Toxic levels of glycosides in herbal medication: a potential cause of hyperkalaemia

We report a previously healthy man presenting with life-threatening hyperkalaemia and heart failure. The only possible cause was thought to be the long list of herbal medications he was taking, several of which contained significant amounts of cardiac glycosides. Hyperkalaemia is known to be associated with digoxin toxicity and we present this as the likely cause in this case, and emphasize the importance of a thorough drug history in forming a differential diagnosis.

Nematode-associated intramural alimentary nodules in pumas are histologically similar to gastrointestinal eosinophilic sclerosing fibroplasia of domestic cats

Intramural alimentary nodules in the gastric pylorus and proximal duodenum are a common finding in free-ranging pumas (Puma concolor) in North America, and are often associated with the presence of an indwelling nematode (most commonly Cylicospirura spp.). This study compares the histological, histochemical and immunohistochemical appearance of three proximal gastrointestinal nodules in pumas with four cases of eosinophilic sclerosing fibroplasia in domestic cats. Histologically, the pattern of inflammation and repair was strikingly similar, consisting of lamillated anastomosing trabeculae of dense sclerotic collagen with interspersed inflammatory cells and reactive fibroblasts. The stromal trabeculae were histologically reminiscent of osteoid and were uniformly positive for collagenous protein by Masson's trichrome stain and negative for mineralized osteoid deposits with Von Kossa's stain. Trabecular cells expressed osteonectin, but not osteocalcin immunohistochemically. Collectively, these findings are most consistent with a stroma comprised of dense collagenous trabeculae that resembles, but is distinct, from osteoid. Both the puma and domestic cat lesions demonstrated an eosinophilic inflammatory component; however, eosinophils were present in small numbers in the puma nodules relative to the nodules in domestic cats. These entities likely represent a unique and stereotypic gastrointestinal repair response of felids, given their similar histological, histochemical and immunohistochemical profiles.

Experimental verification of the chemical sensitivity of two-site double core-hole states formed by an x-ray free-electron laser

We have performed x-ray two-photon photoelectron spectroscopy using the Linac Coherent Light Source x-ray free-electron laser in order to study double core-hole (DCH) states of CO2, N2O, and N2. The experiment verifies the theory behind the chemical sensitivity of two-site DCH states by comparing a set of small molecules with respect to the energy shift of the two-site DCH state and by extracting the relevant parameters from this shift.

Explosions of xenon clusters in ultraintense femtosecond x-ray pulses from the LCLS free electron laser

Explosions of large Xe clusters (<N> ~ 11,000) irradiated by femtosecond pulses of 850 eV x-ray photons focused to an intensity of up to 10(17) W/cm(2) from the Linac Coherent Light Source were investigated experimentally. Measurements of ion charge-state distributions and energy spectra exhibit strong evidence for the formation of a Xe nanoplasma in the intense x-ray pulse. This x-ray produced Xe nanoplasma is accompanied by a three-body recombination and hydrodynamic expansion. These experimental results appear to be consistent with a model in which a spherically exploding nanoplasma is formed inside the Xe cluster and where the plasma temperature is determined by photoionization heating.

Histological subtypes of oral non-tonsillar squamous cell carcinoma in dogs

Several histological subtypes and grades of oral squamous cell carcinoma (SCC) are described in human literature and these subtypes have distinct morphological features and biological behaviour. This retrospective study (1990-2010) included 84 dogs diagnosed with SCC of the oral cavity and oropharynx, excluding the tonsils. Sixty-nine of the SCCs (82.1%) were further diagnosed as conventional SCC (CSCC) (33 [47.8%] well-differentiated, 31 [44.9%] moderately-differentiated and five [7.3%] poorly-differentiated), five (5.95%) each as papillary SCC and basaloid SCC, three (3.6%) as adenosquamous carcinoma and two (2.4%) as spindle cell carcinoma. Compared with the general hospital population, neutered female dogs, dogs aged 10 to <15 years, English springer spaniels and Shetland sheepdogs were overrepresented. The majority (78.1%) of SCCs were proliferative with or without associated ulceration, although no significant association was observed between the gross appearance and different SCC subtypes. 71.4% of SCCs were located in dentate jaws; however, well-differentiated CSCC more often affected the tongue and other non-dentate mucosal surfaces (P=0.0022). No significant association was found between any of the SCC subtypes and tumour-associated inflammation (TAI), perineural and lymphovascular invasion (PNI, LVI), or between gross appearance of the tumour and tumour location, PNI, LVI or TAI or PNI, LVI, TAI and tumour location.

