The Larynx is Protected from Secondary and Vertical Papillomavirus Infection in Immunocompetent Mice

OBJECTIVE

Mouse papillomavirus MmuPV1 causes both primary and secondary infections of the larynx in immunocompromised mice. Understanding lateral and vertical transmission of papillomavirus to the larynx would benefit patients with recurrent respiratory papillomatosis (RRP). To test the hypothesis that the larynx is uniquely vulnerable to papillomavirus infection, and to further develop a mouse model of RRP, we assessed whether immunocompetent mice were vulnerable to secondary or vertical laryngeal infection with MmuPV1.

METHODS

Larynges were collected from 405 immunocompetent adult mice that were infected with MmuPV1 in the oropharynx, oral cavity, or anus, and 31 mouse pups born to immunocompetent females infected in the cervicovaginal tract. Larynges were analyzed via polymerase chain reaction (PCR) of lavage fluid or whole tissues for viral DNA, histopathology, and/or in situ hybridization for MmuPV1 transcripts.

RESULTS

Despite some positive laryngeal lavage PCR screens, all laryngeal tissue PCR and histopathology results were negative for MmuPV1 DNA, transcripts, and disease. There was no evidence for lateral spread of MmuPV1 to the larynges of immunocompetent mice that were infected in the oral cavity, oropharynx, or anus. Pups born to infected mothers were negative for laryngeal MmuPV1 infection from birth through weaning age.

CONCLUSION

Secondary and vertical laryngeal MmuPV1 infections were not found in immunocompetent mice. Further work is necessary to explore immunologic control of laryngeal papillomavirus infection in a mouse model and to improve preclinical models of RRP.

LEVEL OF EVIDENCE

NA Laryngoscope, 134:2322-2330, 2024.

Preclinical Models of Laryngeal Papillomavirus Infection: A Scoping Review

OBJECTIVE

Laryngeal human papillomavirus (HPV) infection causes recurrent respiratory papillomatosis (RRP) and accounts for up to 25% of laryngeal cancers. Lack of satisfactory preclinical models is one reason that treatments for these diseases are limited. We sought to assess the literature describing preclinical models of laryngeal papillomavirus infection.

DATA SOURCES

PubMed, Web of Science, and Scopus were searched from the inception of database through October 2022.

REVIEW METHODS

Studies searched were screened by two investigators. Eligible studies were peer-reviewed, published in English, presented original data, and described attempted models of laryngeal papillomavirus infection. Data examined included type of papillomavirus, infection model, and results including success rate, disease phenotype, and viral retention.

RESULTS

After screening 440 citations and 138 full-text studies, 77 studies published between 1923 and 2022 were included. Models used low-risk HPV or RRP (n = 51 studies), high-risk HPV or laryngeal cancer (n = 16), both low- and high-risk HPV (n = 1), and animal papillomaviruses (n = 9). For RRP, 2D and 3D cell culture models and xenografts retained disease phenotypes and HPV DNA in the short term. Two laryngeal cancer cell lines were consistently HPV-positive in multiple studies. Animal laryngeal infections with animal papillomaviruses resulted in disease and long-term retention of viral DNA.

CONCLUSIONS

Laryngeal papillomavirus infection models have been researched for 100 years and primarily involve low-risk HPV. Most models lose viral DNA after a short duration. Future work is needed to model persistent and recurrent diseases, consistent with RRP and HPV-positive laryngeal cancer.

LEVEL OF EVIDENCE

NA Laryngoscope, 133:3256-3268, 2023.

Efficacy of Topically Administered Dihydroartemisinin in Treating Papillomavirus-Induced Anogenital Dysplasia in Preclinical Mouse Models

The artemisinin family of compounds is cytopathic in certain cancer cell lines that are positive for human papillomaviruses (HPV) and can potentially drive the regression of dysplastic lesions. We evaluated the efficacy of topical dihydroartemisinin (DHA) on cervical dysplasia and anal dysplasia in two papillomavirus mouse models: K14E6/E7 transgenic mice, which express HPV16 oncogenes; and immunodeficient NOD/SCID gamma (NSG) mice infected with Mus musculus papillomavirus (MmuPV1). Mice started treatment with DHA at 25 weeks of age (K14E6/E7) or 20 weeks post infection (MmuPV1-infected), when the majority of mice are known to have papillomavirus-induced low- to high-grade dysplasia. Mice were treated with or without topical DHA at the cervix or anus and with or without topical treatment with the chemical carcinogen 7,12 dimethylbenz(a)anthracene (DMBA) at the anus of in transgenic mice to induce neoplastic progression. Mice were monitored for overt tumor growth, and tissue was harvested after 20 weeks of treatment and scored for severity of histological disease. For MmuPV1-infected mice, anogenital lavages were taken to monitor for viral clearance. Tissues were also evaluated for viral gene expression at the RNA and/or protein levels. Treatment with topical DHA did not reduce dysplasia in the anogenital tract in either papillomavirus-induced mouse model and did not prevent progression to anal cancer in the DMBA-treated K14E6/E7 mice.

