A portfolio analysis of autism research funding in Aotearoa New Zealand 2007-2021

LAY ABSTRACT

We aimed to document the areas of autism research that have previously been funded in Aotearoa New Zealand. We searched for research grants awarded to autism research in Aotearoa New Zealand between 2007 and 2021. We compared the funding distribution in Aotearoa New Zealand to other countries. We asked people from the autistic community and broader autism community whether they were satisfied with this funding pattern, and whether it aligned with what is important to them and to autistic people. We found that the majority of funding for autism research was awarded to biology research (67%). Members of the autistic and autism communities were dissatisfied with the funding distribution, and expressed a lack of alignment with what is important to them. People from the community indicated that the funding distribution did not address the priorities of autistic people, and that it indicated a lack of engagement with autistic people. Autism research funding needs to reflect the priorities of the autistic and autism communities. Autistic people need to be included in autism research and related funding decisions.

Identification of the characteristics of occlusive myocardial infarction: are there any tell-tale signs?

Introduction

Treatment urgency of myocardial infarction (MI) is currently stratified by ST elevation (STEMI) or lack of ST elevation (NSTEMI) on the electrocardiogram. This categorisation arose from the theory that ST elevation indicated total acute coronary artery occlusion (1). However, one-quarter of all NSTEMI have acute occlusion, have a higher mortality and are potentially missed by this strategy (2).

Purpose

The study purpose is to identify clinical features that could help distinguish an occlusive MI from non-occlusive MI.

Methods

The prospectively British Cardiovascular Intervention Society (BCIS) data set was collected from patients undergoing primary cutaneous intervention (dataset) was analysed from the years 2015 to 2019. Data collected included presentation characteristics, co-morbidities, treatments and outcomes. We further undertook latent class analysis, to determine whether distinct patterns of presentation and history are associated with acutely occluded NSTEMI. This methodology proceeds through segmentation of a dataset into clusters (“classes”) based on case similarities for the set of variables or “indicators” of interest; the classes are then statistically analysed to evaluate the differences between them.

Results

A total of 2025 patients underwent percutaneous coronary intervention (PCI) between 2015 and 2019. Of these, 1412 underwent PCI for MI, 510 had a STEMI, and 263 had occlusive MI on angiogram. STEMI patients tended to be younger (66 vs 67; p=0.045), in shock (6.1% vs 1.9%; p<0.001), have cardiac arrest (5.7% vs 1.2%; p<0.001), less co-morbidities, increased left ventricular ejection fraction (LVEF) (<30% 11.8% vs 4.7%; p<0.001, increased short-term mortality (3.5% vs 0.7%; p<0.001) and increased emergency PCI (55.9% vs 6.9%; p<0.001) and thrombolysis (32.7% vs 2.5%; p<0.001),. Occlusive MI patients tended to have ST elevation (63.5% vs 29.9%: p<0.001), cardiogenic shock (9.1% vs 2.1%; p<0.001) cardiac arrest (5.3% vs 2.3%; p=0.007), less co-morbidities but no difference in cerebrovascular disease, increased acute mortality (4.2% vs 1.1%; p<0.001) severe LVEF (11.8% vs 6.2%; p<0.001) and increased emergency PCI (70.3% vs 14.1%; p<0.001), With latent class analysis, while clusters of similar patients are observed in the dataset, we determined that the variables captured by BCIS do not usefully indicate an acutely occluded MI compared to non-occlusive MI (Figure 1).

Conclusion

Features between occlusive MI and STEMI are broadly very similar. However, unlike STEMI/NSTEMI, there was no difference in age and risk of cerebrovascular disease in the occlusive MI/non-occlusive MI group. This could indicate occlusion MI occurs in higher numbers in elderly and frail patients and may be frequently missed, possibly from greater collateralisation. There is no reliable characteristic for identifying occlusive between non-occlusive MI. Improved methods are needed for the identification of occlusive MI patients.

