A phylogenetic approach to explore the Aspergillus fumigatus conidial surface-associated proteome and its role in pathogenesis

Aspergillus fumigatus, an important pulmonary fungal pathogen causing several diseases collectively called aspergillosis, relies on asexual spores (conidia) for initiating host infection. Here, we used a phylogenomic approach to compare proteins in the conidial surface of A. fumigatus, two closely related non-pathogenic species, Aspergillus fischeri and Aspergillus oerlinghausenensis, and the cryptic pathogen Aspergillus lentulus. After identifying 62 proteins uniquely expressed on the A. fumigatus conidial surface, we assessed null mutants for 42 genes encoding conidial proteins. Deletion of 33 of these genes altered susceptibility to macrophage killing, penetration and damage to epithelial cells, and cytokine production. Notably, a gene that encodes glycosylasparaginase, which modulates levels of the host pro-inflammatory cytokine IL-1β, is important for infection in an immunocompetent murine model of fungal disease. These results suggest that A. fumigatus conidial surface proteins and effectors are important for evasion and modulation of the immune response at the onset of fungal infection.

Injury metrics are altered in spica-casted versus non-casted child ATDs in side-impact collisions with door intrusion

Objective: There is little data defining safe transport protocols for spica-casted children. A single earlier study demonstrated the presence of a body cast alters kinematics and injury metrics during simulated side-impact crashes. Since then, the National Highway Transportation Safety Administration (NHTSA) proposed a new side-impact test protocol for evaluating child restraints. This test is more severe than the earlier tests, as it simulates an impact with a door intruding into the occupant space. As no currently available child restraint system (CRS) able to accommodate a spica-casted child has been evaluated using these updated testing criteria, the objective of this study was to evaluate current restraint options in simulated side-impact collisions using an anthropomorphic test device (ATD) modeled after a 3-year-old.Methods: Four commercially available CRSs able to accommodate a spica-casted Q3s side-impact ATD were selected for testing. Side-impact testing was performed using casted and uncasted ATDs in compliance with the NHTSA proposed side-impact test. High-speed photography and ATD instrumentation were used to measure selected injury criteria.Results: HIC₁₅ values were highest in CRSs with less robust side wings, such as the Merritt Wallenburg^TM (HIC₁₅ = 1,373), which allow for the occupant to interact with the intruding door panel. Head contact with the door panel was found to correspond with high resultant neck peak force. Pelvic acceleration magnitudes were greatest for the uncasted tests. Casted tests with a CRS that included an armrest were associated with greater torso rotation in the frontal plane with the left shoulder moving toward the door panel.Conclusions: The presence of a spica cast alters injury metrics in side-impact testing. Spica specific child safety seats are not yet optimized for side-impact with door intrusion. This is due to a lack of adequate side cushion wings, which may place both casted and uncasted occupants at increased likelihood for injury through head contact with an intruding door. Additional work is needed to improve the safety of CRSs for both casted and uncasted children in side-impact collisions.

Multicentric Reticulohistiocytosis: Elective Excision of Symptomatic Hand Nodules With 1-Year Follow-Up

Multicentric reticulohistiocytosis is a rare non-Langerhans cell histiocytic rheumatologic disorder characterized by multiple skin lesions, painful hand nodules, and destructive polyarthritis that results in arthritis mutilans in 20% to 30% of patients. In the current literature, there have been approximately 300 cases reported and the pathogenesis remains unclear. Currently, there is no diagnostic serologic test and no consensus on management. In this case report, we present a patient with multicentric reticulohistiocytosis who was treated with selective excision of 3 painful nodules on the hand. The patient was seen 1 year after surgery. One of the nodules reoccurred whereas the other 2 remained quiescent. This procedure has the potential to produce considerable pain relief and improve quality of life in a disease process for which optimal medical regimen remains to be determined.

