Six-month bracket failure rate with a flowable composite: A split-mouth randomized controlled trial

INTRODUCTION:

The use of flowable composites as an orthodontic bonding adhesive merits great attention because of their adequate bond strength, ease of clinical handling and reduced number of steps in bonding.

OBJECTIVE:

The aim of this Randomized Controlled Trial was to comparatively evaluate over a 6-month period the bond failure rate of a flowable composite (Heliosit Orthodontic, Ivoclar Vivadent AG, Schaan) and a conventional orthodontic bonding adhesive (Transbond XT, 3M Unitek).

METHODS:

53 consecutive patients (23 males and 30 females) who fulfilled the inclusion and exclusion criteria were included in the study. A total of 891 brackets were analyzed, where 444 brackets were bonded using Heliosit Orthodontic and 447 brackets were bonded using Transbond XT. The survival rates of brackets were estimated with the Kaplan-Meier analysis. Bracket survival distributions for bonding adhesives, tooth location and dental arch were compared with the log-rank test.

RESULTS:

The failure rates of the Transbond XT and the Heliosit Orthodontic groups were 8.1% and 6% respectively. No significant differences in the survival rates were observed between them (p= 0.242). There was no statistically significant difference in the bond failure rates when the clinical performance of the maxillary versus the mandibular arches and the anterior versus the posterior segments were compared.

CONCLUSIONS:

Both systems had clinically acceptable bond failure rates and are adequate for orthodontic bonding needs.

Rojan P, Jayasree S. VIRULENCE STUDIES OF PASTEURELLA MULTOCIDA IN MICE, DUCKLINGS AND ADULT DUCKS

Pasteurella multocida is a Gram negative bacterium causing severe disease in a multitude of hosts; the A: 1 strain of this bacterium is extremely virulent to hosts. In this study, the virulence of P. multocida A: 1 strain was assessed in one month old ducklings, six months old ducks and eight weeks old albino mice. The groups of experimental animals were inoculated with the different dilutions of the bacteria through subcutaneous route. The control groups were sham inoculated with sterile phosphate buffered saline via respective routes. Mortality was recorded for two weeks post inoculation. All the dead animals and birds were examined for specific gross lesions of pasteurellosis and attempted re-isolation of the organism on blood agar from their internal organs. The median lethal dose was calculated using Reed and Muench method. For ducklings, the median lethal dose was 13 colony forming units and the dilution giving 50 % end point with 0.1 ml subcutaneous dose was 10-7.4. The median lethal dose could not be arrived at for mice and adult ducks as the strain killed all the inoculated mice even in the lowest dilution tested, while most of the adult ducks were resistant to infection.

G. B, Sebastian P, Somananthan T, Maliekal TT. TM1-IR680 peptide for assessment of surgical margin and lymph node metastasis in murine orthotopic model of oral cancer

Treatment outcome after surgical removal in oral carcinoma is poor due to inadequate methodologies available for marking surgical margins. Even though some methodologies for intraoperative margin assessment are under clinical and preclinical trials for other solid tumours, a promising modality for oral cancer surgery is not developed. Fluorescent-based optical imaging using Near Infrared (NIR) dyes tagged to tumour specific target will be an optimal tool for this purpose. One such target, Gastrin Releasing Peptide Receptor (GRPR) was selected for the study, and its binding peptide, TM1-IR680, was tested for its efficacy for surgical margin prediction in murine orthotopic model of oral cancer, derived from primary samples. Here, for the first time in a preclinical analysis, we show that the size and margin of oral cancer can be predicted, as revealed by 3D-imaging. Interestingly, the peptide was sensitive enough to detect lymph nodes that harboured dispersed tumour cells before colonization, which was impossible to identify by conventional histopathology. We recommend the use of TM1-NIR dyes alone or in combination with other technologies to improve the clinical outcome of oral cancer surgery.

Hughes Abdominal Repair Trial (HART) - Abdominal wall closure techniques to reduce the incidence of incisional hernias: study protocol for a randomised controlled trial

Background

Incisional hernias are common complications of midline closure following abdominal surgery and cause significant morbidity, impaired quality of life and increased health care costs.