Funding Acknowledgement

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): A project supported by the European Union's INTERREG VA Programme, managed by the Special EU Programmes Body (SEUPB). The funders of this project had no input in designing, implementation or writing of this review. Step 1 of latent class analysis

Factors influencing hospital conveyance following ambulance attendance for people with diabetes: A retrospective observational study

AIM

To assess variables contributing to hospital conveyance for people with diabetes and the interactions between them. A secondary aim was to generate hypotheses for further research into interventions that might reduce avoidable hospital admissions.

METHODS

A national retrospective data set including 30 999 diabetes-related callouts from the Scottish Ambulance Service was utilized covering a 5-year period between 2013 and 2017. The relationship between diabetes-related hospital conveyance and seven potential risk factors was analysed. Independent variables included: age, gender, deprivation, paramedic attendance, treatment at the scene, first blood glucose measurement and day of the week.

RESULTS

In Scotland, hyperglycaemia was associated with a higher number of people being conveyed to hospital than hypoglycaemia (49.8% with high blood glucose vs. 39.3% with low glucose, P ≤ 0.0001). Treatment provided in pre-hospital care was associated with reduced conveyance rates (47.3% vs. 58.2% where treatment was not administered, P ≤ 0.0001). Paramedic attendance was also associated with reduced conveyance to hospital (51.4% vs. 59.5% where paramedic was not present, P ≤ 0.0001). Paramedic attendance in hyperglycaemic cases was associated with significantly reduced odds of conveyance (odds ratio 0.52, P ≤ 0.001).

CONCLUSIONS

A higher rate of conveyance associated with hyperglycaemic cases indicates a need for more resources, education and training in this area. Higher conveyance rates were also associated with no paramedic being present and no treatment being administered. This suggests that paramedic attendance may be crucial in reducing avoidable admissions. Developing and validating protocols for pre-hospital services and treatment may help to reduce hospital conveyance rates.

SPICED-ACS: Study of the potential impact of a computer-generated ECG diagnostic algorithmic certainty index in STEMI diagnosis: Towards transparent AI

BACKGROUND

Computerised electrocardiogram (ECG) interpretation diagnostic algorithms have been developed to guide clinical decisions like with ST segment elevation myocardial infarction (STEMI) where time in decision making is critical. These computer-generated diagnoses have been proven to strongly influence the final ECG diagnosis by the clinician; often called automation bias. However, the computerised diagnosis may be inaccurate and could result in a wrong or delayed treatment harm to the patient. We hypothesise that an algorithmic certainty index alongside a computer-generated diagnosis might mitigate automation bias. The impact of reporting a certainty index on the final diagnosis is not known.

PURPOSE

To ascertain whether knowledge of the computer-generated ECG algorithmic certainty index influences operator diagnostic accuracy.

METHODOLOGY

Clinicians who regularly analyse ECGs such as cardiology or acute care doctors, cardiac nurses and ambulance staff were invited to complete an online anonymous survey between March and April 2019. The survey had 36 ECGs with a clinical vignette of a typical chest pain and which were either a STEMI, normal, or borderline (but do not fit the STEMI criteria) along with an artificially created certainty index that was either high, medium, low or none. Participants were asked whether the ECG showed a STEMI and their confidence in the diagnosis. The primary outcomes were whether a computer-generated certainty index influenced interpreter's diagnostic decisions and improved their diagnostic accuracy. Secondary outcomes were influence of certainty index between different types of clinicians and influence of certainty index on user's own-diagnostic confidence.

RESULTS

A total of 91 participants undertook the survey and submitted 3262 ECG interpretations of which 75% of ECG interpretations were correct. Presence of a certainty index significantly increased the odds ratio of a correct ECG interpretation (OR 1.063, 95% CI 1.022-1.106, p = 0.004) but there was no significant difference between correct certainty index and incorrect certainty index (OR 1.028, 95% CI 0.923-1.145, p = 0.615). There was a trend for low certainty index to increase odds ratio compared to no certainty index (OR 1.153, 95% CI 0.898-1.482, p = 0.264) but a high certainty index significantly decreased the odds ratio of a correct ECG interpretation (OR 0.492, 95% CI 0.391-0.619, p < 0.001). There was no impact of presence of a certainty index (p = 0.528) or correct certainty index (p = 0.812) on interpreters' confidence in their ECG interpretation.

