World-wide radiation dosage calculations for air crew members

A greatly improved version of the computer program to calculate radiation dosage to air crew members is now available. Designated CARI-6, this program incorporates an updated geomagnetic cutoff rigidity model and a revision of the primary cosmic ray spectrum based on recent work by Gaisser and Stanev (1998). We believe CARI-6 provides the most accurate available method for calculating the radiation dosage to air crew members. The program is now utilized by airline companies around the world and provides unification for subsequent world-wide studies on the effects of natural radiation on aircrew members.

The atmospheric radiation response to solar-particle-events

High-energy solar particles, produced in association with solar flares and coronal mass ejections, occasionally bombard the earth's atmosphere. resulting in radiation intensities additional to the background cosmic radiation. Access of these particles to the earth's vicinity during times of geomagnetic disturbances are not adequately described by using static geomagnetic field models. These solar fluxes are also often distributed non uniformly in space, so that fluxes measured by satellites obtained at great distances from the earth and which sample large volumes of space around the earth cannot be used to predict fluxes locally at the earth's surface. We present here a method which uses the ground-level neutron monitor counting rates as adjoint sources of the flux in the atmosphere immediately above them to obtain solar-particle effective dose rates as a function of position over the earth's surface. We have applied this approach to the large September 29-30, 1989 ground-level event (designated GLE 42) to obtain the magnitude and distribution of the solar-particle effective dose rate from an atypically large event. The results of these calculations clearly show the effect of the softer particle spectra associated with solar particle events, as compared with galactic cosmic rays, results in a greater sensitivity to the geomagnetic field, and, unlike cosmic rays, the near-absence of a "knee" near 60 degrees geomagnetic latitude.

Development and use of a taxonomy to carry out a systematic review of the literature on methods described to effect distal movement of maxillary molars

OBJECTIVE

To devise a taxonomy for the assessment of the orthodontic literature on methods described to effect distal movement of maxillary molars, to test the taxonomy for inter-assessor reliability, and to use it to classify studies in a systematic review of the literature.

DATA SOURCES

Articles appearing in the American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, (British) Journal of Orthodontics, European Journal of Orthodontics, and the Journal of Clinical Orthodontics between 1988 and 1998. Data selection Articles describing or evaluating the effect of appliances known or thought to have a distalizing effect on maxillary molars.

DATA EXTRACTION

A taxonomy was designed, tested by two reviewers independently to assess levels of agreement, and then used to record the features of the articles in a systematic review of the literature.

DATA SYNTHESIS

Kappa scores were used to assess the level of agreement between reviewers and found to be satisfactory. Studies were grouped according to study design and features of their methodology quantified.

CONCLUSIONS

Having devised and tested the taxonomy, we found that the quality of evidence for any method of moving maxillary molars distally was not high.

Aerobic exercise interventions for adults living with HIV/AIDS

BACKGROUND

The profile of HIV infection is constantly changing. Although once viewed as an illness progressing to death, among those with access to antiretroviral therapy, HIV infection can now present as a disease with an uncertain natural history, perhaps a chronic manageable disease for some. Thus, the needs of persons infected with HIV have increasingly included management of impairments, disabilities and handicaps. Exercise is a key management strategy employed by rehabilitation professionals to address these issues and assist persons living with HIV/AIDS. Exercise has been shown to improve strength, cardiovascular function, and psychological status in seronegative populations (~~Bouchard 1993~~) but what are the effects of exercise for adults living with HIV infection? If the risks and benefits of exercise for people living with HIV infection are better understood, appropriate exercise prescription may be practiced by health care providers, and may enhance the effectiveness of HIV management, thus improving the overall outcome for adults living with HIV infection.

OBJECTIVES

To examine the effect of aerobic exercise interventions on cardiopulmonary, immunological/virological and psychological parameters in adults living with HIV infection.