The ‘Hughes Repair’ combines a standard mass closure with a series of horizontal and two vertical mattress sutures within a single suture. This theoretically distributes the load along the incision length as well as across it. There is evidence to suggest that this technique is as effective as mesh repair for the operative management of incisional hernias; however, no trials have compared the Hughes Repair with standard mass closure for the prevention of incisional hernia formation following a midline incision.

Methods/design

This is a 1:1 randomised controlled trial comparing two suture techniques for the closure of the midline abdominal wound following surgery for colorectal cancer. Full ethical approval has been gained (Wales REC 3, MREC 12/WA/0374). Eight hundred patients will be randomised from approximately 20 general surgical units within the United Kingdom. Patients undergoing open or laparoscopic (more than a 5-cm midline incision) surgery for colorectal cancer, elective or emergency, are eligible. Patients under the age of 18 years, those having mesh inserted or undergoing musculofascial flap closure of the perineal defect in abdominoperineal wound closure, and those unable to give informed consent will be excluded. Patients will be randomised intraoperatively to either the Hughes Repair or standard mass closure. The primary outcome measure is the incidence of incisional hernias at 1 year as assessed by standardised clinical examination. The secondary outcomes include quality of life patient-reported outcome measures, cost-utility analysis, incidence of complete abdominal wound dehiscence and C-POSSUM scores. The incidence of incisional hernia at 1 year, assessed by computerised tomography, will form a tertiary outcome.

Discussion

A feasibility phase has been completed. The results of the study will be used to inform current and future practice and potentially reduce the risk of incisional hernia formation following midline incisions.

Trial registration

Trial Registration Number: ISRCTN 25616490. Registered on 1 January 2012.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-016-1573-0) contains supplementary material, which is available to authorized users.

A Bemisia tabaci midgut protein interacts with begomoviruses and plays a role in virus transmission

Begomoviruses are a major group of plant viruses, transmitted exclusively by Bemisia tabaci (Gennadius) in a persistent circulative non-propagative manner. The information regarding molecular and cellular basis underlying Begomovirus - whitefly interaction is very scarce. Evidences have suggested that the insect gut possesses some crucial protein receptors that allow specific entry of virus into the insect haemolymph. We have performed yeast two hybrid gut cDNA expression library screening against coat protein of Tomato leaf curl New Delhi virus (ToLCV) and Cotton leaf curl Rajasthan virus (CLCuV) as bait. Midgut protein (MGP) was the common protein found interacting with both ToLCV and CLCuV. MGP was localized in whole mount B. tabaci as well as in dissected guts through confocal microscopy. Pull down and dot blot assays confirmed in vitro interaction between ToLCV/CLCuV coat protein and MGP. Immunolocalization analysis also showed colocalization of ToLCV/CLCuV particles and MGP within insect's gut. Finally, anti-MGP antibody fed B. tabaci, exhibited 70% reduction in ToLCV transmission, suggesting a supportive role for MGP in virus transmission.

Distribution of Bemisia tabaci Genetic Groups in India

The whitefly Bemisia tabaci (Gennadius) (Hemiptera: Aleyrodidae) is a phloem-feeding, economically important pest of crops worldwide. In addition to direct damage, it also vectors a number of plant viruses belonging to the family Geminiviridae. Its populations differ biologically with respect to insecticide resistance, virus transmission and host range. Therefore, understanding genetic variation among populations is important for management. We sequenced 850 bp of the mitochondrial COI (mtCOI) gene from B. tabaci populations surveyed across India. BLAST analysis of the mtCOI sequences generated in this study with sequences from the mtCOI dataset showed the presence of one invasive group, MEAM1, and eight other groups of B. tabaci in India. mtCOI sequence analyses showed the presence of Asia I, Asia I-India, Asia II-1, Asia II-5, Asia II-7, Asia II-8, and Asia II-11 genetic groups. We also found China-3 in a field in Birbhum district, West Bengal, India, suggesting a role of anthropogenic activities in the distribution of B. tabaci. Interestingly, more than one genetic group was found coexisting in the same field.

