Open thoracic meningocele associated with amniotic band syndrome

We present a case of an infant born with an open thoracic meningocele secondary to an amniotic band. Although there have been several case reports of encephalocele, anencephaly, closed meningocele and a case of tethered cord associated with amniotic band syndrome (ABS), there has yet to be a report of an open meningocele associated with ABS. The patient remained neurologically intact after the repair of his meningocele. His postoperative course was complicated by meningitis with subsequent hydrocephalus necessitating ventriculoperitoneal shunt placement.

Role of the cytoplasmic domain of the beta-subunit of integrin alpha(v)beta6 in infection by foot-and-mouth disease virus

Field isolates of foot-and-mouth disease virus (FMDV) are believed to use RGD-dependent integrins as cellular receptors in vivo. Using SW480 cell transfectants, we have recently established that one such integrin, alpha(v)beta6, functions as a receptor for FMDV. This integrin was shown to function as a receptor for virus attachment. However, it was not known if the alpha(v)beta6 receptor itself participated in the events that follow virus binding to the host cell. In the present study, we investigated the effects of various deletion mutations in the beta6 cytoplasmic domain on infection. Our results show that although loss of the beta6 cytoplasmic domain has little effect on virus binding, this domain is essential for infection, indicating a critical role in postattachment events. The importance of endosomal acidification in alpha(v)beta6-mediated infection was confirmed by experiments showing that infection could be blocked by concanamycin A, a specific inhibitor of the vacuolar ATPase.

Examination of proficiency and control recovery data from analyses for pesticide residues in food: sources of variability

We examined a number of large proficiency and control databases supporting the values reported for pesticide residues in agricultural commodities at fractions of a part per million (mg/kg). The average recovery from >100,000 recovery records in 13 databases was 94%. The overall average single-value relative standard deviation (RSD) of the reported recoveries was 17% at a mean concentration (C) of about 10(-7) (0.1 mg/kg). The average apparent HORRAT value (RSD found/RSDR predicted from the Horwitz formula [2*C(-0.1505)]) was 0.8. Analysis of variance indicated that about 60-70% of the variance could not be associated with any particular factor or combination of factors-analyte, commodity, method, laboratory, concentration, database, or their interactions. The most predominant factor, analyte, and its third-order interaction with laboratory and concentration contributed most of the assignable variance. These findings suggested that most of the variability of trace analysis for pesticide residues is "random" in the sense of being inherent and not assignable to specific factor fluctuations.

Using computerised patient-level costing data for setting DRG weights: the Victorian (Australia) cost weight studies

Casemix-funding systems for hospital inpatient care require a set of resource weights which will not inadvertently distort patterns of patient care. Few health systems have very good sources of cost information, and specific studies to derive empirical cost relativities are themselves costly. This paper reports a 5 year program of research into the use of data from hospital management information systems (clinical costing systems) to estimate resource relativities for inpatient hospital care used in Victoria's DRG-based payment system. The paper briefly describes international approaches to cost weight estimation. It describes the architecture of clinical costing systems, and contrasts process and job costing approaches to cost estimation. Techniques of data validation and reliability testing developed in the conduct of four of the first five of the Victorian Cost Weight Studies (1993-1998) are described. Improvement in sampling, data validity and reliability are documented over the course of the research program, the advantages of patient-level data are highlighted. The usefulness of these byproduct data for estimation of relative resource weights and other policy applications may be an important factor in hospital and health system decisions to invest in clinical costing technology.

Percutaneous absorption and skin irritation of JP-8 (jet fuel)