SEARCH STRATEGY

To identify the appropriate studies, we conducted a search using MEDLINE, EMBASE, SCIENCE CITATION INDEX, AIDSLINE, CINAHL, HEALTHSTAR, PSYCHLIT, SOCIOFILE, SCI, SSCI, ERIC and DAI. We also reviewed abstracts from international AIDS, ICAAC, and other major meetings. Reference lists from pertinent articles and books and personal contact with authors were also used, as were Collaborative Review Group databases and results of hand searching of targeted journals. All languages were included. Searches for the original review covered the period from 1980 to July 1999. For the purposes of this update, an additional literature search, following the same identification of studies criteria as listed above, was conducted from August 1999 to January 2001.

SELECTION CRITERIA

To be selected, studies had to be randomized controlled trials involving HIV+ adults 18 years of age or older and had to include at least one group randomized to receive aerobic exercise performed at least three times/week for at least four weeks.

DATA COLLECTION AND ANALYSIS

Data on study design, participants, interventions, and outcomes were extracted from the reports onto specifically designed data collection forms by at least two reviewers.

MAIN RESULTS

A total of eight studies (six from the original search and two from the updated search) were identified that satisfied the eligibility criteria. The main results indicated that performing constant or interval aerobic exercise, or a combination of constant aerobic exercise and progressive resistive exercise for at least 20 minutes, at least three times per week for four weeks appears to be safe and may lead to clinically significant improvements in cardiopulmonary fitness. Furthermore, individual studies suggest that aerobic exercise may improve psychological well-being for adults living with HIV/AIDS. These findings are limited to those who continued to exercise and for whom there was adequate follow-up data.

REVIEWER'S CONCLUSIONS

Aerobic exercise appears to be safe and may be beneficial for adults living with HIV/AIDS. These findings are limited by the small sample sizes and large drop-out rates of the included studies. Future research would benefit from an increased attention to participant follow-up and intention-to-treat analysis. Further research is required to determine the optimal parameters of aerobic exercise and stage of disease in which aerobic exercise may be most beneficial for adults living with HIV infection.

Effect of creatine on performance of militarily relevant tasks and soldier health

PURPOSE

Determine the short-term effects of creatine supplementation on performance of military tasks, thermoregulation, and health risks.

METHODS

Male military personnel were randomly assigned to a creatine (CR; N = 8) or a placebo (CON; N = 8) supplementation group. Testing was conducted at baseline, after a 6-day load phase (20 g/d), and after 4 weeks of taking 6 g/d. Measurements included body composition, liver/kidney function tests, core body temperatures during a 10-mile march and 5-mile run, and performance on physical tasks.

RESULTS

Serum and urine creatine increased significantly in the CR group. Body mass and number of pull-ups performed increased significantly in the CR group but not the CON group by week 4. No significant differences between the CR and CON groups were found for other performance measures, body composition, core body temperature, or other biochemical measures.

CONCLUSION

Creatine supplementation increased body mass and pull-up performance but did not cause acute health problems. Creatine did not increase core temperature compared with placebo under the environmental conditions of the study, and it is unlikely that creatine will enhance the overall readiness or performance of soldiers.

Are specialist outreach clinics for orthodontic consultation effective? A randomised controlled trial

OBJECTIVE

To develop outreach clinics for orthodontic consultation and evaluate their costs and effectiveness.

DESIGN

Single centre randomised controlled trial with random allocation of referred patients to outreach or main base consultation appointments.

SETTING

One hospital orthodontic department and three community health centre clinics in Greater Manchester. Subjects 324 patients who were referred for orthodontic treatment.

MAIN OUTCOME MEASURES

The outcome of consultation, the cost and duration of the visit and the consumer's perceptions of the visit.

RESULTS

There were no differences in outcome of the consultation. While consumer travel costs and the duration of appointments were significantly higher for the main base clinics, these differences were not great. However, consumers preferred to attend an appointment in an outreach clinic.