Multi-phased anaerobic baffled reactor treating food waste

This study was conducted to identify the performance of a multi-phased anaerobic baffled reactor (MP-ABR) with food waste (FW) as the substrate for biogas production and thereby to promote an efficient energy recovery and treatment method for the wastes with high organic solid content through phase separation. A four-chambered ABR was operated at an HRT of 30 days with an OLR of 0.5-1.0 g-VS/Ld for a period of 175 days at 35 ± 1°C. Consistent overall removal efficiencies of 85.3% (CODt), 94.5% (CODs), 89.6% (VFA) and 86.4% (VS) were observed throughout the experiment displaying a great potential to treat FW. Biogas generated was 215.57 mL/g-VS removed d. Phase separation was observed and supported by the COD and VFA trends, and an efficient recovery of bioenergy from FW was achieved.

A Case of Histoid Leprosy in a HIV Infected Person on HAART not responding to conventional MB MDT

A 46 year old male diagnosed case of Acquired Immuno Deficiency Syndrome (AIDS) on Highly Active Anti Retroviral Therapy (HAART) presented with raised nodular skin lesions of two months duration which on skin biopsy was diagnosed as Histoid leprosy. Individual was put on standard Multi Bacillary Multi Drug Therapy (MB MDT) for two months has shown exacerbation of lesion and was later put on daily Rifampicin, Ofloxacin and Minocycline (ROM) for which he responded. Interesting feature is rarity of association of HIV with Histoid Leprosy where the patient did not respond to the conventional MB MDT and later responded to daily ROM.

Comparative evaluation of botulinum toxin versus iontophoresis with topical aluminium chloride hexahydrate in treatment of palmar hyperhidrosis

BACKGROUND

Hyperhidrosis is generalised or focal excessive sweating and carries a substantial psychological and social burden. This study compares botulinum toxin versus iontophoresis with topical aluminium chloride hexahydrate in palmar hyperhidrosis.

METHODS

The study included 60 cases of palmar hyperhidrosis randomly allocated to 2 groups. One group was given botulinum toxin type A 100 units per palm and the other group subjected to digital iontophoresis with topical application of aluminium chloride hexahydrate lotion for 4 weeks. They were assessed 4 weeks later and those without improvement were crossed over to the other arm for another 4 weeks. Those with improvement were followed up in the same arm for 6 months.

RESULTS

Botulinum therapy showed significant improvement in the initial (80%) as well as cross over cases (75%) as compared to iontophoresis and aluminium chloride (47%) for initial cases and (17%) for cross over cases.

CONCLUSION

Better improvements were seen with botulinum therapy than with iontophoresis and topical therapy. Residual effects of relief lasted on an average for 4 months for botulinum toxin whereas it was one month with iontophoresis and topical therapy. Advantage with iontophoresis and topical therapy was that it was non invasive and did not require regional anaesthesia as with botulinum therapy.

A case of histoid leprosy in a HIV infected person on HAART not responding to conventional MB-MDT

A 46 year old male diagnosed case of Acquired Immune Deficiency Syndrome (AIDS) on Highly Active Anti Retroviral Therapy (HAART) presented with raised nodular skin lesions of two months duration which on skin biopsy was diagnosed as Histoid leprosy. Individual was put on standard Multi Bacillary Multi Drug Therapy (MB MDT) for two months has shown exacerbation of lesion and was later put on daily Rifampicin, Ofloxacin and Minocycline (ROM) for which he responded. Interesting feature is rarity of association of HIV with Histoid Leprosy where the patient did not respond to the conventional MB MDT and later responded to daily ROM.

Molecular characterization and analysis of bacterial diversity in Aleurocanthus woglumi (Hemiptera: Aleyrodidae)

Aleurocanthus woglumi Ashby (Hemiptera: Aleyrodidae), commonly referred to as citrus blackfly, is a sap-sucking hemipteran insect. Although polyphagous, citrus is its most preferred host plant. Samples of this insect were collected from Murraya koenigii (L.). The cytochrome c oxidase subunit I gene (mtCO1)-based analysis by sequencing helped in molecular identification of the insect. Phylogenetic analysis of cytB-nd1-LrDNA showed the coevolution of A. woglumi with its primary bacterial symbiont Portiera. Sequencing a 16S rDNA library from insect DNA revealed three bacterial phylotypes, namely, Portiera, Wolbachia, and Erwinia chrysanthemi. Further, we used fluorescence in situ hybridization to visualize the endosymbionts in a whole mount of A. woglumi. Culturable bacteria were obtained on different media and were classified on the basis of 16S rDNA. In total, 30 bacterial phylotypes belonging to 14 different genera, namely, Bacillus, Kocuria, Micrococcus, Staphylococcus, Paenibacillus, Rhodococcus, Rummellibacillus, Arthrobacter, Curtobacterium, Psychrobacillus, Listeria, Brevibacillus, Bhargavae, and Pantoea, were isolated by culturable methods.