CONCLUSIONS

Our results show that the presence of an ECG certainty index improves the users ECG interpretation accuracy. This effect is not seen with differing levels of confidence within a certainty index, with reduced ECG interpretation success with a high certainty index compared with a trend for increased success with a low certainty index. This suggests that a certainty index improves interpretation when there is an increased element of doubt, possibly forcing the ECG user to spend more time and effort analysing the ECG. Further research is needed looking at time spent analysing differing certainty indices with alternate ECG diagnoses.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Measurement of muon neutrino quasielastic scattering on a hydrocarbon target at Eν ~ 3.5 GeV

We report a study of ν(μ) charged-current quasielastic events in the segmented scintillator inner tracker of the MINERvA experiment running in the NuMI neutrino beam at Fermilab. The events were selected by requiring a μ- and low calorimetric recoil energy separated from the interaction vertex. We measure the flux-averaged differential cross section, dσ/dQ², and study the low energy particle content of the final state. Deviations are found between the measured dσ/dQ² and the expectations of a model of independent nucleons in a relativistic Fermi gas. We also observe an excess of energy near the vertex consistent with multiple protons in the final state.

Measurement of muon antineutrino quasielastic scattering on a hydrocarbon target at Eν ~ 3.5 GeV

We have isolated ν(μ) charged-current quasielastic (QE) interactions occurring in the segmented scintillator tracking region of the MINERvA detector running in the NuMI neutrino beam at Fermilab. We measure the flux-averaged differential cross section, dσ/dQ², and compare to several theoretical models of QE scattering. Good agreement is obtained with a model where the nucleon axial mass, M(A), is set to 0.99 GeV/c² but the nucleon vector form factors are modified to account for the observed enhancement, relative to the free nucleon case, of the cross section for the exchange of transversely polarized photons in electron-nucleus scattering. Our data at higher Q² favor this interpretation over an alternative in which the axial mass is increased.

Access to and use of NHS Patient Advice and Liaison Service (PALS): the views of children, young people, parents and PALS staff

BACKGROUND

The English National Health Service Patient Advice and Liaison Service (PALS) was set up to provide patients and their relatives with a way of obtaining information or expressing concerns about their health care. This study examined children's, young people's and parents' access to and use of PALS, and how this could be improved.

METHODS

Qualitative and quantitative methods were used to obtain the views of children, young people, parents and PALS staff, on the inclusiveness of the service. These methods included discussion groups and interviews with 30 young people and 16 parents; a postal survey of PALS users, to which 171 (21%) parents responded; and telephone interviews with 14 PALS staff. The data were analysed using qualitative and quantitative methods, and the views of participants on key topics were examined.

RESULTS

Children and young people were found to be low users of PALS, but thought that the service was potentially useful. They and parents and PALS staff all highlighted ways in which access to and use of the service could be improved. Participants' views on the following topics are reported: awareness of PALS existence and role; access to and use of PALS; effectiveness of and satisfaction with PALS; and training of staff.

CONCLUSIONS

and recommendations Patient Advice and Liaison Service has not been designed and developed in ways that are fully inclusive of children, young people and parents. Based on their views and experiences, and the suggestions of PALS staff, the authors recommend that access to and use of the service could be improved, increasing awareness of PALS, facilitating access to and use of the service, providing training for PALS staff on dealing with young people and their issues, and developing links between PALS and other organizations that deal with young people and parents.

National survey of Patient Advice and Liaison Services (PALS) in England: children, young people and parents' access to and use of PALS

BACKGROUND

Patient Advice and Liaison Services (PALS) have been set up in the National Health Service (NHS) in England to enable patients and the public to access information and raise issues they are concerned about their health care. The aim of this study was to examine to what extent, and how, PALS have promoted children's, young people's and parents' access to and use of the service.