CONCLUSIONS

There do not appear to be marked advantages or disadvantages in providing consultation appointments for orthodontics in outreach clinics

Eukaryotic translation initiation factor 5 (eIF5) acts as a classical GTPase-activator protein

GTP hydrolysis occurs at several specific stages during the initiation, elongation, and termination stages of mRNA translation. However, it is unclear how GTP hydrolysis occurs; it has previously been suggested to involve a GTPase active center in the ribosome, although proof for this is lacking. Alternatively, it could involve the translation factors themselves, e.g., be similar to the situation for small G in which the GTPase active site involves arginine residues contributed by a further protein termed a GTPase-activator protein (GAP). During translation initiation in eukaryotes, initiation factor eIF5 is required for hydrolysis of GTP bound to eIF2 (the protein which brings the initiator Met-tRNA(i) to the 40S subunit). Here we show that eIF5 displays the hallmarks of a classical GAP (e.g., RasGAP). Firstly, its interaction with eIF2 is enhanced by AlF(4)(-). Secondly, eIF5 possesses a conserved arginine (Arg15) which, like the "arginine fingers" of classical GAPs, is flanked by hydrophobic residues. Mutation of Arg15 to methionine abolishes the ability of eIF5 either to stimulate GTP hydrolysis or to support mRNA translation in vitro. Mutation studies suggest that a second conserved arginine (Arg48) also contributes to the GTPase active site of the eIF2.eIF5 complex. Our data thus show that eIF5 behaves as a classical GAP and that GTP hydrolysis during translation involves proteins extrinsic to the ribosome. Indeed, inspection of their sequences suggests that other translation factors may also act as GAPs.

Aircrew exposure from cosmic radiation on commercial airline routes

As a result of the recent recommendations of the ICRP 60, and in anticipation of possible regulation on occupational exposure of Canadian-based aircrew, an extensive study was carried out by the Royal Military College of Canada over a one-year period to measure the cosmic radiation at commercial jet altitudes. A tissue-equivalent proportional counter was used to measure the ambient total dose equivalent rate on 62 flight routes, resulting in over 20,000 data points at one-minute intervals at various altitudes and geomagnetic latitudes (i.e. which span the full cut-off rigidity of the Earth's magnetic field). These data were then compared to similar experimental work at the Physikalisch Technische Bundesanstalt, using a different suite of equipment, to measure separately the low and high linear energy transfer components of the mixed radiation field, and to predictions with the LUIN transport code. All experimental and theoretical results were in excellent agreement. From these data, a semiempirical model was developed to allow for the interpolation of the dose rate for any global position, altitude and date (i.e. heliocentric potential). Through integration of the dose rate function over a great circle flight path, a computer code was developed to provide an estimate of the total dose equivalent on any route worldwide at any period in the solar cycle.

Radiation exposure during air travel: guidance provided by the Federal Aviation Administration for air carrier crews

Air carrier crews are occupationally exposed to ionizing radiation, principally from galactic cosmic radiation. To promote radiation safety in aviation the Federal Aviation Administration has: issued educational material on the nature of the radiation received during air travel; recommended radiation exposure limits for pregnant and nonpregnant aircrew members; developed computer programs that estimate for a given flight profile the amount of galactic radiation received on a current flight or on one flown at any time back to January 1958; published tables that enable aircrew members to estimate possible health risks associated with their occupational exposure to radiation; and conducted research on effects of radiation during pregnancy. References for this material are given in the article. In addition, graphic and tabular data in the article show how galactic radiation levels and the composition of the galactic radiation has changed between 1958 and 1999. Also given are estimates of effective doses received by air travelers on a wide variety of air carrier flights.

An improved analytical procedure for determination of total actual acidity (TAA) in acid sulfate soils

An improved analytical procedure is proposed for the determination of total actual acidity (TAA) in acid sulfate soils. The proposed method involves the use of a superior extracting solution, 0.5 M BaCl2, instead of the 1 M NaCl used by Konsten et al. (Konsten CJM, Brinkman R, Andriesse W. A field laboratory method to determine total potential and actual acidity in acid sulfate soils. In: Dost H, editor. Selected papers of the Dakar Symposium on Acid Sulfate Soils. Wageningen: ILRI Publication 44, 1988:106-134.) and improved experimental design to obtain correction factors for calculating TAA. The introduction of a multi-choice procedure also enables increased accuracy of analytical results to be obtained if more accurate TAA estimation is required.