Detection and localization of Rickettsia sp in mealybug

Mealybug, Phenacoccus solenopsis Tinsley, is a sap-sucking hemipteran insect. It is an agricultural pest that is now widely distributed in India. In this study we report the presence of Rickettsia from P. solenopsis. We constructed a 16S rRNA gene library to study the bacterial diversity associated with this insect and we found that all the clones from the library were only of Candidatus Tremblaya phenacola. This study also highlights that the normal protocol adopted to study the bacterial diversity from environmental sample, by preparation of a 16S rRNA gene library, does not work when the bacterial population is highly skewed in favor of one bacteria (primary endosymbiont in this case). Hence, we used bacterial genus specific polymerase chain reaction primers to test the presence of any of the widely known secondary endosymbionts associated with insects. We tested for the presence of Cardinium, Rickettsia, Wolbachia, and Arsenophonus in P. solenopsis collected from 10 different locations across India. Only Rickettsia was detected from four locations while we were not able to find any other bacteria. We confirmed the presence of these bacteria by localizing Rickettsia and the primary endosmbiont, Candidatus Tremblaya sp. to the bacteriocyte of P. solenopsis using fluorescent in situ hybridization.

Haemorrhage control in pelvic fractures--a survey of surgical capabilities

BACKGROUND

In the emergency management of patients with pelvic fractures, there is ongoing debate about the roles of angiography and open pelvic packing. It is agreed that some form of haemorrhage control is required for patients who are haemo-dynamically unstable despite resuscitation. We set out to determine whether on-call general and orthopaedic surgeons would feel able to perform emergency surgical procedures for these patients and whether vascular radiology was available to them.

METHODS

Surveys were sent to all 221 general and orthopaedic surgeons in Wales. Questions included: sub-speciality interest, geographical region, whether there is a pelvic binder in their hospital, availability of interventional radiology, and whether surgeons would perform a range of procedures to control haemorrhage in the emergency setting.

RESULTS

There were 141 responses to the survey, giving a 64% response rate. Only 18% reported that their unit had a formal rota for interventional radiology out of hours. 16% did not know. 96% of orthopaedic surgeons would perform external fixation, although only 49% would use a C-clamp. 90% of general surgeons would be able to pack the pelvis from within the abdominal compartment and 84% would be prepared to cross-clamp the aorta if the situation required. Despite being widely recommended in the literature as a method of haemorrhage control, our survey revealed only 45% would perform extra(pre)-peritoneal packing of the pelvis (58% of general surgeons; 34% of orthopaedic surgeons) and only 12% had received formal training in this procedure.

CONCLUSIONS

With appropriately targeted training it is likely that the care of patients with pelvic fractures can be significantly improved.

Arsenic-induced alteration in intracellular calcium homeostasis induces head kidney macrophage apoptosis involving the activation of calpain-2 and ERK in Clarias batrachus

We had earlier shown that exposure to arsenic (0.50 μM) caused caspase-3 mediated head kidney macrophage (HKM) apoptosis involving the p38-JNK pathway in Clarias batrachus. Here we examined the roles of calcium (Ca(2+)) and extra-cellular signal-regulated protein kinase (ERK), the other member of MAPK-pathway on arsenic-induced HKM apoptosis. Arsenic-induced HKM apoptosis involved increased expression of ERK and calpain-2. Nifedipine, verapamil and EGTA pre-treatment inhibited the activation of calpain-2, ERK and reduced arsenic-induced HKM apoptosis as evidenced from reduced caspase-3 activity, Annexin V-FITC-propidium iodide and Hoechst 33342 staining. Pre-incubation with ERK inhibitor U 0126 inhibited the activation of calpain-2 and interfered with arsenic-induced HKM apoptosis. Additionally, pre-incubation with calpain-2 inhibitor also interfered with the activation of ERK and inhibited arsenic-induced HKM apoptosis. The NADPH oxidase inhibitor apocynin and diphenyleneiodonium chloride also inhibited ERK activation indicating activation of ERK in arsenic-exposed HKM also depends on signals from NADPH oxidase pathway. Our study demonstrates the critical role of Ca(2+) homeostasis on arsenic-induced HKM apoptosis. We suggest that arsenic-induced alteration in intracellular Ca(2+) levels initiates pro-apoptotic ERK and calpain-2; the two pathways influence each other positively and induce caspase-3 mediated HKM apoptosis. Besides, our study also indicates the role of ROS in the activation of ERK pathway in arsenic-induced HKM apoptosis in C. batrachus.