METHODS

A postal questionnaire was sent to PALS in 553 NHS Trusts and Primary Care Trusts (PCTs). PALS in Ambulance Trusts, and Specialist Trusts that were known not to provide services for children and young people, were excluded.

RESULTS

Questionnaires were returned by 320 respondents representing 369 trusts - a response rate of 67%. Seventy-seven responses were not valid, giving a final sample of 243 PALS. This included 122 PALS serving PCTs, 101 serving NHS Trusts, 15 serving a mix of both PCTs and NHS Trusts, and five serving children's hospitals. The responses suggest that, to date, most PALS have been developed as a generic service, with some making special efforts to target specific groups of patients and sections of the public. However, where such efforts have been made, they have tended to focus most of all on older people and least of all on children.

CONCLUSIONS

PALS are intended to serve all sections of the community and accordingly need to be developed in ways that ensure the service is accessible to hard-to-reach groups such as children and young people. The remainder of the research will examine children, young people and parents' perspectives on how PALS can involve them, and will provide associated guidelines for trusts.

Adenocarcinoma of unknown primary site presenting as an isolated retroperitoneal mass and Trousseau's syndrome

BACKGROUND

There are few reported cases of adenocarcinoma of unknown primary site (ACUPS) presenting with Trousseau's syndrome, and no cases presenting as an isolated retroperitoneal pelvic mass.

CASE

This is a case of a 36-year-old woman who presented with an isolated "pelvic" mass and Trousseau's syndrome. The patient underwent abdominal hysterectomy and bilateral salpingo oophorectomy with resection of the retroperitoneal lymph nodes. Surgical findings included normal-appearing uterus, fallopian tubes, and ovaries, with bilaterally enlarged pelvic lymph nodes. Pathology was positive for adenocarcinoma only in the pelvic lymph nodes. Uterine, ovarian, and fallopian tube final pathologies were negative for malignancy. Postoperative metastatic survey was negative, and the patient was diagnosed with ACUPS. The patient received adjuvant chemotherapy consisting of etoposide, carboplatin, and taxol. The patient died 18 months after diagnosis.

CONCLUSION

This case reminds us that ACUPS can present as Trousseau's syndrome and rarely as an isolated retroperitoneal pelvic mass.

Rehabilitation and total hip replacement: patients' perspectives on provision

This paper examines the effectiveness of the rehabilitation component of total hip replacement (THR). It focuses on contrasting rehabilitation regimes in two hospitals in the north of England. Using qualitative methods, patients' perceived needs and goals are described, and the responsiveness of the interventions to their requirements is examined. The provision of information, equipment, and therapy was found to be useful in terms of preparing patients for their operation and facilitating their recovery, but less so in terms of helping them cope with any problems experienced after the operation. Drawing on patients' perspectives, a set of guidelines for good practice in rehabilitation for THR is presented.

A randomized phase 3 study of intraoperative cavernous nerve stimulation with penile tumescence monitoring to improve nerve sparing during radical prostatectomy

PURPOSE

We determine if mapping of the cavernous nerve during radical prostatectomy using intraoperative cavernous nerve stimulation with tumescence monitoring results in improved erectile potency compared to conventional nerve sparing.

MATERIALS AND METHODS

A prospective, randomized, single blinded study was performed on 61 patients at 6 centers. Patients had elected to undergo nerve sparing prostatectomy and had normal preoperative erectile function documented by the Sexual Function Inventory Questionnaire (SFIQ) and RigiScan parallel testing. Patients were randomized between conventional nerve sparing and nerve sparing assisted by the CaverMap Surgical Aid. paragraph sign In all patients neural continuity was assessed immediately after prostate removal by proximal cavernous nerve stimulation. All patients were blinded according to their allocation cohort.

RESULTS

At 1 year there was substantial improvement in erectile function in the CaverMap group as measured by RigiScan. This group had a mean of 15. 9 minutes of greater than 60% nocturnal tumescence compared to 2.1 minutes in the conventional nerve sparing group (p <0.024). By SFIQ there was a nonsignificant trend to improved potency in the CaverMap group (71% versus 62%, p = 0.17). Of patients who had bilateral, unilateral and no response to stimulation after resection erectile function assessed by SFIQ recovered in 68%, 27% and 0%, respectively (p = 0.016).