JP-8 is the major jet fuel used by US Army and Air Force. The purpose of the present study was to investigate the percutaneous absorption of JP-8 across pig ear skin and human skin in vitro and to study the effect of JP-8 exposure on the skin barrier function and irritation in Yucatan minipigs. JP-8 spiked with 5.0 microCi of radiolabeled (14C) tridecane, nonane, naphthalene or toluene (selected components of JP-8) was used for the in vitro percutaneous absorption studies with excised pig ear skin and human skin. For in vivo studies, 250 microl of JP-8 or two of its components (toluene or nonane) was placed in a Hill top chamber(R) and affixed over the marked treatment area for 24 h. Transepidermal water loss (TEWL), skin capacitance (moisture content) and skin irritation (erythema and edema) were evaluated before treatment and at 1,2 and 24 h after removal of the patches. The components of JP-8 such as tridecane, nonane, naphthalene and toluene permeated significantly through pig ear skin and human skin and the permeation rates were found to be proportional to their composition in JP-8. The steady state flux values of tridecane across pig ear skin and human skin did not differ significantly (P>0.05). Though the steady state flux values of nonane, naphthalene and toluene were statistically different between porcine and human skin (P<0.01), the values were close considering the large variations usually observed in the percutaneous absorption studies. Application of toluene, nonane or JP-8 increased the TEWL, JP-8 being the highest (3.5 times at 24 h compared to baseline level). The skin moisture content decreased after the application of JP-8, though it was not significantly different (P>0.05) from the baseline level. JP-8 caused a moderate erythema and a moderate to severe edema. Though the edema decreased after 24 h, the degree of erythema remained about the same until 24 h. The skin irritation caused by JP-8 was greater than neat toluene or nonane. The TEWL data of toluene, nonane and JP-8 correlated well with the skin irritation data (erythema and edema). Exposure of JP-8, which contains hundreds of aliphatic and aromatic hydrocarbons, caused significant changes in the barrier function of the skin as indicated by an increase in TEWL and produced a significant erythema and edema in minipigs. Furthermore, the disruption of barrier function of skin, as indicated by increased TEWL after exposure to JP-8 might result in increased permeation of its own components and/or other chemicals exposed to skin. The present study provides further evidence that pig ear skin may be used as a model for predicting the rates of permeation of chemicals through human skin.

Paying for hospital emergency care under a single-payer system

Hospital emergency services are one of the key drivers of hospital activity, yet there has been surprisingly little attention paid to appropriate funding models for single-payer systems, in which funders must be concerned with issues of access and financial viability of emergency departments. This article analyzes the dynamics of hospital emergency services in terms of the key products and cost drivers. It reviews the currently available systems for categorizing emergency activity and evaluates their applicability for funding purposes with particular emphasis on the susceptibility to gaming of both triage and disposition. It identifies and evaluates 3 models for use in single-payer health systems for funding hospital emergency services (fully variable, fully fixed, and mixed variable/fixed) in terms of the key products and cost drivers in the ED. Approaches to the setting and rebasing of fixed grants are considered. Problems of potential incentive effects and double payment for admitted patients make the setting of variable payments problematic, particularly for patients subsequently admitted as inpatients. Key characteristics of an ED funding model in single-payer systems are proposed.

Percutaneous permeation and skin irritation of JP-8+100 jet fuel in a porcine model

JP-8 is the major jet fuel used by US Air Force. JP-8+100 is a new jet fuel recently introduced by the US Air Force, which contains JP-8 plus three performance additives [butylated hydroxytoluene (BHT), metal deactivator (MDA) and 8Q405]. The purpose of the present study was to investigate the percutaneous permeation of JP-8+100 across pig ear skin in vitro and to study the effect of JP-8+100 exposure on the skin barrier function, moisture content and irritation in Yucatan minipigs. The influence of performance additives on the permeation of JP-8 was studied by adding each additive individually to JP-8. The percutaneous permeation and skin irritation data obtained with JP-8+100 were compared with that of JP-8. JP-8+100 spiked with 5.0 microCi of radiolabeled [14C]tridecane, nonane, naphthalene or toluene (selected components of JP-8+100) was used for the in vitro percutaneous permeation studies. For skin irritation studies, 250 microl of JP-8+100 was placed in a Hill top chamber and affixed over the marked treatment area for 24 h. The components of JP-8+100 such as tridecane, nonane, naphthalene and toluene permeated readily through pig ear skin without any apparent lag time. Compared to JP-8, the permeation of tridecane, toluene and nonane from JP-8+100 was significantly lower (P<0.05). However, the permeation of naphthalene from JP-8+100 was significantly higher than from JP-8. When BHT was added to JP-8, the permeation of all four chemicals were significantly decreased (P<0.05). Though the addition of 8Q405 to JP-8 decreased the permeation of all four chemicals, the values were not significantly different (P>0.05) from that of JP-8. Addition of MDA did not show any significant change in the permeation of the selected chemicals from JP-8. Application of JP-8+100 increased the transepidermal water loss (TEWL) about three times compared to the baseline level. The skin moisture content decreased consistently after the application of JP-8+100, though it was not significantly different (P>0.05) from the baseline level. JP-8+100 caused a moderate erythema (score: 1.60) and a moderate to severe edema (score: 2.60). These results suggest that JP-8+100 produces significant changes in the barrier function of the skin and a local irritant effect upon occlusive dermal exposure. However there was no significant difference in the skin irritation data observed from JP-8 and JP-8+100.