The mechanism of lens placode formation: a case of matrix-mediated morphogenesis

Although placodes are ubiquitous precursors of tissue invagination, the mechanism of placode formation has not been established and the requirement of placode formation for subsequent invagination has not been tested. Earlier measurements in chicken embryos supported the view that lens placode formation occurs because the extracellular matrix (ECM) between the optic vesicle and the surface ectoderm prevents the prospective lens cells from spreading. Continued cell proliferation within this restricted area was proposed to cause cell crowding, leading to cell elongation (placode formation). This view suggested that continued cell proliferation and adhesion to the ECM between the optic vesicle and the surface ectoderm was sufficient to explain lens placode formation. To test the predictions of this "restricted expansion hypothesis," we first confirmed that the cellular events that accompany lens placode formation in chicken embryos also occur in mouse embryos. We then showed that the failure of lens placode formation when the transcription factor, Pax6 was conditionally deleted in the surface ectoderm was associated with greatly diminished accumulation of ECM between the optic vesicle and ectoderm and reduced levels of transcripts encoding components of the ECM. In accord with the "restricted expansion hypothesis," the Pax6-deleted ectoderm expanded, rather than being constrained to a constant area. As a further test, we disrupted the ECM by deleting Fn1, which is required for matrix assembly and cell-matrix adhesion. As in Pax6(CKO) embryos, the Fn1(CKO) lens ectoderm expanded, rather than being constrained to a fixed area and the lens placode did not form. Ectoderm cells in Fn1(CKO) embryos expressed markers of lens induction and reorganized their cytoskeleton as in wild type ectoderm, but did not invaginate, suggesting that placode formation establishes the minimal mechanical requirements for invagination.

The tumor suppressor gene Trp53 protects the mouse lens against posterior subcapsular cataracts and the BMP receptor Acvr1 acts as a tumor suppressor in the lens

We previously found that lenses lacking the Acvr1 gene, which encodes a bone morphogenetic protein (BMP) receptor, had abnormal proliferation and cell death in epithelial and cortical fiber cells. We tested whether the tumor suppressor protein p53 (encoded by Trp53) affected this phenotype. Acvr1 conditional knockout (Acvr1^CKO) mouse fiber cells had increased numbers of nuclei that stained for p53 phosphorylated on serine 15, an indicator of p53 stabilization and activation. Deletion of Trp53 rescued the Acvr1^CKO cell death phenotype in embryos and reduced Acvr1-dependent apoptosis in postnatal lenses. However, deletion of Trp53 alone increased the number of fiber cells that failed to withdraw from the cell cycle. Trp53^CKO and Acvr1;Trp53^DCKO (double conditional knockout), but not Acvr1^CKO, lenses developed abnormal collections of cells at the posterior of the lens that resembled posterior subcapsular cataracts. Cells from human posterior subcapsular cataracts had morphological and molecular characteristics similar to the cells at the posterior of mouse lenses lacking Trp53. In Trp53^CKO lenses, cells in the posterior plaques did not proliferate but, in Acvr1;Trp53^DCKO lenses, many cells in the posterior plaques continued to proliferate, eventually forming vascularized tumor-like masses at the posterior of the lens. We conclude that p53 protects the lens against posterior subcapsular cataract formation by suppressing the proliferation of fiber cells and promoting the death of any fiber cells that enter the cell cycle. Acvr1 acts as a tumor suppressor in the lens. Enhancing p53 function in the lens could contribute to the prevention of steroid- and radiation-induced posterior subcapsular cataracts.