Utility of an HIV-1 RNA assay in the diagnosis of acute retroviral syndrome

Highly active antiretroviral therapy (HAART) begun during primary infection with human immunodeficiency virus type 1 (HIV-1) can preserve immune function and may alter the long-term clinical course of HIV-1 infection. To diagnose primary HIV-1 infection (PHI) early, when screening serologies may yield negative or indeterminate results, the Department of Health and Human Services recommends the use of an HIV-1 RNA assay for at-risk patients suspected of having acute retroviral syndrome (ARS). Because of the RNA assay's 1.9% to 3.0% false-positive rate, results must be carefully interpreted and compared to HIV-1 viral load levels seen during proven HIV-1 seroconversion. We report the case of a sexually active woman with symptoms suggestive of ARS who had a false-positive HIV-1 RNA assay result. We discuss use and interpretation of the HIV-1 RNA assay in diagnosing PHI.

The effects of clinical case management on hospital service use among ED frequent users

This study examined the impact of case management on hospital service use, hospital costs, homelessness, substance abuse, and psychosocial problems in frequent users of a public urban emergency department (ED). Subjects were 53 patients who used the ED five times or more in 12 months. Utilization, cost, and psychosocial variables were compared 12 months before and after the intervention. The median number of ED visits decreased from 15 to 9 (P < .01), median ED costs decreased from $4,124 to $2,195 (P < .01) and median medical inpatient costs decreased from $8,330 to $2,786 (P < .01). Homelessness decreased by -57% (P < .01), alcohol use by -22% (P = .05) and drug use by -26% (P = .05). Linkage to primary care increased 74% (P < .01). Fifty-four percent of medically indigent subjects obtained Medicaid (P < .01). There was a net cost savings, with each dollar invested in the program yielding a $1.44 reduction in hospital costs. Thus, case management appears to be a cost-effective means of decreasing acute hospital service use and psychosocial problems among frequent ED users.

Outcome of infants 23-26 weeks' gestation pre and post surfactant

To describe mortality and neurodevelopmental outcome before and after the introduction of rescue therapy with natural surfactant in two neonatal units in Toronto, Canada, a retrospective cohort study of 891 liveborn 23-26 wk gestational age infants, 421 presurfactant (1982-1987) and 470 postsurfactant (1990-1994) was performed. Overall mortality was stable over time (41% vs 35%, p = 0.077), but declined for inborn 24 (71% vs 43%, p = 0.03) and 26 wk (26% vs 13%, p = 0.01) gestational age infants and was higher in surfactant-treated infants (p < 0.0001). Chronic lung disease (61% vs 34%, p < 0.0001) and bilateral blindness (8% vs 4%, p = 0.004) declined over time, with stable rates of cerebral palsy (12% vs 15%), cognitive deficit (27% vs 26%) and aided sensorineural hearing loss (5% vs 4%). Sixty-five percent of surviving infants in both eras were free from neurodevelopmental impairment, and severe impairment declined over time (p = 0.035). This study shows no secular change in overall mortality in a large cohort of 23-26 wk gestational age infants since the introduction of rescue therapy with natural surfactant. However, it does suggest that maternal transfer to and delivery of all extremely preterm infants in high risk perinatal centres is justified.

A new method of measuring how much anterior tooth alignment means to adolescents

The aim of this study was to develop an instrument to measure an individual's value of the appearance of their anterior teeth. Structured interviews were carried out using the Index of Orthodontic Treatment Need (IOTN) as a basis for time trade-off and visual analogue utility measurement. The subjects of the study were forty-five 11-14-year-old children at new patient consultation with an orthodontist (seekers) and forty-five 11-14-year-old children in school (non-seekers) It was possible to derive utility values using the techniques adopted. The seekers and non-seekers of treatment had significantly different utility values for anterior tooth appearance (P < 0.05, Mann-Whitney). This study suggests that it is possible to develop utilities that reflect how patients value the appearance of anterior teeth. These utilities had a predictive validity in that there were significant differences in seekers' and non-seekers' utility values. The seekers placed a higher value than non-seekers on the desirability of a good aesthetic appearance.

