PEHO and PEHO-like syndromes: report of five Australian cases

PEHO syndrome is a rare progressive infantile encephalopathy with onset within the first few months of life. Few patients fulfilling the diagnostic criteria for PEHO syndrome have been reported outside Finland. Affected infants have facial dysmorphism and suffer from severe hypotonia, profound mental retardation, convulsions (often with a hypsarrhythmic EEG pattern), transient or persistent peripheral oedema, and optic atrophy. Cerebellar and brainstem atrophy are usually present on neuroimaging. A PEHO-like syndrome has been described, in which the affected individuals have neither optic atrophy nor the typical neuroradiological findings. We report five Australian patients, the first with classical features of PEHO syndrome, and four who have a PEHO-like disorder. We compare their features with other published cases. We suggest that PEHO or a PEHO-like syndrome may affect more patients than are currently identified, based on the original diagnostic criteria for this disorder.

CIR sand casting system for trans-tibial socket

The authors have developed a trans-tibial socket fabrication system based on the "dilatancy" principle, a process that has been commonly used in forming wheelchair Seating. The CIR Sand Casting System replaces plaster of Paris with sand for forming both a negative sand mould and a positive sand model, which can be modified for either thermoplastic socket formation or resin lamination. Initial clinical trials suggest that fabrication times are approximately 90 minutes from patient evaluation and casting to dynamic alignment. Compatibility with all existing prosthetic components is retained. It is believed the CIR socket fabrication system may be a competitive alternative for prosthetic service providers in developing countries.

A simple, reproducible substrate for studying biofilms in aquatic environments

In this paper we present a simple in expensive substrate for studying biofilms. Bioballs are robust plastic spheres with high surface area to volume ratios (ca 130:1) used in home aquarium filters. Their properties make them ideal substrates for use in studies of aquatic biofilms. As examples, in this paper we describe the growth and enzyme activities of biofilms grown on these substrates and explore the interaction between DOC concentration and biofilm biomass. Biofilm growth and activity on the bioballs was very reproducible. For example maximum biofilm growth following approximately 3 months inundation was estimated to be 40 (+/- 3.6) mg protein and 120 (+/- 11) microg chlorophyll a per bioball.

Health visiting at the crossroads: which way to the 21st century?

This article presents a response from a group of lecturers at Florence Nightingale School of Nursing and Midwifery, King's College London and one service user to the perception of a crisis of confidence within health visiting. Changes in registration procedures and shifts in policy have led health visiting to question its place within primary care and the model of preparation for health visiting practice. The group argues that this debate is based on a misunderstanding of the changing health care environment and that health visiting can find a place within the primary care team. Key to this is the continued adherence to a basic nursing training. The authors suggest an incremental model of health visitor training to provide the fullest scope to implement the new health agenda.

Coregulation of balance between children's prosocial approaches and acts of compliance: a pathway to mother-child cooperation?

Examined the free-field interaction of 32 mother-child dyads who volunteered to participate in a 1-hr home observation. Observers coded mother instructions, child compliance, and child prosocial approaches plus mothers' social attention as potential reinforcers for the children's compliance and social approaches. Herrnstein's matching law was used to analyze covariations between mothers' attention and the children's 2 responses. This analysis was followed by correlational and sequential probability analyses to determine linkages between these 2 child responses and the children's willingness to obey their mothers' instructions. Results showed consistent matching between mothers' social attention and the children's production of prosocial approaches and acts of compliance. An index of the proportions of these 2 responses also covaried with the children's compliance probabilities, and the prosocial approach component was the direct covariate. These findings are discussed within an interactional synchrony framework in which children's willingness to obey their mothers is influenced by opportunities for the dyad to engage each other in specific forms of social interaction.

Combined strabismus and phacoemulsification cataract surgery: a useful option in selected patients

PURPOSE

To evaluate the role of combined strabismus and phacoemulsification cataract extraction in patients with symptomatic cataract and strabismus.

METHODS

Four procedures of combined strabismus and cataract surgery are described in 3 elderly patients with strabismus of differing aetiologies. Two patients underwent one procedure; the other patient underwent two combined procedures, one to each eye.

RESULTS

The visual acuity improved in all 3 patients. Post-operative alignment of the visual axis was achieved which allowed resolution of symptomatic diplopia in patient 1, functional binocular single vision in patient 2 and a noticeably reduced compensatory head posture in patient 3.