Expanded Basal Compartment and Disrupted Barrier in Vocal Fold Epithelium Infected with Mouse Papillomavirus MmuPV1

Laryngeal infection with low-risk human papillomaviruses can cause recurrent respiratory papillomatosis (RRP), a disease with severe effects on vocal fold epithelium resulting in impaired voice function and communication. RRP research has been stymied by limited preclinical models. We recently reported a murine model of laryngeal MmuPV1 infection and disease in immunodeficient mice. In the current study, we compare quantitative and qualitative measures of epithelial proliferation, apoptosis, differentiation, and barrier between mice with MmuPV1-induced disease of the larynx and surrounding tissues and equal numbers of uninfected controls. Findings supported our hypothesis that laryngeal MmuPV1 infection recapitulates many features of RRP. Like RRP, MmuPV1 increased proliferation in infected vocal fold epithelium, expanded the basal compartment of cells, decreased differentiated cells, and altered cell–cell junctions and basement membrane. Effects of MmuPV1 on apoptosis were equivocal, as with RRP. Barrier markers resembled human neoplastic disease in severe MmuPV1-induced disease. We conclude that MmuPV1 infection of the mouse larynx provides a useful, if imperfect, preclinical model for RRP that will facilitate further study and treatment development for this intractable and devastating disease.

Voice Handicap Index Changes After Microflap Surgery for Benign Vocal Fold Lesions Are Not Associated With Recommended Absolute Voice Rest Duration

PURPOSE

Voice rest is frequently prescribed after phonosurgery, but optimal type and duration for voice outcomes have not been demonstrated. Studies to date have been characterized by heterogeneity in surgical procedures and laryngeal diagnoses. We sought to analyze the effect of recommended absolute voice rest duration on outcomes of microflap surgery for benign vocal fold lesions. A secondary purpose was to identify patient factors associated with postoperative voice outcomes.

METHOD

Forty-three patients were included in this retrospective review of patients aged 18 years and above who underwent direct microlaryngoscopy with microflap for vocal fold polyp or cyst over a 5-year period at a multidisciplinary voice center. Duration of recommended postoperative absolute voice rest was classified as less than 7 days, 7 days, and more than 7 days. Demographic and vocal hygiene data and voice treatment history were collected. Outcome measures consisted of one pre- and two postoperative Voice Handicap Index (VHI) scores. Effects of recommended voice rest on outcomes were analyzed using mixed models for repeated measures. Effects of patient factors on outcomes were analyzed as exploratory measures. Stroboscopy ratings were analyzed descriptively.

RESULTS

Thirteen patients were recommended 7 days of absolute voice rest, 15 were recommended less than 7 days, and 15 were recommended more than 7 days. Postoperatively, VHI scores significantly improved for all patients. Voice rest as a continuous variable was associated with the Functional subscale score in the short term, but there was no effect on VHI total score and no longer term effect of voice rest on any outcome. Age, sex, and preoperative voice therapy were associated with at least one VHI subscale score on at least one time point.

CONCLUSION

VHI outcomes of microflap surgery for polyps and cysts do not differ by duration of recommended absolute postoperative voice rest.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19178459.

Role of Voice Therapy in Adherence to Voice Rest After Office-Based Vocal Fold Procedures

Purpose Patients undergoing vocal fold procedures significantly reduce but often do not cease voice use during absolute postprocedure voice rest. We hypothesized that patients who completed preprocedure voice therapy would increase adherence to postprocedure voice rest. Method Eighty-six participants completed this prospective cohort study. Patients scheduled for office-based vocal fold procedures, 1-3 days of absolute postprocedure voice rest, and preprocedure speech-language pathology (SLP) care were recruited. SLP care consisted of either (a) multiple voice therapy sessions, (b) one counseling/therapy session, or (c) voice evaluation only. Participants reported talking and other specific voice behaviors on 100-mm visual analog scales for up to 3 days pre- and postprocedure as well as changes in overall voice use at follow-up at least 1 week postprocedure. Results Talking decreased postprocedure by 63% in the therapy group and 65% in the counseling group, both significantly more than the 35% decrease measured in the evaluation group. There were group differences in talking at baseline but not during voice rest. Coughing and throat clearing were highest in the voice evaluation group and decreased less than talking during voice rest. At follow-up, 84% of participants reported that they completed voice rest for at least as long as recommended and 39.5% reported that they never used their voices during voice rest. Participants estimated a 98% overall reduction in voice use during voice rest at follow-up. Conclusions Voice use before and after vocal fold procedures varies by participation in preprocedure voice therapy. Patients significantly decrease talking during postprocedure voice rest but are not perfectly adherent. Communicative voice use decreases more than noncommunicative voice use during voice rest. Patients may overestimate adherence to voice rest at follow-up. Supplemental Material https://doi.org/10.23641/asha.16589864.