Axial computed tomography of the pedicle in the lower cervical spine

Using axial computed tomography (CT), we measured pedicle width, pedicle axis length, pedicle transverse angle, and distance between screw entry point and vertebrae midline in the cervical spines (C3-C7) of 40 patients. All measurements were greater in men than in women, and we noted significant sex differences at most levels of pedicle inner and outer widths (P < or = .05 or P < or = .01). Mean pedicle inner and outer widths for all levels and all patients ranged from 2.3 to 3.0 mm and from 5.0 to 6.0 mm, respectively. Mean distances between screw entry point and vertebrae midline ranged from 22.2 to 23.7 mm. Results of this study-along with axial CT measurements of individual pedicle diameter, pedicle transverse angle, and screw entry point-would be useful when considering and performing transpedicular screw fixation in the cervical spine.

Interstitial cells of cajal and inflammation-induced motor dysfunction in the mouse small intestine

BACKGROUND & AIMS

Interstitial cells of Cajal (ICC) play an important role in the control of gastrointestinal motility. We aimed to determine a potential role for ICC in the pathophysiology of inflammation-induced motor disorders.

METHODS

Effects of Trichinella spiralis infection on electrical pacemaker activity, the structure of ICC associated with Auerbach's plexus, and in vivo motor patterns were studied in the mouse small intestine.

RESULTS

Between days 1 and 15 after infection, structural damage occurred in the network of ICC, particularly in the processes connecting ICC to each other and to smooth muscle cells. This was associated with desynchronization of electrical pacemaker activity. Abnormal slow wave activity occurred, including doubling of frequency and electrical quiescence, leading to the development of ectopic pacemaker activity in vivo. In vivo motor patterns in the small intestine changed from consistent peristaltic contractile activity in control animals to periods of quiescence alternating with both orally and aborally propagating contractile activity in the presence of inflammation. Sixty days after infection, all parameters studied had returned to normal values.

CONCLUSIONS

Inflammation-induced alterations in the network of ICC of the small intestine associated with Auerbach's plexus lead to disorganization of motor patterns. Because of the strong temporal correlation between damage to the ICC network, electrical uncoupling, the appearance of ectopic pacemaker activity, and the occurrence of retrograde peristalsis, it is concluded that ICC can play a major role in inflammation-induced motor disturbances.

Part I: propofol, thiopental, sevoflurane, and isoflurane-A randomized, controlled trial of effectiveness

When compared with thiopental and isoflurane, propofol and sevoflurane are associated with a faster return to wakefulness after anesthesia. Yet their wider usage in inpatient surgery has been restrained by concerns regarding their acquisition costs and by lack of studies demonstrating improved patient outcome. We randomly allocated 453 adult surgical inpatients to one of four anesthetic regimens (thiopental-isoflurane, propofol-isoflurane, propofol induction and maintenance, or sevoflurane induction and maintenance) and measured their rate and quality of recovery. We found no significant differences in the rate and quality of recovery between groups. Propofol was associated with more pain on injection (P: < 0. 0005), but less cough during induction (P: = 0.003), and less early postoperative nausea and vomiting (P: = 0.003). We could not detect any significant advantages with propofol and sevoflurane, when compared with thiopental and isoflurane in adults undergoing elective inpatient surgery.

IMPLICATIONS

Propofol and sevoflurane do not offer any significant advantages over thiopental and isoflurane in adults undergoing elective inpatient surgery.