Pre-bending a dynamic compression plate significantly alters strain distribution near the fracture plane in the mid-shaft femur

This study evaluated the effect of pre-bending dynamic compression plates on fracture site compression. Recommendations of 1 to 2 mm of pre-bend have been proposed, but there does not appear to be experimental data to confirm the optimal pre-bend magnitude. Dynamic compression plating was performed on the lateral convex surface of 18 femoral analogs to fixate a simulated mid-shaft fracture. Plates with 0 mm (flat plate), 1 mm, and 2 mm of pre-bend were evaluated for their production of compression by determining the strain magnitudes for 10 equal-sized zones across the anterior cortex at the osteotomy site using digital imaging correlation. The 0 and 1 mm plates produced significantly more compression at the near cortex (p = 0.001 and p = 0.003, respectively) than the 2 mm plate. However, the 0 and 1 mm plates also created visible diastasis at the far cortex, while the 2 mm plate exhibited compression across all zones. The strain magnitudes for the 0 mm (R² = 0.62) and 1 mm (R² = 0.86) plates linearly and significantly decreased from the region adjacent to the plate until a region 50%-60% across the analog diameter. In contrast, the 2 mm plate exhibited uniform strains across the osteotomy site. This study demonstrates that pre-bending a dynamic compression plate 2 mm prior to fixation on a convex lateral femur provides the most compression at the far cortex. It also produces more uniform compression across the fracture when compared to 0 and 1 mm of pre-bend.

Development and implementation of a science training course for breast cancer activists: Project LEAD (leadership, education and advocacy development)

OBJECTIVE

To develop and implement Project LEAD (leadership, education, and advocacy development), a science course for breast cancer activists.

POPULATION

Students were breast cancer activists and other consumers, mainly affiliated with advocacy organizations in the United States of America.

SETTING

Project LEAD is offered by the National Breast Cancer Coalition; the course takes place over 5 days and is offered 4 times a year, in various cities in the United States of America.

RESULTS

The Project LEAD curriculum has developed over 5 years to include lectures, problem-based study groups, case studies, interactive critical appraisal sessions, a seminar by an 'expert' scientist, role play, and homework components. A core faculty has been valuable for evaluating and revising the course and has proved necessary to provide consistent high quality teaching. Course evaluations indicated that students gained critical appraisal skills, enhanced their knowledge and developed confidence in selected areas of basic science and epidemiology.

CONCLUSIONS

Project LEAD comprises a unique curriculum for training breast cancer activists in science and critical appraisal. Course evaluations indicate that students gain confidence and skills from the course.

Recovery of sensibility after digital neurorrhaphy: a clinical investigation of prognostic factors

A multicenter retrospective review of 172 epineural digital nerve repairs using microsurgical techniques was performed. A total of 71 men and 25 women ranged in age from 5 to 64 years (mean age, 33.3 years). Sharp injuries occurred in 55.6% of patients and mild crush occurred in 44.4%. Isolated nerve injuries occurred in only 24.6% of patients. The majority of digital nerve injuries involved other structures: flexor tendons (33.5%), tendons and fractures (9.0%), and fractures (4.2%). Replantations were performed in 18 digits (21.6%) and revascularizations in 7 digits (7.2%). Injury to repair was less than 1 day in 47.8%, 2 to 7 days in 22.6%, 8 to 30 days in 23.3%, and 31 to 300 days in 6.3%. Follow-up averaged 22.2 months (range, 6-77 months). The authors found a significant correlation between age and recovery of sensibility as measured by Weber's two-point discrimination test (p < 0.001). Patients older than 40 years demonstrated significantly poorer recovery of sensibility than patients younger than 40 years. A trend of better sensibility return was noted in the younger age decades (<40) with declining age; however, the intergroup differences were not significant. There was also a significant correlation between severity of injury and recovery of sensibility (p < 0.001). Sharp injuries (8.2 mm) demonstrated significantly improved recovery of sensibility compared with mild crush (10.8 mm). Fractures (11.1 mm), fractures and tendon involvement (11.4 mm), and replantations (11.8 mm) demonstrated significantly diminished recovery of sensibility compared with isolated nerve injuries (7.9 mm), tendon involvement (8.1 mm), and revascularizations (9.3 mm). There did not appear to be any significant difference in recovery of sensibility according to gender, digit involved, radial or ulnar side of digit, median or ulnar nerve distribution, level of injury (except for the metacarpophalangeal joint and the distal palmar crease where most replantations occurred), or time interval from injury to repair. There was a weak negative correlation between length of follow-up and recovery of sensation.