CONCLUSIONS

Combined strabismus and cataract surgery is a safe procedure that can optimise visual alignment and improve visual acuity with a minimum number of operations.

The genetics of keratoconus

Keratoconus is a relatively common, bilateral, non-inflammatory corneal ectasia. The aetiology of this condition is probably multifactorial, or it represents the final common pathway for a variety of different pathological processes. Although a familial history is present only in a minority of cases, one of the major aetiological factors is certainly genetic. This is evidenced by: the condition's familial inheritance; its discordance between monozygotic and dizygotic twins; and its association with other known genetic disorders such as Down's and Marfan's syndromes. In the keratoconic cornea, a possible genetic predisposition to increased sensitivity to apoptotic mediators by keratocytes has also been hypothesized. Differences in prevalence between ethnic groups have been identified. Recent advances in computerized topographic diagnostic techniques for keratoconus, including forme fruste keratoconus, enables higher accuracy in delineating abnormal from normal, and helps define study populations for genetic linkage studies. However, genetic heterogeneity and the phenotypic diversity of keratoconus means that genetic analysis continues to be a complex process. None the less, it is foreseeable that over the next decade, improved diagnostic techniques, in combination with molecular genetics, may reveal conclusive data on the precise nature of the genetic inheritance of keratoconus in specific populations. This review considers the evidence that suggests keratoconus is primarily an inherited condition, and examines research strategies aimed at unveiling the genetic predisposition, and the enigma of environmental influences on its phenotypic expression.

The structure of symptom report in asthma: a reevaluation

OBJECTIVES

We studied the structure of symptom report in a sample of British asthma patients using the Asthma Symptom Checklist (ASC).

METHODS

The ASC was administered to 193 patients, together with a questionnaire on demographics and asthma-related information and the Perceived Control of Asthma Questionnaire.

RESULTS

Principal Component Analysis yielded evidence for a six-dimensional structure of the ASC, with positively correlated subscales for panic-fear, irritation, obstruction-dyspnea, obstruction-congestion, fatigue, and hyperventilation symptoms. Individual subscales showed good to excellent item characteristics and internal consistencies in individual subscales. Panic-fear and obstruction-congestion were related to self-reported duration of oral corticosteroid intake. Other ASC subscales were positively related to aspects of health care utilization, limitations in daily activity, and lower perceived control of asthma mainly in women. The dyspnea subscale of the ASC showed only little relationship with either of these variables.

CONCLUSION

The ASC can reliably assess the multidimensional structure of asthma symptom report. Its subscales are associated with important aspects of asthma management behavior.

Laparoscopic myomectomy after failure of uterine artery embolization

A patient experienced continuing pain and growth of a broad-based pedunculated myoma 6 months after uterine artery embolization (UAE). A 7-cm myoma was found growing directly from the serosa of the fallopian tube and was removed laparoscopically. To our knowledge, this is the first report of laparoscopic myomectomy performed after failure of UAE. This case identifies one of the predictable limitations of UAE of which gynecologists must be cognizant when recommending the procedure.

Spatial interactions minimize relative disparity between adjacent surfaces

Computational models of stereopsis employ a number of algorithms that constrain stereo matches to produce the smallest absolute disparity and to minimize the relative disparity between nearby features. In some natural scenes, such as large slanted textured surfaces, these two constraints lead to different matching solutions. The current study utilized a stimulus in which there was a large discrepancy in both the magnitude and direction of matches that solved for minimum absolute and minimum relative disparity. This discrepancy revealed a dominance for the minimum relative disparity over the minimum absolute disparity matching solution that increased with spatial proximity, spatial frequency and width of adjacent features. The likelihood of a minimum-relative-disparity matching solution also increased when the difference between the amplitudes of the alternative relative disparities was large. When alternative relative disparity matching solutions had similar amplitudes but opposite signs (crossed vs. uncrossed), an idiosyncratic depth bias served as a tie-breaker. The present results show that absolute disparity matches are constrained to minimize relative disparity between adjacent features.