The presence or absence of the gamma-activated site determines IFN gamma-mediated transcriptional activation in CAEV promoters cloned from the mammary gland and joint synovium of a single CAEV-infected goat

The caprine arthritis encephalitis virus (CAEV) long terminal repeat promoter was cloned and sequenced from mammary gland and carpal joint synovium isolated from a 15.5 year old, CAEV-infected Toggenburg doe with chronic mastitis and carpal arthritis. A deletion of the CAEV gamma activated site (GAS) was identified in the mammary gland but not the synovial isolate. Subsequent promoter-reporter gene construct experiments indicated that the GAS is necessary for interferon γ-mediated promoter activation. Utilizing a molecular clone of the classic isolate CAEV-CO, these findings were corroborated by a set of GAS mutant promoter-reporter constructs with and without the CAEV GAS. Results of experiments with U937 monocyte cell lines stably transfected with molecular clones of CAEV-CO GAS deletion mutants also indicated the GAS is necessary for IFNγ-mediated promoter activation. The mammary gland CAE viral isolate was propagated in caprine peripheral blood mononuclear cells and was assigned the name CAEV-MA. This is the first report describing two CAE viral isolates cloned from different anatomical locations in the same animal with and without the CAEV GAS, and is the first report detailing cytokine-induced CAEV promoter function in a naturally occurring ΔGAS promoter.

When good intentions are not enough: obtaining follow-up data in living kidney donors

The Organ Procurement Transplant Network/United Network for Organ Sharing (OPTN/UNOS) has increased the amount of data collected before and after donation and increased the duration of donor follow-up to 2 years, yet there is evidence that reporting is incomplete. We examined the frequency of missing data in the OPTN/UNOS donor follow-up registry and found that reporting rates were low, particularly for donors who may have limited access to health care. We argue that a national donor follow-up registry is essential to ensure transparency in ascertaining long-term health outcomes among all living donors and in providing assessments of quality assurance within transplant programs. We have suggested approaches to strengthen the donor follow-up registry system. These include setting clear and high standards for follow-up reporting, a system of incentives and penalties that would motivate transplant centers to comply with these standards and would encourage donors to follow-up and lifelong follow-up reporting by primary care providers. We argue that the US government must provide funding to support a donor follow-up registry that can allow for meaningful and valid conclusions, in recognition of donors' public service and to maintain trust in the system of living organ donation.

Systemic Coxiella-like infection with myocarditis and hepatitis in an eclectus parrot (Eclectus roratus)

A multiorgan infection with a Coxiella-like organism was determined to be the cause of death of a female eclectus parrot (Eclectus roratus). The diagnosis was based on gross lesions, histopathology, Gimenez and Gram special stains, immunohistochemistry, electron microscopy, and polymerase chain reaction amplification and sequencing of a bacterial 16s rRNA gene fragment isolated from hepatic and cardiac tissue. Gross postmortem examination revealed multifocal to coalescing foci of hepatic necrosis. The most significant histologic lesions included multifocal lymphohistiocytic necrotizing hepatitis, locally extensive lymphoplasmacytic myocarditis, and myocardial degeneration and necrosis. Intralesional cytoplasmic organisms were identified in cardiomyocytes, biliary epithelium, and pancreatic exocrine cells. This is the first description of a Coxiella-like organism with wide-ranging cellular tropisms in a psittacine bird. In addition, lymphoplasmacytic neuritis, myositis, splenitis, airsacculitis, and enteritis were detected. It is also the first report of a Coxiella-like infection in an eclectus parrot.