Magnetic resonance imaging quantification of dehydration and rehydration in vocal fold tissue layers

Clinicians commonly recommend increased hydration to patients with voice disorders. However, effects on clinical voice outcome measures have been inconsistent. Hydration-induced change within different layers of vocal fold tissue is currently unknown. Magnetic Resonance Imaging (MRI) is a promising method of noninvasively measuring water content in vocal folds. We sought to image and quantify changes in water content within vocal fold mucosa and thyroarytenoid muscle after dehydration and rehydration. Excised porcine larynges were imaged using proton density (PD) weighted MRI (1) at baseline and (2) after immersion in one of five hypertonic, isotonic, or hypotonic solutions or in dry air. Larynges dehydrated in hypertonic solutions or dry air were rehydrated and imaged a third time. Scans revealed fluid-rich vocal fold mucosa that was distinct from muscle at baseline. Baseline normalized signal intensity in mucosa and muscle varied by left vs. right vocal fold (p < 0.01) and by anterior, middle, or posterior location (p < 0.0001). Intensity changes in the middle third of vocal fold mucosa differed by solution after immersion (p < 0.01). Hypertonic solutions dehydrated the middle third of mucosa by over 30% (p < 0.001). No difference from baseline was found in anterior or posterior mucosa or in muscle after immersion. No association was found between intensity change in mucosa and muscle after immersion. After rehydration, intensity did not differ by solution in any tissue, and was not different from baseline, but post-rehydration intensity was correlated with post-immersion intensity in both mucosa and muscle (p < 0.05), suggesting that degree of change in vocal fold water content induced by hypertonic solutions ex vivo persists after rehydration. These results indicate that PD-MRI can be used to visualize large mammalian vocal fold tissue layers and to quantify changes in water content within vocal fold mucosa and thyroarytenoid muscle independently.

The use of Tetraphenylboron for the Determination and Characterisation of Organic Bases in Pharmaceutical Preparations

A method has been developed for the assay of basic nitrogen compounds by precipitation at pH 3·7 with sodium tetraphenylboron; excess reagent is then determined by back titration with a quaternary ammonium salt. Melting-points of the organic tetraphenylboron salts may be used for the identification of the bases concerned. The method has been applied to the determination of 15 compounds in a variety of pharmaceutical preparations. It compares well in accuracy and speed with existing methods.

Two-stage robust control of substrate concentration for an activated sludge process

A two-stage robust control scheme improving the performance of an Activated Sludge Process is proposed. In the first stage, asymptotic command following the substrate concentration with simultaneous attenuation of the fluctuations of the dissolved oxygen concentration is assured. The first stage is a pure dynamic controller. The second stage is a PID controller. Good performance of the proposed control scheme on the corresponding nonlinear ASP model is illustrated through extensive simulation experiments. The contribution of the paper can be summarized to the derivation of the following two results: An accurate to a wide range of inputs and disturbances, linearized generic model of the ASP and, most important, a linear robust controller that controls accurately the effluent substrate concentration without using measurements of it.

Revised NEO Personality Inventory profiles of male and female U.S. Air Force pilots

The study of pilot personality characteristics has a long and controversial history. Personality characteristics seem to be fairly poor predictors of training outcome; however, valid personality assessment is essential to clinical psychological evaluations. Therefore, the personality characteristics of pilots must be studied to ensure valid clinical assessment. This paper describes normative personality characteristics of U.S. Air Force pilots based on the Revised NEO Personality Inventory profiles of 1,301 U.S. Air Force student pilots. Compared with male adult norms, male student pilots had higher levels of extraversion and lower levels of agreeableness. Compared with female adult norms, female student pilots had higher levels of extraversion and openness and lower levels of agreeableness. Descriptive statistics and percentile tables for the five domain scores and 30 facet scores are provided for clinical use, and a case vignette is provided as an example of the clinical utility of these U.S. Air Force norms.