Galactic cosmic radiation exposure of pregnant flight crewmembers

BACKGROUND

In recommending the occupational dose limit of ionizing radiation for pregnant women, the International Commission on Radiological Protection apparently assumes that the dose to the conceptus from ionizing radiation exposure is about half the dose at the surface of the mother's abdomen.

METHODS

To test this assumption with respect to galactic cosmic radiation, calculations were made using FAA computer program CARI-LF2, which calculates equivalent doses from galactic cosmic rays at selected depths in soft tissue at any specified location in the atmosphere or on user-entered flight profiles.

RESULTS

The calculations showed that the equivalent dose of galactic radiation was almost the same at all depths.

CONCLUSIONS

Thus the assumption of considerable shielding of the conceptus being provided by the woman's body is not correct with respect to galactic cosmic radiation, the principal type of radiation to which aircrews are exposed. The effective dose as calculated with FAA computer program CARI-5E, which calculates effective dose in an anthropomorphic phantom at any specified location in the atmosphere or on user-entered flight profiles, was found to be a good estimate of the equivalent dose at the depth of the conceptus.

Systemic Candida infection in extremely low birth weight infants: short term morbidity and long term neurodevelopmental outcome

OBJECTIVE

To describe mortality, morbidity at discharge and neurodevelopmental outcome at 2 years corrected age in extremely low birth weight infants with systemic Candida infection during intensive care stay.

METHOD

We identified all extremely low birth weight (birth weight <1000 g) infants diagnosed with Candida sepsis and/or meningoencephalitis between 1988 and mid-1996 in the tertiary neonatal intensive care centers of Toronto. The outcome of the infected infants at discharge and at 2 years corrected age was compared with a cohort of 470 extremely low birth weight infants born between 1990 and 1994.

RESULTS

Forty-six extremely low birth weight infants with systemic Candida infection, mean (+/-SD) gestational age of 24.7 +/- 1.6 weeks and birth weight 699 +/- 135 g, were identified. Case fatality rate was 37% (17 of 46), not significantly different from the control group (35%). Data on 27 infected survivors were available at discharge. All had chronic lung disease compared with 33% in the control cases (P = 0.0001), a high incidence of periventricular leukomalacia (26% vs. 12%, P = 0.06) and an increase in severe retinopathy of prematurity (22% vs. 9%, P = 0.04); 60% had adverse neurologic outcomes at 2 years corrected age compared with 35% in the control group, and 41% vs. 12% had severe disabilities (P = 0.005). Cranial ultrasound examination was the only diagnostic modality in 5 of 13 (38%) cases with central nervous system Candida involvement. All infants with brain parenchymal lesions detected by cranial ultrasound had poor outcome. Early diagnosis and commencement of antifungal treatment favorably affected the outcome.

CONCLUSIONS

Systemic Candida infection is associated with increased short and long term morbidity in extremely low birth weight infants. Candida infection of the central nervous system has a significant impact on long term neurodevelopmental outcome. Performance of cranial ultrasound examination is recommended as a part of the diagnostic investigation in these infants. Detection of brain parenchymal involvement might provide further information to predict outcome.

Acute vasospastic attack after extradural block in a patient with Raynaud's disease

IMPLICATIONS

Raynaud's disease is an episodic and debilitating disease of the circulation to the fingers and toes. This case report describes an acute exacerbation of Raynaud's disease in a patient undergoing surgery with epidural anesthesia. This potentially hazardous complication has not been previously reported.

The effect of orthodontic referral guidelines: a randomised controlled trial

OBJECTIVE

To develop and evaluate the effectiveness of referral guidelines for the referral of orthodontic patients to consultant and specialist practitioner orthodontists.