Part II: total episode costs in a randomized, controlled trial of the effectiveness of four anesthetics

Newer anesthetics promise improved clinical outcomes, but usually come at a higher price per dose. Previous studies have found few economic benefits in the immediate postoperative period, but have hypothesized that earlier recovery may lead to lower costs for the whole episode of hospitalization. This study uses cost data for patients enrolled in a randomized, controlled clinical trial comparing four anesthetics to test whether the higher costs of the newer anesthetics would be offset against decreased use of other hospital resources. Five hundred general surgery patients were randomly assigned to one of four anesthetic regimens. Estimates from the hospital's patient costing system were used, with validated cost records for a subset of 360 patients. Five patients admitted to the intensive care unit or requiring prolonged hospitalization skewed the distribution of costs, but none of these complications could be attributed to anesthesia. No significant differences were found on length of stay, mean episode cost, operating room costs, ward costs, or readmission rate within 3 mo. The study was not powered to sufficiently show differences in intensive care unit admission or other uncommon outcomes. Patient quality of recovery did not vary among groups, but neither patient willingness-to-pay nor satisfaction were directly measured.

IMPLICATIONS

Propofol and sevoflurane do not offer any significant economic advantages over thiopental and isoflurane in adults undergoing elective inpatient surgery.

Evaluation of skin sensitization potential of jet fuels by murine local lymph node assay

Jet A and JP-8 are the major jet fuels used in civilian and military (US Air Force) flights, respectively. JP-8+100 is a new jet fuel recently introduced by the US Air Force. Besides lung exposure, skin is the potential route of exposure to jet fuels. The purpose of the present study was to investigate the skin sensitization potential of jet fuels (Jet A, JP-8 and JP-8+100) using murine Local lymph node assay (LLNA). Female CBA/Ca mice (8-12-weeks-old) were used in the study. Dinitrochlorobenzene (DNCB, 0.25% w/v) and paraaminobenzoic acid (PABA, 2.5% w/v) were used as positive and negative control, respectively and acetone: olive oil (4:1, AOO) was used as the vehicle (control). All three jet fuels caused a proliferative activity significantly greater than the control (P<0.01). Our results demonstrate that JP-8 is a weak skin sensitizer [stimulation index (SI)=3.17]. The SI of Jet A and JP-8+100 were 2.44 and 2.38, respectively, hence are not considered as skin sensitizers. Interestingly, the SI of JP-8 with butylated hydroxytoluene (BHT) was consistently lower than JP-8, though the difference was not statistically significant (P>0.05). BHT, which is an antioxidant additive of JP-8+100, reduced the skin sensitization potential of JP-8. Furthermore, the lower SI of JP-8+100 could be partially attributed to the presence of BHT. The findings reported here suggest that care should be taken to minimize dermal exposure to jet fuels especially JP-8 to avoid skin sensitization.

The epithelial integrin alphavbeta6 is a receptor for foot-and-mouth disease virus

Field isolates of foot-and-mouth disease virus (FMDV) have been shown to use the RGD-dependent integrin alphavbeta3 as a cellular receptor on cultured cells. However, several other RGD-dependent integrins may have the potential to act as receptors for FMDV in vivo. Of these, alphavbeta6 is a likely candidate for use as a receptor by FMDV as it is expressed on epithelial cells, which correlates with the tissue tropism of the virus. In this report, we show that human colon carcinoma cells (SW480) that are normally nonpermissive for FMDV become susceptible to infection as a result of transfection with the integrin beta6 subunit and expression of alphavbeta6 at the cell surface. Integrin alphavbeta6 is the major site for virus attachment on the beta6-transfected cells, and binding to alphavbeta6 serves to increase the rate of virus entry into these cells. In addition, we show that virus binding and infection of the beta6-transfected cells is mediated through an RGD-dependent interaction that is specifically inhibited by a monoclonal antibody (10D5) that recognizes alphavbeta6. These studies establish a role for alphavbeta6 as a cellular receptor for FMDV.