Aedes aegypti transducing densovirus pathogenesis and expression in Aedes aegypti and Anopheles gambiae larvae

Aedes aegypti densovirus (AeDNV) is a small DNA virus that has been developed into an expression and transducing vector for mosquitoes [Afanasiev et al. (1994) Exp Parasitol 79: 322-339; Afanasiev et al. (1999) Virology 257: 62-72; Carlson et al. (2000) Insect Transgenesis: Methods and Applications (Handler, A.M. & James, A.A., eds), pp. 139-159. CRC Press, Boca Raton]. Virions carrying a recombinant genome expressing the GFP gene were used to characterize the pathogenesis of the virus in 255 individual Aedes aegypti larvae. The anal papillae of the larvae were the primary site of infection confirming previous observations (Afanasiev etal., 1999; Allen-Muira et al. (1999) Virology 257: 54-61). GFP expression was observed in most cases to spread from the anal papillae to cells of the fat body, and subsequently to many other tissues including muscle fibers and nerves. Infected anal papillae were also observed to shrink, or melanize and subsequently fall off in a virus dependent manner. Three to four day-old larvae were less susceptible to viral infection and, if infected, were more likely to survive into adulthood, with 14% of them still expressing GFP as adults. Higher salt concentrations of 0.10-0.15 M inhibited viral infection. Anopheles gambiae larvae also showed infection of the anal papillae (17%) but subsequent viral dissemination did not occur. The persistence of the reporter gene expression into adulthood of Aedes aegypti indicates that transduction of mosquito larvae with recombinant AeDNV may be a means of introducing a gene of interest into a mosquito population for transient expression.

Envelope size tuning for stereo-depth perception of small and large disparities

Stereopsis is the sense of depth derived from binocular disparities that are formed between targets that are matched between the two retinal images. Binocular matches for sustained stereopsis are based on similarity of orientation, spatial frequency and contrast of the two retinal images whereas matches for transient stereopsis depend on these parameters to a very limited extent. In this investigation we have tested the possibility that transient stereopsis forms matches between objects of similar overall size. The tuning of sustained and transient stereopsis to contrast-envelope size was investigated by presenting narrow-band Gabor targets of unequal size to the two eyes. Bandwidth for envelope-size tuning was estimated from the range of dichoptic size-differences over which stereo performance remained above chance level. An equal bandwidth of 2 octaves was found for the sustained and transient stereo systems when stimulated with parallel orientation Gabors that subtended a small disparity. Sustained-stereo performance with orthogonal carriers was reduced with large envelope sizes. Bandwidth of the transient stereo system increased to 3 octaves when tested with a larger disparity stimulus and it was independent of carrier orientation. Reducing the contrast of the larger-size Gabor improved transient-stereo performance from near chance (48-58%) to 85-95%. Thus the bandwidth for envelope-size tuning is much broader than indicated with equal physical contrast stimuli. The observed tuning to envelope size, while broad, is tighter than that observed for carrier spatial-frequency [Vis. Res. 38 (1998) 3057], carrier orientation [Vis. Res. 39 (1999) 2717] and contrast polarity [Vis. Res. 39 (1999) 4010] of the stimulus. Thus it would appear that envelope size and, to a greater extent, temporal synchrony of the dichoptic stimuli [Perception 24 (1995) 33] are the primary means for selecting matched binocular inputs for transient stereopsis.

Implications of aqueous silica sorption to iron hydroxide: mobilization of iron colloids and interference with sorption of arsenate and humic substances

This work highlighted practical implications of aqueous silica sorption to iron hydroxide in natural and engineered systems. Two types of surfaces were prepared by exposing 10 mg/L preformed Fe(OH)3 to aqueous silica (0-200 mg/L as SiO2) for periods of 1.5 h or 50 days. After 1.5 h, the concentration of iron passing through a 0.45 microm pore size filter at pH 6.0-9.5 was always negligible, but if zeta potential < or =-15 mV as much as 35% of the iron passed through filters after 50 days of aging. When arsenate was added to 10 mg/L iron hydroxide particles equilibrated with aqueous silica for 1.5 h, percentage arsenate removals were high. In contrast, if silica was preequilibrated with iron for 50 days, arsenate removals decreased markedly at higher pH and aqueous silica concentrations. Similar trends were observed for humic substances, although their removal was nearly completely prevented at pH 8.5 at SiO2 concentrations above 50 and 10 mg/L at 1.5 h and 50 days exposure, respectively. The mechanism of interference was hindered sorption to the iron hydroxide surface.