"Spaghetti wrist": management and results

A retrospective review of 60 patients with "spaghetti wrist" lacerations operated on by the authors between July of 1988 and June of 1996 was completed. Spaghetti wrist injuries were defined as those occurring between the distal wrist crease and the flexor musculotendinous junctions involving at least three completely transected structures, including at least one nerve and often a vessel. A total of 41 men and 19 women, average age of 29.0 years (range, 5 to 54 years), sustained spaghetti wrist injuries. The most frequent mechanisms of injury were accidental glass lacerations (61.0 percent), knife wounds (23.7 percent), and suicide attempts (8.5 percent). An average of 7.8 structures were injured including 5.8 tendons, 1.2 nerves, and 0.73 arteries. The most frequently injured structures were flexor carpi ulnaris (66.7 percent), median nerve (60.0 percent), flexor digitorum superficialis 2-5 (59.2 percent), ulnar nerve (58.3 percent), and ulnar artery (56.7 percent). A predilection for injury to the ulnar structures was observed. The flexor carpi ulnaris was more commonly injured than the more superficial central and radial palmaris longus (48.3 percent) and flexor carpi radialis (45.0 percent). The most common pattern of injury involved the ulnar nerve and artery and flexor carpi ulnaris, or so-called ulnar triad (41.7 percent). Combined median nerve, flexor carpi radialis, and palmaris longus lacerations occurred in 26.7 percent. Simultaneous lacerations of both median and ulnar nerves occurred in 23.3 percent. No distinct pattern of injury was noted in patients with simultaneous injury to both nerves. Simultaneous lacerations of both ulnar and radial arteries occurred in 6.7 percent; neither artery was injured in 33.3 percent. In the subset of 19 patients available for follow-up examination, range of motion was excellent in 12 patients and good in 7 patients. In 12 patients with sufficient follow-up, intrinsic muscle recovery was good in 7 patients and fair to poor in 5 patients. Sensory return was disappointing: seven patients recovered only protective sensation and five patients demonstrated return of two-point discrimination that ranged from 7 to 12 mm in three patients and from 2 to 6 mm in two patients.

The diagnosis of foetal distress: a challenge to midwives

The diagnosis of foetal distress is complex: it is influenced by a number of factors which range from the physical examination of the mother and foetus to the psychological and social world in which the mother, the midwife and other health care professionals work. The consequences of an incorrect diagnosis of normality or foetal distress are potentially serious for both mother and baby. Recent changes in the practice and delivery of midwifery care have placed more responsibility on midwives. It is therefore imperative that midwives become more aware of the complexity of the diagnosis as well as of some of the factors which can improve the quality of their diagnosis. This paper reviews the literature associated with the diagnosis of foetal distress, physiological and pathological changes during pregnancy and labour, and the usefulness and limitation of the tools readily available to midwives for the diagnosis. It also examines the limits of the relationship that exists between intra-uterine and neonatal markers. The purpose of this paper is to provide background information that would support midwives in the diagnosis of foetal distress in the hope that the false positive diagnoses can be reduced for the benefit of mothers and babies. Ultimately an improvement in outcome should be reflected in the more efficient and effective use of resources available to maternity services.

Dose requirements, efficacy and side effects of morphine and pethidine delivered by patient-controlled analgesia after gynaecological surgery

We have compared the dose requirements and side effects of morphine with those of pethidine when administered by patient-controlled analgesia in 40 patients (ASA I-II, 20-65 yr) after elective total abdominal hysterectomy. Patients were allocated randomly, in a double-blind manner, to receive either morphine (bolus dose 2 mg, lockout time 10 min) or pethidine (bolus dose 20 mg, lockout time 10 min) for postoperative pain relief. Mean 24-h morphine and pethidine consumption was 70 (SEM 6.2) mg and 660 (67.8) mg, respectively (ratio 1:9.4). There were no significant differences in postoperative sedation, nausea, pain relief and patient satisfaction (VAS 0-100 mm), and requirements for antiemetics. Four patients receiving pethidine were withdrawn because of postoperative confusion and one receiving morphine because of intractable nausea and vomiting. The 95% confidence interval for this difference between the groups for VAS scores of sedation, nausea and pain were approximately 30 mm.