Clinical procedures for the neuropsychological evaluation of U.S. Air Force pilots

The neuropsychological assessment of U.S. Air Force pilots presents several unique problems given their relatively high cognitive functioning. The U.S. Air Force currently has a baselining procedure whereby student pilots undergo computerized cognitive assessment. The intent of this assessment is to archive premorbid data against which to compare potential future postinsult performance. The current work provides the background, clinical methods, and data needed to assess pilots who have suffered cortical insult such as trauma, disease, or exposure to toxins. Methods are delineated for pilots with premorbid testing and for pilots without such testing.

A comparison of two U.S. Air Force pilot aptitude tests

BACKGROUND

The Air Force Officer Qualifying Test (AFOQT) and Multidimensional Aptitude Battery (MAB) were administered to 2233 U.S. Air Force pilot candidates to investigate the common sources of variance in those batteries. The AFOQT was operationally administered as part of the officer commissioning and aircrew selection testing requirement. The MAB is a clinical test battery and was administered to provide an intellectual baseline to assist clinicians when it becomes necessary to evaluate pilots with cognitive referral questions.

RESULTS

A joint factor analysis of the AFOQT and MAB revealed that each battery had a hierarchical structure. The higher-order factor in the AFOQT previously had been identified as general cognitive ability (g). The intercorrelation between the higher-order factors from the batteries was 0.981, indicating that both measured g. Although both batteries measured g and included verbal, spatial, and perceptual speed tests, the AFOQT also included tests of aviation knowledge not found in the MAB.

CONCLUSION

Additional studies are required to evaluate the utility of the AFOQT for clinical assessment and the MAB for officer and aircrew selection.

Interpersonal relationship and prisoner of war concerns of rated military male and female aircrew

BACKGROUND

The issue of women flying military aircraft in a combat role has been very controversial.

HYPOTHESIS

To succeed, female military aircrew are very similar to their male peers.

METHODS

We conducted a comprehensive anonymous questionnaire survey of all U.S. Army and U.S. Air Force rated female aircrew, with an equal number of age and duty matched male aircrew. We are reporting on the interpersonal relationship and prisoner of war (P.O.W.) responses here.

RESULTS

Male and female aircrew respond in a similar manner to posed questions, although differences do exist. Women reported: unequal treatment by opposite gender peers; problems relating to peers, superiors and subordinates; their gender influences assignments; the need to perform to higher standards and the need to work harder to be accepted as equals; ability to bond equally to their own and opposite gender peers; improved squadron cohesiveness in mixed gender squadrons; problems with peers' spouses; and, in a P.O.W. situation, fear of rape and sexual abuse. Men reported: women get inappropriate privileges and get special "breaks"; a gender difference in how flight duties are performed; worsened squadron cohesiveness in mixed gender squadrons; less likeliness to recommend their career path to their daughters; and a higher concern for welfare of families in a P.O.W. situation.

CONCLUSIONS

Although responding in a similar manner to most questions, male and female military aircrew differ in the perception of their ability to function in mixed squadrons because of their gender. Some of these perceptions can be modified through training, others may need to be resolved through high level orders/policy; while in others, the military may have to accept women are different from men in some aspects.

Female United States Air Force pilot personality: the new right stuff

With increasing numbers of female military pilots, it is important to understand the psychological and psychiatric gender differences of pilots. Using the "big five" personality structure (neuroticism, extraversion, openness to new experiences, agreeableness, and conscientiousness), female United States Air Force pilots were compared with both male Air Force pilots and to a female comparison group. Female Air Force pilots were higher on the Extraversion, Agreeableness, and Conscientiousness scales than male pilots. Female pilots were also higher on these scales than the female comparison group and lower on the Neuroticism and Openness scales than that comparison group. It is suggested that these traits are highly adaptive for Air Force pilots, given the nature of modern military operational requirements.

Women in combat: concerns of U.S. Air Force and U.S. Army rated male and female aircrew

The issue of women flying military aircraft in a combat role has been very controversial. We conducted a comprehensive survey, via anonymous questionnaire, of all U.S. Army and U.S. Air Force rated female aircrew, with an equal number of age- and duty-matched male aircrew. Here we report on the women in combat section of the questionnaire: should women be allowed to fly aircraft on combat missions? if allowed to do so, should they have the option of doing so? The great majority of women (87%) felt that they should be allowed to fly aircraft on combat missions, whereas only 41% of the men agreed. If women were allowed to fly in combat, both genders felt that women should be forced to do so on an equal basis with the men. Major concerns were that there be no quotas, that combat slots be opened to the best qualified, and prisoner-of-war concerns. Many women opined that they should not be forced to go into combat because they believe men are not forced to do so. There seemed to be a great deal of animosity between men and women concerning women flying in combat.