DESIGN

Single centre randomised controlled trial with random allocation of referral guidelines for orthodontic treatment to general dental practitioners.

SETTING

Hospital orthodontic departments and specialist orthodontic practices in Manchester and Stockport.

SUBJECTS

General dental practitioners and the patients they referred for orthodontic treatment.

MAIN OUTCOME MEASURE

Appropriateness of referral, defined as whether the patient was accepted for orthodontic treatment.

RESULTS

The referral guidelines did not reduce the number of inappropriate referrals.

CONCLUSIONS

Referral guidelines for orthodontic referrals did not influence the behaviour of the general dental practitioners. More research into the optimum methods of dissemination and implementation of referral guidelines for use in the general dental service is needed.

Metabolism of thalidomide in human microsomes, cloned human cytochrome P-450 isozymes, and Hansen's disease patients

Previous in vitro studies in rat microsomal preparations suggested that thalidomide is metabolized by the cytochrome P450 system (CYP). In this study, we examined the extent of thalidomide metabolism by preparations of pooled human microsomes, microsomes containing cloned human CYP isozymes (CYPIA2, CYP2A6, CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP2E1, CYP3A4), and Hansen's disease patients. Results indicated that thalidomide was a poor substrate for CYP isozymes. Alteration of incubation buffer, pH, incubation time, and microsome and thalidomide concentrations did not increase the production of any metabolites. Thalidomide also did not inhibit metabolism of CYP-specific substrates and therefore any interactions with other drugs that are metabolized by the same enzyme system are unlikely. Hansen's patients were given a single oral dose of thalidomide (400 mg), and their blood and urine were collected at time points up to 72 hours, processed, and analyzed by tandem mass spectrometry. Although thalidomide was present in the plasma and urine, no metabolites were found in the plasma and very low amounts of the 5-OH thalidomide metabolite were present in the urine. These results suggest that thalidomide does not undergo significant metabolism by human CYP and that clinically important interactions between thalidomide and drugs that are also metabolized by this enzyme system are unlikely. The major route of thalidomide breakdown in humans and animals is through spontaneous hydrolysis with subsequent elimination in the urine.

Do oral appliances enlarge the airway in patients with obstructive sleep apnoea? A prospective computerized tomographic study

This study evaluated the effect of an anterior mandibular positioning appliance (AMPA) on minimum pharyngeal cross-sectional area (MPCSA) in 32 conscious supine obstructive sleep apnoea (OSA) subjects. The change in MPCSA was measured using low dose computerized tomography, with and without an AMPA in situ. The results showed that the mean presenting respiratory disturbance index (RDI) was 26.6 events/hour, with a body mass index of 28.6 kg/m2 and mean age of 51.5 years. There was a statistically significant increase in MPCSA of 28.34 mm2 on appliance insertion (SD = 59.06 mm2; range -145 to +190 mm2; P = 0.011). The mean mandibular displacement was 5.73 mm (SD = 2.51 mm) in protrusion and 8.27 mm (SD = 4.51 mm) inferiorly. A poor correlation was found between the size of the mandibular displacement and the change in MPCSA (protrusion r = 0.268; inferiorly r = 0.240, P > 0.05). In conclusion, the AMPA significantly increased MPCSA, suggesting that it may be an effective therapy for OSA. There was, however, a wide but unpredictable individual variation of response. As a small number of patients may worsen in their condition with temporary mandibular advancement (TMA), it is essential that all patients treated with TMA should be investigated by polysomnography both before and after treatment.

Plasma paracetamol concentrations and pharmacokinetics following rectal administration in neonates and young infants

BACKGROUND

Despite widespread use in children pharmacokinetic data about paracetamol are relatively scarce, not the least in the youngest age groups. This study aimed to describe plasma paracetamol concentrations and pharmacokinetics of a single rectal paracetamol dose in neonates and young infants.