Cost estimates for hospital inpatient care in Australia: evaluation of alternative sources

OBJECTIVE

This paper presents a framework for evaluation of alternative sources of estimates of the costs of hospital inpatient care in Australia. It argues that the choice of costing methods depends on the decision-context and the sensitivity of the decision to estimation errors.

METHOD

Five criteria are proposed for evaluation of sources of hospital cost data, with detailed consideration of the way estimates are derived in two computerised approaches which use accounting data. Three broad approaches to cost estimation are evaluated against these criteria.

RESULTS

Choosing an estimation method entails an optimisation analysis for each decision context. 'Microcosting' techniques remains the most valid approach to cost estimation, but are costly and this may, in turn, limit the sample of patients or institutions. Protocol-based cost estimates vary widely in their validity, depending on source data, but there is little justification for continued use of crude per diem cost estimates in such protocols. When precision and resolution are important objectives, clinical costing approaches provide the most valid inpatient cost estimates at a reasonable data cost. When external validity is important, or where standardisation of hospital costs is desired, use of published national cost weights may be preferred.

CONCLUSION

Both primary and secondary sources of cost data must withstand challenges to internal and external validity. The 'resolution' (or precision) of cost estimates and the relative costs of collection must also be considered.

IMPLICATIONS

Studies using estimates of the costs of hospital care should defend the appropriateness of the costing approach and data source for the decision context.

Personality differences between eating-disordered women and a nonclinical comparison sample: a discriminant classification analysis

The present study evaluated the extent to which eating-disordered and nonclinical comparison samples could be differentiated on self-reported personality measures of autonomy and sociotropy and a projective measure of dependency. Sixty-two women meeting diagnostic criteria for eating disorder and a nonpsychiatric comparison group of 62 women completed the autonomy and sociotropy subscales of the Personal Style Inventory-II and the Rorschach Oral Dependency Scale (ROD). A discriminant classification analysis indicated 85.5% of eating-disordered subjects and 88.7% of control subjects were identified accurately from their scores on autonomy, sociotropy. and ROD. Results suggest that the experience of eating disorders is associated with a mixed clinical presentation characterized by issues related to sociotropy-dependency, and especially, achievement-related vulnerabilities. Potentially fruitful areas for future study include assessing the utility of autonomy and sociotropy as predictors of eating disturbances in prospective research and evaluating their utility in predicting treatment prognosis among patients with eating disorders.

Foot-and-mouth disease virus is a ligand for the high-affinity binding conformation of integrin alpha5beta1: influence of the leucine residue within the RGDL motif on selectivity of integrin binding

Field isolates of foot-and-mouth disease virus (FMDV) use RGD-dependent integrins as receptors for internalization, whereas strains that are adapted for growth in cultured cell lines appear to be able to use alternative receptors like heparan sulphate proteoglycans (HSPG). The ligand-binding potential of integrins is regulated by changes in the conformation of their ectodomains and the ligand-binding state would be expected to be an important determinant of tropism for viruses that use integrins as cellular receptors. Currently, alphavbeta3 is the only integrin that has been shown to act as a receptor for FMDV. In this study, a solid-phase receptor-binding assay has been used to characterize the binding of FMDV to purified preparations of the human integrin alpha5beta1, in the absence of HSPG and other RGD-binding integrins. In this assay, binding of FMDV resembled authentic ligand binding to alpha5beta1 in its dependence on divalent cations and specific inhibition by RGD peptides. Most importantly, binding was found to be critically dependent on the conformation of the integrin, as virus bound only after induction of the high-affinity ligand-binding state. In addition, the identity of the amino acid residue immediately following the RGD motif is shown to influence differentially the ability of FMDV to bind integrins alpha5beta1 and alphavbeta3 and evidence is provided that alpha5beta1 might be an important FMDV receptor in vivo.