Female United States Air Force (USAF) pilots: themes, challenges, and possible solutions

BACKGROUND

Identification of stresses of mixed-gender squadrons, attention to the psychological concerns of pilots in combat, and recognition of the difficulties of balancing a career and family are important in today's United States Air Force (USAF). What qualities are desirable in male and female pilots in combat situations, how do men and women view their career and family goals, and how do men and women work together in day-to-day squadron activities versus deployment and combat situations?

METHODS

A semi-structured clinical interview sought in formation about personal/family health, squadron relationships, and career/deployment stresses. The interview covered the effect of grounding for more than 30 d, motivation to fly, health decrements due to aircraft design, teamwork difficulties and blocks to success, career demands, combat and prisoner of war (POW) concerns, stress and coping styles, flying goals, and family/health concerns. There were 114 (64 male and 50 female) pilots who participated in the study.

RESULTS

The majority of male pilots interviewed asserted that they would be more protective of a woman in combat than a man and were concerned about their reaction to a female POW. Many women were concerned about being used to exploit men in a POW camp. The majority of pilots believed women were well integrated into their squadrons. Those interviewed reported that the squadron members with the most difficulty dealing with women were older males, including enlisted crew and some commanders.

CONCLUSION

The information gained from this study will assist the USAF in understanding and coping with the psychological stresses associated with combat, deployment, and mixed-gender squadrons.

Cognitive assessment of USAF pilot training candidates

BACKGROUND

Most intellectual and cognitive assessment of pilots is done with locally developed assessment devices. The United States Air Force currently uses the recently developed CogScreen (Aeromedical Edition) to assess these areas.

HYPOTHESES

There will be differences on the CogScreen across USAF student pilot candidates and commercial pilots.

METHODS

This paper presents the test scores of 512 USAF pilot training candidates who were tested with this commercially available, "off-the-shelf" product. Comparison data was abstracted from the test manual on commercial pilots.

RESULTS

Data from the new CogScreen (Aeromedical Edition) is provided and shows consistent differences between pilot training candidates and commercial pilots across reaction time, accuracy, throughput, and process measures.

DISCUSSION

The new CogScreen appears to be an appropriate device for the assessment of pilot candidates, student pilots, and pilots.

Differential regulation of hippocampal AMPA and kainate receptor subunit expression by haloperidol and clozapine

Dopamine-glutamate interactions within discrete neural circuits are increasingly recognized as potential substrates for dysregulation in schizophrenia, and as a result, potential targets for pharmacological intervention in this illness. We examined the regulation, by haloperidol (2 mg kg-1 day-1) and clozapine (20 mg kg-1 day-1), of the mRNAs encoding the four AMPA receptor subunits (gluR1-gluR4), three low-affinity kainate receptor subunits (gluR5-gluR7), and two high-affinity kainate subunits (KA1 and KA2) in the rat hippocampal formation and associated entorhinal cortex. A complex and differential pattern of AMPA and kainate subunit mRNA regulation by clozapine and haloperidol was observed in this study. Both drugs caused significant alterations of most of these mRNAs, but in a heterogeneous and region-specific fashion. These data suggest that these antipsychotic drugs alter the expression of the genes encoding the subunits that express ionotropic glutamate receptors. Given the importance of glutamatergic mechanisms and the hippocampal formation in schizophrenia, these data suggest a potential substrate for neurotransmitter dysregulation in this illness, as well as a potential target for therapeutic intervention.

Defining and measuring the "right stuff": neuropsychiatrically enhanced flight screening (N-EFS)

BACKGROUND

United States Air Force (USAF) commanders wish to make better pilot-selection and cockpit-assignment decisions. Also, some pilots will sustain head injuries that will affect their flying careers. The complex and unforgiving nature of aviation demands a conservative approach to occupational return after neurological insult. Therefore, a neuropsychological assessment is required to return to flying. The lack of pre-injury neuropsychological data, however, hinders accurate assessment of post-injury functioning.

HYPOTHESES

a) Psychological data may improve the pilot selection and assignment processes as military resources dwindle; and b) baseline intellectual/cognitive data may support the scientific basis of aeromedical decision-making.

METHODS

Neuropsychiatrically Enhanced Flight Screening (N-EFS) attempts to validate the Multidimensional Aptitude Battery (MAB), CogScreen, Revised NEO-PI (NEO-PI-R), and Personal Characteristics Inventory (PCI) for pilot selection and cockpit assignment. N-EFS also measures baseline intelligence (using the MAB) and cognitive functioning (using the CogScreen) for comparison purposes if a future medical flying waiver is needed after neurological insult. These assessments will compare the aviator's postinjury functioning to a personal intellectual functioning baseline captured at entry into aviation training.