Time from hospital admission to CT brain in acute ischaemic stroke

A retrospective study of all acute ischaemic stroke patients admitted to Midland Regional Hospital Mullingar (MRHM) between January 2004 and September 2009 was undertaken in order to assess the median time from hospital admission to CT brain scan (n = 496). The median time to CT scan ranged from 19-24 hours between 2004-7. In 2008, coinciding with setting up a new Acute Stroke Service (ACSS), the median time to CT scan dropped to 15 hours (n = 130, p =0.03) and decreased further to 3 hours in 2009 (n = 125, p = 0.003). The proportion scanned within 1 hour of admission increased from 7 patients (4.6%) over 2004-7, to 28 patients (21.5%) in 2008 (p = 0) and 44 patients (35%) in 2009 (p = 0.018). This clinically and statistically significant reduction occurred following reorganisation of existing resources on a budget neutral basis at MRHM and was facilitated by the enthusiastic support of a range of disciplines bridging the community and acute hospital interface. Measurement of admission to CT brain scan time is one of several audit parameters which can assess hospitals responsiveness to acute stroke.

Randomized Controlled Trial of Clozapine and CBT for First-Episode Psychosis with Enduring Positive Symptoms: A Pilot Study

Here we report the results of a pilot study investigating the relative and combined effects of a 12 week course of clozapine and CBT in first-episode psychosis patients with prominent ongoing positive symptoms following their initial treatment. Patients from our early psychosis service who met the inclusion criteria (n = 48) were randomized to one of four treatment groups: clozapine, clozapine plus CBT, thioridazine, or thioridazine plus CBT. The degree of psychopathology and functionality of all participants was measured at baseline then again at 6, 12 and 24 weeks, and the treatment outcomes for each group determined by statistical analysis. A substantial proportion (52%) of those treated with clozapine achieved symptomatic remission, as compared to 35% of those who were treated with thioridazine. Overall, those who received clozapine responded more rapidly to treatment than those receiving the alternative treatments. Interestingly, during the early treatment phase CBT appeared to reduce the intensity of both positive and negative symptoms and thus the time taken to respond to treatment, as well having as a stabilizing effect over time.

Nonossifying Fibroma in the Mandible of a Goat

An 8-year-old male Nubian goat was presented with a peracute history of straining to urinate and unilateral mandibular swelling. At necropsy, the rostral half body of the left mandible was distorted by fusiform swelling that, on sagittal section, had marked medullary bone loss and replacement with a well-demarcated fibrous mass. Histologically, the mass comprised streaming spindloid cells with whorls and storiform patterns, interspersed with numerous multinucleated giant cells. Bone formation was not present in the neoplasm. The mandibular mass was diagnosed as nonossifying fibroma, a relatively common tumor in children but seldom reported in domestic animals.

Rhabdomyosarcoma in 8 Horses

This multi-institutional report describes 8 cases of rhabdomyosarcoma in horses. Four neoplasms were in the tongue and other areas of the mouth or head, 2 were in the abdominal wall, and 1 each was in right shoulder muscles and heart. Four rhabdomyosarcomas that were less than 10 cm in diameter were treated by surgical excision or radiation with no recurrence. Two neoplasms greater than 10 cm in diameter in the abdominal wall and the right shoulder were considered inoperable and led to decisions to euthanize the horses. Two neoplasms were incidental findings at necropsy. All the neoplasms were classified as embryonal except for 1 pleomorphic rhabdomyosarcoma. These 8 cases were evaluated with 9 published case reports of equine rhabdomyosarcoma. For all cases, the most common sites were limb muscles (5/17) and tongue (4/17). Metastasis was reported in 4 of the previously published cases; none was found in this study.

The effect of sporting events on emergency department attendance rates in a district general hospital in Northern Ireland

BACKGROUND

Previous studies have reported a conflicting relationship between the effect of live and televised sporting events on attendance rates to emergency departments (ED). The objectives of this study were to investigate the relationship of major sporting events on emergency department attendance rates and to determine the potential effects of such events on service provision.

METHODS

A retrospective analysis of ED attendances to a district general hospital (DGH) and subsequent admissions over a 24-h period following live and televised sporting activities was performed over a 5-year period. Data were compiled from the hospital's emergency record books including the number of attendances, patient demographics, clinical complaint and outcome. Review patients were excluded. Analysis of sporting events was compiled for live local, regional and national events as well as world-wide televised sporting broadcasts.

