopic reduction and 18 patients (22%) undergoing an open operation. Laparoscopic reduction carried similar complication rates (11%) when compared with children undergoing an open reduction (11%, P = 1.00). Furthermore, both hospital readmission rates and returns to the operating room were similar between the two groups (P = .345 and P = .672, respectively). The median postoperative length of stay was shorter for patients undergoing a laparoscopic reduction (4 days, interquartile range [IQR], 2-5 days) than for patients undergoing an open reduction (5 days, IQR, 4-6 days, P = .001). Children undergoing a laparoscopic reduction had a decreased rate of bowel resection (43% versus 50%, P = .591) despite similar rate of pathological lead points (21% versus 22%, P = .884). Laparoscopic management of intussusception after failed radiographic reduction yields a reduced hospital length of stay with no increase in hospital readmission rates and reoperations.


Health studies on the Indian house crow (Corvus splendens).
Fifteen Indian house crows (Corvus splendens) were obtained from a live-trap in Dar es Salaam, Tanzania. Two died soon after arrival. The remainder were examined clinically prior to euthanasia. All birds were examined post-mortem and a limited number of laboratory investigations was performed. None of the birds showed significant clinical signs or pathological lesions. Lice were found on one. Only Escherichia coli and Proteus spp. were isolated from the rectum. Coccidia were detected in three birds and cestodes in one. Haematological values were low. No blood parasites were seen. More extensive studies are warranted on the possible role of this species in the dissemination of pathogens.


Ideology and technology: the social context of procreative technology.
Biomedical practices and research in procreation are shaped by three ideologies deeply rooted in American society: patriarchy with its control of women's bodies in the interest of men's procreative concerns and with its focus on 'seeds' and therefore genetics; technology as an ideology of efficiency, productivity, rationality, and control; and capitalism both as an ideology and as a practice, a mechanism that markets technologies of procreation.