RESULTS

N-EFS students are scoring from below average to very superior in intellectual assessment. Very preliminary personality testing results suggest few significant differences between male and female student pilots, with high extraversion being the most striking personality characteristic.

DISCUSSION

The wide range of intellectual functioning in pilot candidates argues for baseline data collection to improve future aeromedical decisions.

Assessing aviators for personality pathology with the Millon Clinical Multiaxial Inventory (MCMI)

Psychiatrists independently evaluated 82 aviators referred to an aeromedical consultation service who had been administered the Millon Clinical Multiaxial Inventory (MCMI). The MCMI personality scales of those aviators psychiatrically deemed to be free from personality pathology were compared to the scales of those aviators psychiatrically assessed to have maladaptive personalities. The MCMI personality scales reached statistical significance (p < 0.005) for identifying Diagnostic and Statistical Manual of Mental Disorders (2) Cluster C (dependent or avoidant or both) maladaptive personality traits, but did not reach statistical significance for Cluster B (histrionic or narcissistic or both) traits. Military aviators are a highly selected group who have mastered numerous obstacles and who continually prove their adaptability. The prevalence of personality pathology is likely not as great in this population as would be suggested by the MCMI. An elevation of a Cluster C scale, however, warrants a high index of suspicion.

Flight psychology at Sheppard Air Force Base

Flight psychology is the application of psychological principles to the unique environment of the aviator in order to enhance training, flight safety, and mission accomplishment. At Sheppard Air Force Base, TX, flight psychology is a cooperative effort between a clinical psychologist and the aeromedical services, with the former acting as a consultant to the latter. The primary focus of the flight psychology program is stress management, including managing the stress response of airsickness, for students in the Euro-NATO Joint Jet Pilot Training (ENJJPT) program. Psychological assessments of flying personnel, air traffic controllers, and individuals being considered for special duties constitute a valuable contribution to aeromedical services. We present clinical vignettes to illustrate the interaction of the flight psychologist and aeromedical services, and the effect on flying training and flight safety.

Listeria monocytogenes cerebritis, bacteremia, and cutaneous lesions complicating hairy cell leukemia

Hairy cell leukemia is a lymphoreticular malignancy characterized by a chronic course and multiple defects in host defense mechanisms. Infections are the major cause of morbidity and mortality in this malignancy. Opportunistic infections due to pathogens normally controlled by cell-mediated immune mechanisms have been increasingly described but have not included listerial infections. This report describes a case of disseminated Listeria monocytogenes infection including the uncommon manifestations of cerebritis and cutaneous lesions in a patient with hairy cell leukemia.

Lung mechanics, radiography and 67Ga scintigraphy in experimental Pneumocystis carinii pneumonia

Respiratory system pressure-volume (P-V) studies, 67Ga-citrate scans, and chest radiographs were made in the corticosteroid-treated rat model of Pneumocystis carinii pneumonia. The steroid treatment used to provoke Pneumocystis infection in this model resulted in a reduction in body weight, lung weight and lung volumes compared to age-matched controls but no change in the normalized pressure-volume curve. P. carinii infection was associated with increased lung wet weight and flattening of the respiratory system P-V curve when compared to either age matched controls or steroid-treated animals on trimethoprim-sulfamethoxazole prophylaxis for P. carinii. Radiographs were interpreted as positive in only three of 11 animals with P. carinii, whereas 10 of 12 animals showed positive gallium-67 lung scans. We conclude that both gallium uptake and altered lung mechanics occur in the rat with Pneumocystis carinii and may reflect increased alveolar permeability and surfactant abnormalities noted in other studies.

Identification and treatment of masked depression in a general medical practice

The usefulness of the Zung Self-Rating Depression Scale as a screening instrument to uncover masked depression, and the benefits of early identification and treatment with alprazolam, were evaluated in a general medical practice population. There was a 95% scale acceptance by patients and a 12% overall prevalence of depression based on SDS results. Patients who scored in the depressed range on the SDS were, on a randomized basis, either identified immediately to their physicians and treated with alprazolam (N = 21) or identified after 4 weeks (natural history controls, N = 20). Treatment resulted in improvement in 66% of the identified group versus a 35% spontaneous improvement in the control group (p less than .05).