Reducing recurrence in child protective services: impact of a targeted safety protocol

Statewide implementation of a child safety assessment protocol by the Illinois Department of Children and Family Services (DCFS) in 1995 is assessed to determine its impact on near-term recurrence of child maltreatment. Literature on the use of risk and safety assessment as a decision-making tool supports the DCFS's approach. The literature on the use of recurrence as a summative measure for evaluation is described. Survival analysis is used with an administrative data set of 400,000 children reported to DCFS between October 1994 and November 1997. An ex-post facto design tests the hypothesis that the use of the protocol cannot be ruled out as an explanation for the observed decline in recurrence following implementation. Several alternative hypotheses are tested: change in use of protective custody, other concurrent changes in state policy, and the concurrent experience of other states. The impact of the protocol to reduce recurrence was not ruled out.

Imaging posterior polymorphous corneal dystrophy by in vivo confocal microscopy

To identify features of posterior polymorphous dystrophy (PPMD) by in vivo confocal microscopy, the corneas of a female patient with PPMD were exam ned using slit-lamp biomicroscopy and slit-scanning in vivo confocal microscopy. Characteristic endothelial vesicular and band lesions were seen clinically and easily identified using in vivo confocal microscopy. However endothelial pleomorphism, an increased density and reflectance of posterior stromal keratocytes, and prominence of corneal nerves were also delineated. In vivo confocal microscopy enhances clinicopathological diagnosis and follow up of corneal dystrophies with subtle clinical presentations, such as PPMD.

Replication and extension studies of inflammatory bowel disease susceptibility regions confirm linkage to chromosome 6p (IBD3)

Inflammatory bowel disease (IBD) is a chronic inflammatory disease of the intestine, commonly diagnosed as either ulcerative colitis (UC) or Crohn's disease (CD). Epidemiological studies have consistently shown that both genetic and environmental factors influence the pathogenesis of IBD. A number of genome scans have been conducted in cohorts of IBD families with affected sibling pairs (ASPs) to identify chromosomal regions that harbour IBD susceptibility genes. Several putative linked loci have been identified, including two loci on chromosomes 16 and 12, IBD1 and IBD2, which have subsequently been replicated by independent region-specific studies. We have conducted both a replication study on another linkage region, chromosome 6p (IBD3), and extension studies on two other regions, chromosomes 3p and 7q. Microsatellite markers across each region were genotyped in 284 IBD ASPs from 234 families. A nonparametric peak multipoint LOD score of 3.0 was observed near D6S291, replicating the previous linkage to chromosome 6p (IBD3). Nominal evidence of linkage was observed at both the 3p and 7q regions.

Preoperative intraaortic balloon pumps in high-risk patients undergoing open heart surgery

BACKGROUND

The use of the preoperative intraaortic balloon pump (IABP) in patients with severe left ventricular dysfunction or unstable angina with critical coronary anatomy is becoming more frequent as surgical casemix changes. The aim of this study was to determine the impact of preoperative IABP use on survival in high-risk patients having open heart surgery.

METHODS

Prospectively collected data for 645 consecutive patients were reviewed. Patients receiving an IABP were identified and grouped as follows: group A (preoperative IABP for high-risk nonemergent cases), group B (preoperative IABP for emergent cases), and group C (intra/postoperative IABP). Risk-adjusted hospital mortality rates in these three groups was compared using the modified Parsonnet score for preoperative risk stratification.

RESULTS

IABPs were used in 101 cases (16%). The predicted versus actual hospital mortality rate was 20% versus 5.7% in group A, 32.1% versus 47.6% in group B, and 12.6% versus 22.2% in group C (group A vs group B, p = 0.0014; group A vs group C, p = 0.012). IABP-related morbidity occurred in 3% of cases (all in group C).

CONCLUSIONS

Risk-adjusted mortality was significantly lower in high-risk cases with preoperative IABPs compared with emergent cases and intraoperative/postoperative IABPs. We encourage the use of preoperative IABPs in selected high-risk patients.