Action of the SP2-11 and SP3-11 fragments of substance P on rat peritoneal mast cells

The ability of the SP fragments SP2-11 and SP3-11 to release histamine from rat peritoneal mast cells has been compared with that of the whole peptide. SP1-11 was found to be about 3.4 times more active than SP2-11 and about 10.4 times more active than SP3-11. The substance P antagonist [D-Pro4, D-Trp7,9,10] SP4-11 was equally effective at antagonizing the histamine releasing action of SP1-11, SP2-11 and SP3-11. Benzalkonium chloride was found to be a competitive antagonist of SP and SP3-11: the dissociation constants for the benzalkonium chloride-receptor interaction being about the same when either SP1-11 or SP3-11 was used as the agonist.

Ego development and psychopathology: a study of hospitalized adolescents

This paper explores the relationship between ego development and psychiatrically relevant behaviors in a group of hospitalized adolescents. Building on Loevinger's model of ego development, we administered the Sentence Completion Test to 114 adolescent girls and boys. To study psychiatric symptoms, Achenbach and Edelbrock's Child Behavior Checklist was used. With these procedures, the Achenbach and Edelbrock factor scores were compared to ego stage using correlational and multiple regression analyses. Findings indicate significant negative correlations with the externalizing and internalizing factors as well as a variety of behavioral subscales. A significant relationship also exists between the total number of symptoms and ego development. Ego development is found to be an important predictor for the externalizing factor and 2 subscales after the background variables of age, sex, and SES are partialed out. Our discussion addresses the question of the relationship between stages and transitions in ego development in relation to psychopathology. In addition, "age-stage dysynchronies" are discussed as ways of understanding psychopathology from a developmental perspective.

Echo- and phonocardiographic studies in patients with Lillehei-Kaster aortic valve prostheses

Simultaneous echo- and phonocardiographic studies were performed in 17 patients with normally functioning Lillehei-Kaster (LK) tilting disc prosthesis in the aortic position. The LK aortic valve prosthesis was well recorded by echocardiography with a disc excursion of 14 to 25 mm and very fast opening and closing velocities, too rapid for quantitative assessment. On phonocardiography the opening click of the prosthesis was only rarely observed (2 out of 17 cases), while the closing sound was consistently present in all patients, occurring within 5 msec of the point of complete closure of aortic disc prosthesis by echocardiography. Systolic time intervals (STI) measured by combined echo-and phonocardiography were similar to the predicted values in 15 patients who had no evidence of residual cardiac dysfunction. In the remaining 2 patients, one or more components of the STI differed by more than 2 standard deviations from the predicted values, and in these there were associated findings to explain the discrepancies. This study illustrates the echo- and phonocardiographic features of the normally functioning LK aortic valve prosthesis. In addition, precise measurements of the isometric contraction and relaxation periods as well as standard systolic time intervals are possible with these techniques.

Comments on the division of labor in occupations concerned with food

The roles of men and women in relation to food have always been sharply defined: animals belonged to men and plants and food preparation to women. Thus, when the land-grant colleges were established, men were taught animal husbandry and agricultural methods; in home economics, women learned the "home-making" arts, including nutrition and were concerned with people. But, as nutrition became more scientific, men took it over, separating it from home economics. In so doing, less attention was paid to the human elements in food production. World food policies are now made without regard to feeding people, and women have been progressively left out in the decision-making. The increase in nutritional knowledge in the last half century has had little effect on policies. Because Americans set the pattern the rest of the world will emulate, we must come to the realization that we cannot alleviate hunger with money alone-hunger is relieved with food, and food supplies are finite. Real sacrifices in terms of food itself, such as were made in World Wars I and II, will be necessary. Knowledge that millions are truly hungry may convince mothers to feed their children and families in different ways.