Actuarial status of the Hospital Insurance and Supplementary Medical Insurance Trust Funds

This article, adapted from a summary of the 1983 Annual Reports of the Medicare Boards of Trustees, presents the present and projected future actuarial status of the Hospital Insurance (HI) and Supplementary Medical Insurance (SMI) Trust Funds following the enactment of the Tax Equity and Fiscal Responsibility Act of 1982 and the Social Security Amendments of 1983. Although the Trustees characterize the outlook for the HI Trust Fund as slightly more optimistic than it was a year earlier, they report that the fund may be exhausted sometime between 1988 and 1996 unless benefits under the HI part of Medicare are reduced or financing is improved. The SMI Trust Fund, which is financed by premiums adjusted each year to reflect actual experience and by general revenue contributions, is characterized as actuarially sound. The Trustees note, however, the growing extent to which general revenue financing is becoming the major source of income for the SMI part of Medicare.

The histological appearance of carbon fibre implants and neo-ligament in man

The results of this study indicate that a fibrous ingrowth occurs in man after surgical replacement of a tendon or ligament with carbon fibre. This ingrowth resembles normal tendon or ligament very closely, with parallel orientation of collagen fibres and fibroblasts. A multinucleate foreign-body giant-cell response was seen, but it was not possible to ascertain whether the fragmented carbon lay within or on these cells and other macrophagic components. Numerous intact carbon fibres were still present 2 and 3 years after implantation.

The effect of experimental ligation of the external carotid artery and its major branches on haemorrhage from the maxillary artery

The effect of ligation of the external carotid artery and its major branches on blood flow from the maxillary artery was investigated in four Chacma baboons. The left common carotid artery and its branches were surgically exposed and the maxillary artery was isolated, sectioned and cannulated. Blood flow from the proximal segment of the maxillary artery was determined with and without occlusion of the common carotid artery, the external carotid artery above and below the origin of the linguo-facial trunk and the posterior auricular occipital trunk. Ligation of the external carotid artery below and above the origin of the lingual and facial arteries reduced maxillary artery blood flow by 40% and 73% respectively. Ligation of the external carotid artery above the origin of the lingual and facial vessels, together with ligation of the posterior auricular occipital trunk reduced maxillary artery blood flow by 99.2%. On the basis of these experimental findings, it is suggested that maxillary artery haemorrhage in man may be most effectively controlled by ligation of the external carotid artery in the retromandibular fossa, distal to the origin of the posterior auricular artery, combined with ligation of the superficial temporal artery at the root of the zygoma.

A comparison of prazepam, diazepam, lorazepam and placebo in anxious outpatients in non-psychiatric private practices

A double-blind, random design, parallel group, four-week study of prazepam, diazepam, lorazepam, and placebo was conducted in diverse private outpatient practices (surgeon, internist, and obstetrician-gynecologist) using a common protocol, in order to evaluate their comparative efficacy in these settings. In addition, the effects of these anxiolytics on depressive symptoms in patients with anxiety were studied. Results showed that the non-psychiatric practitioners used lower dosages than psychiatrists in previous reports, and perception of anxiety levels of their patients were lower than the psychiatric raters. When patients were divided into two groups (1. predominantly depressed with anxiety, and 2. predominantly anxious with depression), differences between the benzodiazepines were shown. In the high depression-low anxiety group, all four treatment methods were effective in alleviating both anxiety and depression. In the high anxiety-low depression group, only prazepam and placebo were effective in alleviating both anxiety and depression, while diazepam and lorazepam decreased anxiety levels, but not depression.

Acute gastric dilation and rupture in Macaca arctoides associated with Clostridium perfringens

A clinical case of gastric dilation and rupture is described in an adult male Macaca arctoides. Clostridium perfringens was isolated from the heart blood and liver. Data collected from our macaque colony for 13 years indicated a mortality rate of 3.5% due to acute dilation.

Results of extended resection of tumors involving the cervical part of the trachea

Extended resection of the trachea with construction of a mediastinal tracheostomy was performed upon 21 patients with primary or recurrent carcinoma involving the cervical part of the trachea. In 12 patients, major complications developed, and eight died of these complications. Necrosis of skin flaps and tracheal wall, leading to sepsis of the mediastinum and rupture of major vessels, were the two most common complications and causes of death. Three patients remained free of disease for 143, 77 and 48 months. A review of this experience suggests that this procedure should be limited to patients witha tumor localized to the cervical portion of the trachea and that well vascularized skin flaps--myocutaneous flaps--should be used to resurface the mediastinum and base of the neck as a means of preventing most of the complications reported in this investigation.