Envelope size-tuning for transient disparity vergence

Our prior studies have demonstrated that the transient-vergence system responds preferably to dichoptic stimulus pairs that contain the highest combined energy, regardless of dichoptic differences in spatial frequency, contrast, orientation, or luminance polarity (Edwards, M., Pope, D. R., & Schor, C. M. (1998), Vision Research 38, 705; Pope, D. R., Edwards, M., & Schor, C. M. (1999) Vision Research 39, 575). This broadband tuning for spatial frequency, orientation and contrast is indicative of a second order (non-linear) extraction system. The current study examined the potential size-tuning of binocular channels to the contrast envelope that is extracted by a non-linear process. Stimuli were size-scaled Gabor patches with parallel and orthogonal carrier orientations that subtended a large (3.8 degrees ) disparity. Results indicate that the transient-vergence system exhibits broad band-pass tuning to overall size of dichoptic targets, independent of interocular differences in carrier orientation, spatial frequency or contrast. Equal sizes elicited a higher proportion of vergence responses than unequal sizes, however responses to unequal size still occurred over a 2-octave range, illustrating broad band-pass tuning. Size tuning was found to be broader for small than large envelope sizes. The broad tuning for envelope size is likely to result from the overlapping extracted low-pass frequency spectra of the contrast envelopes. However, the transient-vergence system also responds to monocular, hemi-retinal stimuli over a larger (3-octave) range. Thus some of the observed "binocular tuning" may be due to these monocular responses.

Nursing management of constipation in housebound older people

In this article two algorithms are suggested for use by district nurses in the management of constipation in dependent older people at home. Prescribing for this group of patients requires a complex assessment of medical and social factors as 24-hour supervision is not always available and local health and social service resources may impact on the level of care that is available in terms of the provision of food and drink and the taking of medicines.

Orphan receptor promiscuity in the induction of cytochromes p450 by xenobiotics

The mechanisms by which different classes of chemicals induce the same cytochrome P450 (CYP) or the same chemical differentially induces more than one CYP are not well understood. We show that in primary hepatocytes and in vivo in liver (transfected by particle-mediated delivery) two orphan nuclear receptors, constitutive androstane receptor and pregnane X receptor (PXR1), transactivate a CYP gene via the same response element in a xenobiotic-specific manner. The constitutive androstane receptor mediates the barbiturate activation of expression of CYP2B1 and CYP3A1. PXR1 activates both genes in response to synthetic steroids. To exert their effect the receptors bind to the same direct repeat site (DR4) within the phenobarbital response element of the CYP2B1 promoter and to the same DR3 site in the pregnane X response element of CYP3A1. The receptors are therefore promiscuous with respect to DNA binding but not ligand binding. Differences in enhancer half-site spacing may influence the efficiency of interactions between the receptor and the transcription machinery and hence form the basis for the differential induction of CYP2B1 and CYP3A1 in response to barbiturates and synthetic steroids.

Improving psychosocial assessment in oncology

A project that encouraged nurses to give greater emphasis to cancer patients' psychological, social and spiritual concerns, and not only to the condition's physical effects, reflects one target outlined in The NHS Cancer Plan.

Xenobiotic induction of cytochrome P450 2B1 (CYP2B1) is mediated by the orphan nuclear receptor constitutive androstane receptor (CAR) and requires steroid co-activator 1 (SRC-1) and the transcription factor Sp1

The constitutive androstane receptor (CAR) activates the expression of a reporter gene attached to the phenobarbital-response element (PBRE) of the cytochrome P450 2B1 (CYP2B1) gene in response to the barbiturate phenobarbital and the plant product picrotoxin. The xenobiotic-mediated increase in transactivation occurs in transfected primary hepatocytes and in liver transfected by biolistic-particle-mediated DNA transfer, but not in the transformed cell lines HepG2, CV-1 and HeLa, which support only constitutive activation of gene expression by CAR. Steroid co-activator 1 (SRC-1) enhances both constitutive and xenobiotic-induced CAR-mediated transactivation via the CYP2B1 PBRE in transfected primary hepatocytes. The nuclear receptor 1 (NR1) site of the PBRE is sufficient for CAR-mediated transactivation, but additional sequences within the PBRE, and hence the proteins that bind to them, are required for the interaction of CAR with SRC-1. The NR2 site of the PBRE binds proteins other than CAR, including an unidentified nuclear receptor heterodimerized with retinoid X receptor alpha. By binding to the proximal promoter of CYP2B1, the transcription factor Sp1 increases both basal transcription and xenobiotic-induced expression via the PBRE. Thus induction of CYP2B1 expression by xenobiotics is mediated by the nuclear receptor CAR and, for optimal expression, requires SRC-1 and Sp1.