METHODS

Perioperatively, 17 neonates and infants < or =160 days of age received one rectal paracetamol dose (mean 23.9 mg/kg (+/-4.2 mg/kg)). Blood samples were drawn at 60, 120, 180, 240, 300 and 360 min, according to the infants' weights. Plasma paracetamol concentrations were measured by a Colorometric Assay, Ectachem Clinical Chemistry Slides (Johnson & Johnson Clinical Diagsnostics).

RESULTS

The plasma paracetamol concentrations were mainly below the therapeutic (i.e. antipyretic) range of 66-132 micromol/l and did not exceed 160 micromol/l in any infant. The mean maximum plasma concentration (Cmax) was 72.4 micromol/l (+/-33.5 micromol/l) and the time to Cmax, i.e. the mean Tmax was 102.4 min (_+59.1 min). The mean "apparent" terminal half-life (n=10) was 243.6 min (+/-114.1 min).

CONCLUSION

The absorption of rectal paracetamol (mean dose 23.9 mg/kg, +/-4.2mg/kg) in young infants <160 days is variable and often prolonged and achieves mainly subtherapeutic plasma concentrations.

Effect of blood storage on radiation-induced micronuclei in human lymphocytes

To evaluate the effect of blood storage on the yield of micronuclei (MN) in both irradiated (in vivo and ex vivo) and unirradiated peripheral blood lymphocytes (PBL), we applied the MN assay in cytokinesis-blocked (CB) PBL obtained from healthy subjects (n=11), and from cancer patients (n=10) who were undergoing fractionated partial-body radiotherapy (xRT). The heparinized blood samples were exposed to 137Cs-irradiation (0 Gy or 2 Gy) immediately after blood collection and were stored upright in test tubes either at room temperature (22 degrees C) or in the refrigerator (5 degrees C). Duplicate whole blood cultures from each sample were set up at 0 h, 96 h, and 120 h after ex vivo irradiation. Giemsa (10%) stained slides were prepared from each culture. MN yield was determined per 1000 binucleated cells. As compared to that obtained from the corresponding fresh blood samples, we found that (1) the 22 degrees C blood storage temperature did not affect MN yields in PBL of either healthy subjects or cancer patients up to 96 h, either with or without ex vivo irradiation; and (2) while blood samples were stored at 5 degrees C, the MN yield increased significantly in PBL of healthy subjects (with or without ex vivo irradiation) at 120 h, and in cancer patients (with ex vivo irradiation) at 96 h and 120 h. Since handling of the blood sample is important for CBMN assay during shipment or in the laboratory, our findings showed that blood storage at 22 degrees C or at 5 degrees C up to 96 h appeared to provide insignificant variations of the MN results as compared to fresh blood samples. However, the 96 h of blood storage at 5 degrees C elevated the MN frequency in ex vivo irradiated PBL of cancer patients who were undergoing xRT.

Early-infantile galactosialidosis: prenatal presentation and postnatal follow-up

Galactosialidosis (GS) is an autosomal recessive condition caused by combined deficiency of the lysosomal enzymes beta-galactosidase and alpha-neuraminidase. The combined deficiency has been found to result from a defect in protective protein/cathepsin A (PPCA), an intralysosomal protein which protects these enzymes from premature proteolytic processing. The most severe form of GS, the early-infantile form, results in early onset of edema, ascites, visceromegaly, and skeletal dysplasia. We report a case of early-infantile GS in a male infant who presented with nonimmune fetal hydrops (NIH), "coarse" facial appearance, massive fluid-filled inguinal hernias, multiple telangiectasia, and diffuse hypopigmentation; he subsequently developed visceromegaly. The diagnosis of GS was confirmed biochemically and the defect in PPCA characterized at the protein level. Examination of fetal peripheral blood smears sampled at 30 weeks gestation demonstrated vacuolation of lymphocytes, suggesting blood film examination may be a useful screening tool for cases of NIH where a metabolic disorder is suspected. Skeletal radiography at birth demonstrated punctate epiphyses of the femora, calcanei, and sacrum. We present a discussion of and differential diagnosis for this radiographic finding. To the best of our knowledge, this is the first case of early-infantile GS presenting with stippled epiphyses.