Isolation of Staphylococcus hyicus subsp hyicus from a pig with septic polyarthritis

Staphylococcus hyicus subsp hyicus (coagulase-positive) was isolated in pure culture from the left coxafemoral and right shoulder joints of a 4-week-old pig with septic polyarthritis. Present taxonomic criteria and DNA-DNA hybridization studies with reference strains were utilized to identify the isolate. There were no clinical signs or generalized skin lesions of porcine exudative epidermitis noticed in this pig.

Fabrication of a maxillary complete denture utilizing the neuromuscular or centric occlusion position

The patient was unable to wear a maxillary complete denture that had been made from a verifiable record in the centric jaw relation position or terminal hinge position. When she brought her teeth together, only a few touched. Clinical examination showed that this patient had a discrepancy of approximately 3 mm anteroposteriorly and a discrepancy of 1 mm mediolaterally between the terminal hinge position and the centric occlusion or neuromuscular position. A new denture was made for the patient. The neuromuscular position was used as the starting position and as the position of maximum intercuspation (centric occlusion), and the terminal hinge position was used as a mounted border position of reference for occlusal adjustment and equilibration.

The host/parasite relationships of Xenopsylla astia and X. cheopis on Bandicota bengalensis in Rangoon, Burma

In Rangoon, Burma, over half the commensal B. bengalensis taken in live traps were found to be infested with Xenopsylla species fleas. X. astia infestations were twice as common as those of the classic plague vector X. cheopis. In terms of absolute numbers X. astia outnumbered X. cheopis by 10 to 1. X. astia was more commonly found as a monospecific infestation, and X. cheopis was more commonly found mixed with X. astia. The flea indicies were high, with a specific index of 2.4 for X. cheopis and 10.2 for X. astia. The flea indicies and flea sex ratios remained stable across the host population and could not be correlated to changes in the head and body length of the host and were not different on male or female hosts. The evidence of this and other surveys is that X. cheopis is not as well adapted for parasitism on free ranging B. bengalensis as is X. astia.

Basal cell extensions in human oral mucosa

Basal cell extensions have frequently been observed in a variety of odontogenic lesions as well as in the fibrous epulis (fibrous hyperplasia of the gingiva). In order to determine the frequency of these extensions in normal human oral nucosa, a study using autopsy and surgical material was conducted. The results indicated that a specific type of rete ridge morphology exists for gingiva, including the presence of thin double stranded extensions which may be related to the functional role of the gingiva or to the fact that the odontogenic apparatus is derived from surface epithelium in this region in the developing embryo, or both. Similar extensions have not been found in other oral epithelia.

Aflatoxicosis in swine

In an episode of aflatoxicosis in feeder pigs, mortality was about 20%. Histopathologic findings characteristic of experimentally induced aflatoxicosis and the finding of aflatoxin B1 in the serum of pigs and in the cornbased feed confirmed the diagnosis. Aflatoxins B1 and B2 were found in the corn used to prepare the feed. Combine harvesting of the corn, which cracked a large percentage of the kernels, coupled with prolonged drying time of the corn probably contributed to the aflatoxin production. Although the corn was fed to adult swine without observable effect, 47 of the 250 feeder pigs developed typical signs of aflatoxicosis. Unseasonably cold weather apparently was a factor in initiating the onset of clinical signs and probably increased the severity of the disease.

Control and monitoring system for clinically employed pneumatic blood pumps

Instantaneous position of the flexing member in pneumatic blood pumps is monitored on-line by measuring the electrical capacitance across the gas space within the pump. Monitor output is utilized in closed-loop pump control and for automatic pump shutdown in response to operational abnormalities. Thus, safety and efficacy are enhanced through operational optimization, automatic safety features, and facilitated evaluation.

Mycobacterium tuberculosis infection in two East African oryxes

Tuberculous lesions were observed at necropsy of 2 East African oryxes (Oryx gazella beisa) at a municipal zoological park in Jackson, Ms. Microscopic examination revealed granulomas containing acid-fast bacilli in the lungs and liver of both animals, as well as in the uterus and mediastinal lymph nodes of 1 animal. Mycobacterium tuberculosis was isolated from the tissues of both oryxes and from fluid aspirated from the mammary gland of 1 oryx; the organism was pathogenic for guinea pigs but not for rabbits.

Experience with opposite breast biopsy in patients with operable breast cancer

One hundred and nine patients with unilateral breast carcinoma and no palpable abnormality of the contralateral breast were evaluated by opposite breast biopsy. Our patient population yielded four noninfiltrating carcinomas, and one infiltrating carcinoma for an incidence of 4.5%. The one infiltrating cancer was suspected on a preoperative mammogram. We have discontinued the routine use of the opposite breast biopsy as a diagnostic tool in patients with unilateral breast cancer, in patients with no palpable abnormality and a normal mammogram.