Novel roles for elongin C in yeast

Mammalian Elongin C is a 112-amino acid protein that binds to the von Hippel-Lindau (VHL) tumor suppressor and to Elongin A, the transcriptionally active subunit of the RNA polymerase II elongation factor, SIII. It is conserved in eukaryotic cells, as homologs have been identified in Saccharomyces cerevisiae, Drosophila melanogaster and Caenorhabditis elegans. The mammalian protein is thought to function as part of a ubiquitin targeting E3 ligase, yet the function in yeast has not been determined. In this report we examine the role of Elongin C in yeast and establish that yeast Elongin C may function in a mode distinct from its role as an E3 ligase. The RNA is expressed ubiquitously, albeit at low levels. Two hybrid analyses demonstrate that Elongin C in yeast interacts with a specific set of proteins that are involved in the stress response. This suggests a novel role for Elongin C and provides insights into additional potential functions in mammalian cells.

Comparison of in vitro and in vivo release characteristics of sustained release ofloxacin microspheres

The sustained release nature of ofloxacin microspheres--to eradicate bacterial biofilm associated with chronic infections from sensitive strains of bacteria--was determined both in vitro and in vivo. Ofloxacin microspheres were prepared by emulsion solvent evaporation procedure using poly(glycolic acid-co-dl-lactic acid) (PLGA) as the biodegradable polymer. The microspheres were characterized by scanning electron microscopy, in vitro release in an incubator, and in vivo release in the rat subcutaneous model. The microspheres were highly spherical with a very smooth surface. Approximately 45% of the drug was released from microspheres in sizes of 125-250 microns and 250-425 microns in 2 days compared with approximately 22% from microspheres of size range 37-125 microns indicating that surface area of the microspheres did not control the kinetics of in vitro release. However, about 96% of the drug was released from the three different size ranges in 35 days. The in vitro release profile of microspheres of size range 125-250 microns is not significantly different from microspheres in sizes of 250-425 microns. The peak plasma level of ofloxacin in animals that received the drug suspension occurred within 2 hr and was higher than that of the microspheres that occurred by the end of the second day. The plasma of animals that received the free drug was depleted of ofloxacin by the end of the first day, but the drug was sustained above 0.5 microgram/mL in the plasma of animals that received the microspheres for about 3 weeks. The results suggest that biodegradable ofloxacin microspheres can be prepared that release the antibiotic in vivo for about 3 weeks. This should provide a means for continuous treatment of chronic infections in which bacterial biofilm can occur.

Culture and self-presentation as predictors of shyness among Japanese and American female college students

Self-presentation theories of shyness have been supported in North American samples but have not been evaluated cross-culturally. This study examined the relative influence of cultural and psychological variables on self-reported shyness among Japanese and American college students. 35 female Japanese-born and 47 United States-born Euro-American female students completed the Shyness Scale, Rosenberg Self-esteem Scale, Interpersonal Competence Questionnaire, Sensitivity to Rejection Scale, and Individualism-Collectivism Scale, and a demographic data sheet. After statistically controlling for Individualism-Collectivism, psychological measures, especially perceived interpersonal competence and sensitivity to rejection, combined for Adjusted R2 = .32 in shyness. Findings suggest that similar factors are central to experiences of shyness for both samples. Researchers should assess the stability of such findings in larger, heterogeneous samples and evaluate whether treatment strategies that reduce expectations of rejection and increase perceived interpersonal competence have comparable efficacy in reducing shyness across cultures.

In vitro and in vivo characterization of biodegradable enoxacin microspheres

The in vitro release and plasma concentration profiles of sustained release enoxacin microspheres intended for the treatment of bone and systemic infections due to sensitive strains of bacteria were investigated. Microspheres of enoxacin were prepared by using poly(glycolic acid-co-DL-lactic acid) (PLGA) by the emulsion solvent evaporation technique and characterized by in vitro release in an incubator, and in vivo release in the rat subcutaneous model. The microspheres were spherical in nature, and particle size range had a significant influence on the in vitro release. The enoxacin plasma concentration 2 h after the administration of treatments was two-fold higher in animals who received the free drug compared with those who received microspheres of size range 125-250 microm. The plasma of animals who received the free drug was depleted of enoxacin by the end of the first day. However, the plasma concentration of enoxacin in the animals who received microspheres was sustained above 0.5 microg/ml for about 8 days. The results show that biodegradable microspheres of enoxacin can be prepared which release the antibiotic in vivo for days following a subcutaneous administration. This should provide a means for the sustained treatment of infections due to sensitive strains of bacteria.