CONCLUSIONS

CaverMap assisted prostatectomy led to improved erectile function as assessed by RigiScan testing with no associated adverse events. A response to stimulation immediately after removal of the prostate accurately predicted return of erectile function.

Extraosseous Ewing sarcoma of the vagina

BACKGROUND

Ewing sarcoma is a highly malignant childhood bone neoplasm. Extraosseous presentations of Ewing sarcomas include the trunk, extremities, uterus, cervix, and vagina.

CASE

A 35-year-old woman, gravida 3, para 3, presented with a painless vaginal mass. After surgical excision, pathology results diagnosed an extraosseous Ewing sarcoma. Chemotherapy was given, followed by external beam and vaginal intracavitary brachytherapy, then more chemotherapy. After 48 months post-treatment, there is no clinical evidence of recurrence.

CONCLUSION

Although rare, Ewing sarcoma can present as a vaginal mass.

Measurement of patient perceptions of pain and disability in relation to total hip replacement: the place of the Oxford hip score in mixed methods

OBJECTIVES

To describe the practical difficulties experienced by patients when completing the Oxford hip score, and to highlight the need to reconsider aspects of its structure and conceptual base.

DESIGN

Qualitative study incorporating the Oxford hip score in semi-structured interviews with patients before and four months after their operation.

SETTING

Two hospitals in the North of England.

SUBJECTS

Osteoarthritic patients undergoing primary elective total hip replacement.

RESULTS

Use of the Oxford hip score provided quantitative data on disability in the sample, particularly about pain and immobility. It also facilitated the collection of qualitative data, serving as a useful starting point for interviews and as a prompt for indepth discussion. Concerns about the clarity, coverage, and content validity of the score were identified, however, raising questions about the measure's conceptual base.

CONCLUSION

The Oxford hip score was found to be a useful precursor to the semi-structured interviews. However, deficiencies in instruction and lack of clarity in purpose have implications for its ongoing development and future application, both in this type of study and other, more general, contexts.

Identification of determinants of interaction between CXCR4 and gp120 of a dual-tropic HIV-1DH12 isolate

Using a panel of chimeric viruses and their chimeric envelope glycoproteins, we have previously reported that the V1/V2 or the V3 regions of a dual-tropic primary human immunodeficiency virus type 1 (HIV-1) isolate (HIV-1DH12) could individually confer CXCR4 usage when introduced into the backbone of a macrophage-tropic (M-tropic) virus isolate (HIV-1AD8). In this study, chimeric CXCR4-CXCR2 chemokine receptors were employed to identify the determinants involved in the interaction between CXCR4 and the dual-tropic HIV-1DH12 gp120. Our results indicate that (i) HIV-1DH12 gp120 interacts primarily with the extracellular domains 1 (E1) and 2 (E2) of CXCR4, (ii) the V1/V2 and the V3 regions interact with different domains of CXCR4, and (iii) the V1/V2 region plays a more critical role in the interaction between CXCR4 and HIV-1DH12 gp120. Combining our data and those of others suggests that the pattern of CXCR4 usage is highly dependent on HIV-1 isolates. In addition, an M-tropic virus may evolve to become dual-tropic by first acquiring the ability to interact with CXCR4 through the V1/V2 region of gp120.

Carers tell it like it is

Carers want a great deal more medical and practical information than they are given at present. Their need for information may conflict with doctors' duty of confidentiality. Carers are often taking responsibility for day-to-day care while being kept in ignorance of many aspects of the patient's condition. Health professionals would not accept responsibility in these circumstances. Unless the availability of information, and its delivery, becomes more methodical, carers are likely to remain critical of health and social services.