The function of FGF signaling in the lens placode

Previous studies suggested that FGF signaling is important for lens formation. However, the times at which FGFs act to promote lens formation, the FGFs that are involved, the cells that secrete them and the mechanisms by which FGF signaling may promote lens formation are not known. We found that transcripts encoding several FGF ligands and the four classical FGF receptors are detectable in the lens-forming ectoderm at the time of lens induction. Conditional deletion of Fgfr1 and Fgfr2 from this tissue resulted in the formation of small lens rudiments that soon degenerated. Lens placodes lacking Fgfr1 and 2 were thinner than in wild-type embryos. Deletion of Fgfr2 increased cell death from the initiation of placode formation and concurrent deletion of Fgfr1 enhanced this phenotype. Fgfr1/2 conditional knockout placode cells expressed lower levels of proteins known to be regulated by FGF receptor signaling, but proteins known to be important for lens formation were present at normal levels in the remaining placode cells, including the transcription factors Pax6, Sox2 and FoxE3 and the lens-preferred protein αA-crystallin. Previous studies identified a genetic interaction between BMP and FGF signaling in lens formation and conditional deletion of Bmpr1a caused increased cell death in the lens placode, resulting in the formation of smaller lenses. In the present study, conditional deletion of both Bmpr1a and Fgfr2 increased cell death beyond that seen in Fgfr2(CKO) placodes and prevented lens formation. These results suggest that the primary role of autocrine or paracrine FGF signaling is to provide essential survival signals to lens placode cells. Because apoptosis was already increased at the onset of placode formation in Fgfr1/2 conditional knockout placode cells, FGF signaling was functionally absent during the period of lens induction by the optic vesicle. Since the expression of proteins required for lens formation was not altered in the knockout placode cells, we can conclude that FGF signaling from the optic vesicle is not required for lens induction.

Expression, purification, and characterization of pro-phenoloxidase-activating serine protease from Spodoptera litura

One of the important trigger molecules for innate immunity is a serine protease that activates zymogen phenol oxidase (PPO). Central to wound healing response is the activation of phenol oxidase zymogen. Molecular characterization of phenol oxidase has been recently reported by us. Here, we report isolation, cloning, expression, and purification of prophenol oxidase activating enzyme 1 (slppae1) from polyphagous pest, Spodoptera litura. SLPPAE1 is induced within 6 h of physical injury. The structural features of the mature polypeptide are reminiscent of other lepidopteran PPAE in having a signal peptide, propeptide, and catalytically active polypeptide. The cDNA has been expressed in Sf21 cells using baculovirus expression vector. Fractionation of expressing Sf21 cells revealed its expression in the membranes. The recombinant protein was solubilized from membranes and purified by Ni-NTA affinity chromatography. The purified enzyme is catalytically active on chromogenic substrate, activates recombinantly expressed prophenol oxidase (PPO) of S. litura, and is sensitive to inhibition by aprotenin. N-terminal sequencing of processed phenol oxidase revealed 11 kDa propeptide instead of in-silico predicted 6 kDa polypeptide.

The type I BMP receptors, Bmpr1a and Acvr1, activate multiple signaling pathways to regulate lens formation

BMPs play multiple roles in development and BMP signaling is essential for lens formation. However, the mechanisms by which BMP receptors function in vertebrate development are incompletely understood. To determine the downstream effectors of BMP signaling and their functions in the ectoderm that will form the lens, we deleted the genes encoding the type I BMP receptors, Bmpr1a and Acvr1, and the canonical transducers of BMP signaling, Smad4, Smad1 and Smad5. Bmpr1a and Acvr1 regulated cell survival and proliferation, respectively. Absence of both receptors interfered with the expression of proteins involved in normal lens development and prevented lens formation, demonstrating that BMPs induce lens formation by acting directly on the prospective lens ectoderm. Remarkably, the canonical Smad signaling pathway was not needed for most of these processes. Lens formation, placode cell proliferation, the expression of FoxE3, a lens-specific transcription factor, and the lens protein, alphaA-crystallin were regulated by BMP receptors in a Smad-independent manner. Placode cell survival was promoted by R-Smad signaling, but in a manner that did not involve Smad4. Of the responses tested, only maintaining a high level of Sox2 protein, a transcription factor expressed early in placode formation, required the canonical Smad pathway. A key function of Smad-independent BMP receptor signaling may be reorganization of actin cytoskeleton to drive lens invagination.