RESULTS

A total of 137,668 (80,445 men) patients attended from April 2002 to July 2007. Mean attendance rate per day was 80 patients (men = 47). Mean admission rate was 13.6 patients per day. Major sporting events during the study period included; Soccer: 4 FA Cup and 1 World Cup (WC) finals; Rugby: 47 Six Nations, 25 Six nations games involving Ireland, 1 WC final, 2 WC semi-finals, 2 WC quarter-finals and 4 WC games involving Ireland; and Gaelic Football [Gaelic Athletic Association (GAA)]: 5 All-Ireland finals, 11 semi-finals, 11 quarter-finals and 5 provincial finals. There was a significantly higher patient admission rate during the soccer FA Cup final, Rugby Six Nations and games involving Ireland and for GAA semi- and quarter-final games (p = 0.001-0.01). There was no difference identified in total attendance or non-admission rates for sporting events throughout the study period. Although there was no correlation identified between any of these sporting events and total emergency department attendances (r < 0.15, p > 0.07), multinomial logistic regression demonstrated that FA Cup final (p = 0.001), Rugby Six Nations (p = 0.019), Rugby WC games involving Ireland (p = 0.003), GAA All-Ireland semi- and quarter-finals (p = 0.016; p = 0.016) were predictors of patient admission rates.

CONCLUSION

This study suggests that live or televised sporting events do not significantly affect ED attendances to a DGH. However, some events appeared to be predictors of patient admission rates. Although it may be beneficial to consider the effect of sporting events on service stratification during these periods, the overall effect is probably minimal and should not create a major concern for future service provision despite the implementation of the European Working Time Directive.

Immune reconstitution following rabbit antithymocyte globulin

Depletional induction therapies are routinely used to prevent acute rejection and improve transplant outcome. The effects of depleting agents on T-cell subsets and subsequent T-cell reconstitution are incompletely defined. We used flow cytometry to examine the effects of rabbit antithymocyte globulin (rATG) on the peripheral T-cell repertoire of pediatric and adult renal transplant recipients. We found that while rATG effectively depleted CD45RA+CD27+ naïve and CD45RO+CD27+ central memory CD4+ T cells, it had little effect on CD45RO+CD27- CD4+ effector memory or CD45RA+CD31-, CD45RO+CD27+ and CD45RO+CD27- CD8+ T cell subsets. When we performed a kinetic analysis of CD31+ recent thymic emigrants and CD45RA+/RO+ T cells, we found evidence for both thymopoiesis and homeostatic proliferation contributing to immune reconstitution. We additionally examined the impact of rATG on peripheral CD4+Foxp3+ T cells. We found that in adults, administration of rATG-induced peripheral expansion and new thymic emigration of T cells with a Treg phenotype, while CD4+Foxp3+ T cells of thymic origin predominated in children, providing the first evidence that rATG induces Treg in vivo. Collectively our data indicate that rATG alters the balance of regulatory to memory effector T cells posttransplant, providing an explanation for how it positively impacts transplant outcome.

Apis mellifera has two isoforms of cytoplasmic HSP90

Unlike most other insects, annotated genomic data suggest that Apis mellifera has two homologous copies of the cytoplasmic gene HSP90. In this study, we did a phylogenetic analysis on these two copies with some other insects HSP90 genes, and we also manipulated a reverse transcript (RT)-PCR to find all the putative transcripts for both copies. Phylogenetic analysis indicates that A. mellifera possesses two isoforms of cytoplasmic HSP90: The 'traditional' isoform clusters with cytoplasmic HSP90 of other insects. The other isoform, which occurs phylogenetically as the sister group of all insects, may be a new gene and specific to A. mellifera. The results of RT-PCR indicate that this new isoform contains at least eight transcripts derived from the same genomic locus by complicated alternative splicing (GenBank accession numbers: FJ713701, FJ713702, FJ713703, FJ713704, FJ713705, FJ713706, FJ713707 and FJ713708, respectively). The existence of this specific HSP90 might be related to the caste differentiation of bees.