Pulmonary vasodilation to adrenomedullin: a novel peptide in humans

The present study investigates the effects of human adrenomedullin (ADM) on the pulmonary vascular bed of isolated, blood-perfused rat lung. Because pulmonary blood flow and left atrial pressure were constant, changes in pulmonary arterial pressure directly reflect changes in pulmonary vascular resistance. Under conditions of resting (low) pulmonary vasomotor tone, intra-arterial bolus injections of ADM-(1-52) and two truncated sequences of ADM-(1-52) [ADM-(1-12) and ADM-(13-52)] did not alter pulmonary arterial pressure. When pulmonary vasomotor tone was increased by U-46619, a thromboxane A2 mimic, intra-arterial bolus injections of ADM-(1-52) and ADM-(13-52) at similar doses produced similar, dose-dependent reductions in pulmonary arterial pressure. On a molar basis, ADM-(1-52) had greater pulmonary vasodilator activity than isoproterenol. In contrast, ADM-(1-12) had no activity. When pulmonary vasomotor tone was actively increased to the same level using KCl, the pulmonary vasodilator activity of ADM-(13-52) was decreased 10-fold. The present data demonstrate that ADM-(1-52) dilates the pulmonary vascular bed and suggest that the pulmonary vasodilator activity of ADM is greater on pulmonary blood vessels preconstricted through a receptor-dependent mechanism. Because meclofenamate, nitro-L-arginine methyl ester, methysergide, BW A-1433U83, U-37883A, and calcitonin gene-related peptide [CGRP-(8-37)], a CGRP-receptor antagonist, did not alter the pulmonary vasodilator response to ADM-(1-52), the present data suggest that ADM dilates the pulmonary vascular bed independently of cyclooxygenase products, endothelium-derived relaxation factor, serotoninergic receptors, adenosine1 purinoreceptors, ATP-dependent potassium channels, and CGRP receptors.(ABSTRACT TRUNCATED AT 250 WORDS)

An adrenomedullin fragment retains the systemic vasodepressor activity of rat adrenomedullin

The present study was undertaken to investigate the effects of human adrenomedullin, a newly discovered peptide present in normal human plasma, as well as a fragment of adrenomedullin, on systemic hemodynamics in the anesthetized rat. Intravenous (i.v.) bolus injections of rat adrenomedullin, rat adrenomedullin-(11-50), human adrenomedullin-(13-52) decreased mean systemic arterial pressure in a dose-dependent manner. Since rat adrenomedullin and human adrenomedullin did not decrease cardiac output, the decreases in systemic arterial pressure reflect dose-dependent reductions in systemic vascular resistance. The systemic vasodepressor responses to similar doses of the adrenomedullin fragments studied and to their respective parent adrenomedullin peptides were similar. The present data demonstrate that the entire adrenomedullin molecule is not required for full systemic vasodilator activity in vivo suggesting that rat adrenomedullin-(11-50) or a structurally similar peptide, if formed endogenously, could mediate the hemodynamic properties of adrenomedullin in vivo. Since rat adrenomedullin had significantly greater systemic vasodilator activity than human adrenomedullin at similar doses in the rat, the present data suggest that adrenomedullin has greater systemic vasodilator activity in its native species and that limited changes in the peptide's sequence confer markedly different vascular activity in vivo.

Communication patterns in patients with erectile dysfunction and their partners

Patients with erectile dysfunction (ED) and their partners (n = 18) were compared on perceived distress caused by the ED, attribution of responsibility for the ED and marital communication. Comparisons were also made between couples in whom the ED was organically based versus those in whom it was psychogenically based. No differences were found between organic versus psychogenic ED couples on perceived distress, attributions, or marital communication skills. Patients and partners differed on communication (P < 0.001), attributions (P < 0.001) and perceptions of distress experienced by their spouse (P < 0.001). However, both members of the couple found the ED equally distressing. Partners tended to attribute more responsibility for the ED to themselves when they believed it was psychogenic (P < 0.001), while patients claimed sole responsibility regardless of their perceptions of its etiology. Patients had clinically problematic communication scores (P < 0.001), while partners did not. Contrary to initial hypotheses, communication scores did not predict agreement/disagreement between patients and partners on perceived etiology, attributions or distress. Discussion is focused on the need for therapy to address couples' communication specific to sexual activity and the effects of the ED.