FGF-regulated BMP signaling is required for eyelid closure and to specify conjunctival epithelial cell fate

There are conflicting reports about whether BMP signaling is required for eyelid closure during fetal development. This question was addressed using mice deficient in BMP or TGFbeta signaling in prospective eyelid and conjunctival epithelial cells. Genes encoding two type I BMP receptors, the type II TGFbeta receptor, two BMP- or two TGFbeta-activated R-Smads or the co-Smad Smad4 were deleted from the ocular surface ectoderm using Cre recombinase. Only mice with deletion of components of the BMP pathway had an 'eyelid open at birth' phenotype. Mice lacking Fgf10 or Fgfr2 also have open eyelids at birth. To better understand the pathways that regulate BMP expression and function during eyelid development, we localized BMPs and BMP signaling intermediates in Fgfr2 and Smad4 conditional knockout (CKO) mice. We found that Fgfr2 was required for the expression of Bmp4, the normal distribution of Shh signaling and for preserving the differentiation of the conjunctival epithelium. FGF signaling also promoted the expression of the Wnt antagonist Sfrp1 and suppressed Wnt signaling in the prospective eyelid epithelial cells, independently of BMP function. Transcripts encoding Foxc1 and Foxc2, which were previously shown to be necessary for eyelid closure, were not detectable in Smad4(CKO) animals. c-Jun, another key regulator of eyelid closure, was present and phosphorylated in eyelid periderm cells at the time of fusion, but failed to translocate to the nucleus in the absence of BMP function. Smad4(CKO) mice also showed premature differentiation of the conjunctival epithelium, conjunctival hyperplasia and the acquisition of epidermal characteristics, including formation of an ectopic row of hair follicles in place of the Meibomian glands. A second row of eyelashes is a feature of human lymphedema-distichiasis syndrome, which is associated with mutations in FOXC2.

Quetiapine: Relatively safe in overdose?

Compared to other antipsychotics quetiapine has been reported to be relatively safer in overdose. We report a case with paranoid schizophrenia who attempted suicide with 1400 mg of quetiapine and manifested drowsiness, supraventricular tachycardia (167/minute) and minimal ST depression in leads V1 to V6 on ECG; all other physiological parameters were normal. Gastric lavage, lorazepam 2mg i/v to control agitation, and 14-hour observation in emergency ended in she being sent home. Subsequently she was successfully managed with ECTs, and quetiapine 600mg and risperidone 6mg daily. This report tends to support the literature suggesting quetiapine as a relatively-safer-in-overdose antipsychotic, and preferable in medication-overdose-suicidal-risk cases.

Economics of place-based monitoring under the safe drinking water act, part I: spatial and temporal patterns of contaminants, and design of screening strategies

The goals of environmental legislation and associated regulations are to protect public health, natural resources, and ecosystems. In this context, monitoring programs should provide timely and relevant information so that the regulatory community can implement legislation in a cost-effective and efficient manner. The Safe Drinking Water Act (SDWA) of 1974 attempts to ensure that public water systems (PWSs) supply safe water to its consumers. As is the case with many other federal environmental statutes, SDWA monitoring has been implemented in relatively uniform fashion across the USA. In this three part series, spatial and temporal patterns in water quality data are utilized to develop, compare, and evaluate the economic performance of alternative place-based monitoring approaches to current monitoring practice. Under the Safe Drinking Water Act (SDWA), a common list of over 90 contaminants is analyzed nationwide using EPA-authorized laboratory procedures. National and state-level summaries of SDWA data have shown that not all contaminants occur in all places at all times. This hypothesis is confirmed and extended by showing that only a few (less than seven) contaminants are of concern in any one of 19 Iowa surface water systems studied. These systems collectively serve about 350,000 people and their sizes vary between 1,200 and 120,000. The distributions of contaminants found in these systems are positively skewed, with many non-detect measurements. A screening strategy to identify such contaminants in individual systems is presented. These findings have significant implications not only for the design of alternative monitoring programs, but also in multi-billion-dollar decisions that influence the course of future drinking water infrastructure, repair, and maintenance investments.