Prodepin: a new product of the adrenomedullin (ADM) gene has systemic vasodilator activity

The purpose of the present study was to investigate the effects of products of the ADM gene other than ADM on systemic hemodynamics in the anesthetized rat, rabbit, piglet, cat and dog. Bolus intravenous (i.v.) injections of rat proADM22-41 (3-30 micrograms) significantly decreased systemic arterial pressure (SAP) and systemic vascular resistance in the anesthetized rat. Unlike ADM, rat proADM22-41 markedly increased cardiac output in the rat. Bolus i.v. injections of human proADM22-41 up to 500 micrograms had not effect in all species studied and rat proADM22-41 had no effect in species other than the rat. The present data suggest that rat proADM22-41 is a novel product of the ADM gene other than ADM and possesses marked systemic vasodilator activity. The present data also suggest that the hemodynamic activity of this peptide is species specific.

Value of urologic investigation in a targeted group of women with recurrent urinary tract infections

According to the conclusions of clinical studies, excretory urography and cystoscopy are of no value in managing the majority of women who have a history of recurrent urinary tract infection (UTI). Of 475 women with recurrent UTIs, 186 were prospectively targeted for evaluation by cystoscopy and ultrasonography or excretory urography from selection criteria based on the degree of complicating factors, to determine the value of urologic investigation. Thirty-nine patients had significant detectable abnormalities, and 20 of them required surgical intervention. Definite indications for urologic evaluation include hematuria (gross hematuria and persistent microscopic hematuria between infections), pyelonephritis and a presentation that is not typical for simple uncomplicated UTIs (obstructive symptoms, infection with urea-splitting bacteria, clinical impression of persistent infection or urinary calculi). Diabetes itself does not warrant urologic evaluation. The findings from this study suggest that cystoscopy and upper urinary tract evaluation do play a role in the management of a selected group of women with UTIs.

Extracorporeal membrane oxygenation for nonneonatal respiratory failure

Extracorporeal membrane oxygenation (ECMO) has been used for 20 years in neonates and children with cardiac and respiratory failure. The number of neonates treated with ECMO has increased exponentially, but the number of older children treated is small. The selection and exclusion criteria for pediatric ECMO are poorly defined, and the results vary because of variable selection criteria and institutional experience with the technique. In order to help define the role of pediatric ECMO, we reviewed our experience in noneonatal pediatric respiratory failure. We have treated 22 patients ranging in age from 1 to 105 months and ranging in weight from 3 to 35 kg. Eighteen patients met the criteria for adult respiratory distress syndrome, two had respiratory syncytial virus pneumonia, and one had severe barotrauma complicating the management of reactive airway disease. All patients were considered by the referring institutions and by us to be failing conventional management as evidenced by hypoxia, hypercarbia, excessive ventilatory pressures, or progressive barotrauma. All were considered likely to die with continued conventional management. Sixteen of the 22 patients had complications (73%), but half of the last 10 patients had no complications. Hemorrhagic complications occurred in 12 patients. Mechanical complications included membrane failure, raceway rupture, pump malfunction, and improper cannula positioning. Other complications included culture-proven infection and renal failure. Eleven of the 22 patients survived (50%); nine of the last 12 survived (75%). These results suggest that ECMO may be a useful technique in selected pediatric patients with respiratory failure. Survival and complication rates improve as experience with the technique increases.

A correlation of pulmonary hypoplasia, mean airway pressure, and survival in congenital diaphragmatic hernia treated with extracorporeal membrane oxygenation

Thirty infants with congenital diaphragmatic hernia (CDH) who required therapy within the first day of life were treated in our institution over the past 3 years. Eighteen of these infants were not treated with extracorporeal membrane oxygenation (ECMO). Survival in this group was 83%. Twelve infants were treated with ECMO. Seven (58%) were weaned from ECMO and ventilator support with six (50%) long-term survivors. Minimum preoperative alveolar-arterial oxygen gradient (AaDO2), maximum postoperative mean airway pressure (MAP), and pulmonary hypoplasia were evaluated. Bohn et al have prospectively shown that the relationship of PaCO2 to mechanical ventilatory requirements accurately predicted survival in a group of 58 infants with CDH in whom ECMO was not a therapeutic option. This criteria would predict nonsurvival in all 12 of our patients treated with ECMO, including the seven survivors. Differences between our ECMO and non-ECMO groups were statistically significant for all three criteria. All P values less than .05. Morphometric analysis of the lungs of all ECMO nonsurvivors revealed hypoplastic ipsilateral lungs by lung weight to body weight ratios and radial alveolar counts when compared with experimental and historical controls (P less than .05). The contralateral lung was hypoplastic in 80% of the nonsurvivors. There is a strong correlation between the maximum postoperative MAP and the degree of contralateral pulmonary hypoplasia (r = .03, P = .02). We conclude that the maximum postoperative MAP is an accurate predictor of survival in the treatment of CDH and can be correlated with the degree of pulmonary hypoplasia.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial biofilm in persistent penile prosthesis-associated infection

The ultrastructural microbiology of 2 cases of infection associated with rigid penile prostheses was studied. The persistence of these infections appeared to be related to the mode of growth of the bacteria in protected biofilms adherent to the inert surface of the prosthesis.

Idiopathic mesangiocapillary glomerulonephritis. Comparison of types I and II in children and adults and long-term prognosis

Of 104 patients with idiopathic mesangiocapillary glomerulonephritis studied for at least two years, 69 patients had type I disease and 35 had type II. Forty-five patients were children, and 59 were adults. Type II mesangiocapillary glomerulonephritis was more common in children than in adults, but no other clinical feature distinguished the two types at onset. Complement studies revealed that patients with type II had lower serum C3 concentrations and more frequently showed C3-splitting activity (C3 nephritic factor) in the serum. Children had hypertension or a lowered glomerular filtration rate less frequently at onset than did adults, but children had a higher incidence of a hematuric onset; C3 nephritic factor was also more frequent in the children. During a follow-up period of two to 21 years (mean eight years), only seven patients (five with type I and two with type II) showed clinical remission, whereas 38 percent of patients with type I and 49 percent of patients with type II died or required dialysis; a further 23 percent of patients with type I and 16 percent of patients with type II had continuing disease and reduced glomerular filtration rate. Only the presence and persistence of a nephrotic syndrome in type I predicted renal failure. In both types, the presence of sclerosis or crescents in the initial renal biopsy specimen was associated with a poorer prognosis, but no other feature was of major prognostic value.

Prostaglandins and the control of muscle tone in the ductus arteriosus

Several lines of evidence implicate E-type PGs in the maintenance of patency of the foetal ductus arteriosus. The PGE mechanism is functional in man, sheep, rat and rabbit, but it is seemingly absent in guinea pig. The role of the PGs in the closure of the vessel at birth is uncertain. Work with different species suggests that as PO2 rises at birth the relaxant effect of PGEs on the ductal muscle decreases. This decreased sensitivity may facilitate the oxygen triggered contraction. The calf ductus is an exception and its closure may be mediated by PGF2alpha. An important fact emerging from this review is that species may differ with regard to the occurrence and possible function of the PGs in the ductus arteriosus. The significance of these differences to the function of the oxygen-sensing mechanism remains a major question for future research.

Further evidence implicating E-type prostaglandins in the patency of the lamb ductus arteriosus

A blocker of prostaglandin (PG) snythesis, indomethacin, given to pregnant ewes near term produces constriction of the lamb ductus arteriosus in utero. The result supports the hypothesis formulated previously that E-type prostaglandins, which are potent relaxant on the ductus, are responsible for maintaining the patency of the vessel during foetal life.

Cholinesterase in endplates of rat and chick: relationship of activity to log-dose response curves and the effects of some inhibitors

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