A multi-centred sequential trial comparing PEGASUS, an intervention to promote shared decision making about breast reconstruction with usual care

Decision making about breast reconstruction (BR) is complex. The Patients' Expectations and Goals: Assisting Shared Understanding of Surgery (PEGASUS) intervention aims to support shared decision making by helping women and clinicians clarify and discuss their expectations around reconstructive surgery. We conducted a multi-centred sequential trial comparing PEGASUS (n = 52) with usual care (UC) (n = 86) in women considering reconstruction, who completed outcome measures at baseline, and 3, 6 and 12 months post-surgery. The primary outcome was BR-specific quality of life (Breast-Q) 6 months post-intervention. Secondary outcomes were health-related quality of life (EQ-5D-5L), capabilities (ICECAP-A) and decisional regret, compared using t-tests and Cohen's d. Comparative analyses revealed no significant differences between groups in Breast-Q scores at any time point, except for a favourable effect for UC on psychological well-being at 3 months (t = -2.41, p = .019, d= -0.59). Intervention participants reported significantly higher, therefore improved, ICECAP-A (t = -2.13, p = .037, d = -0.45) and EQ VAS (t = -2.28, p = .026, d = -0.49) scores at 12 months compared to UC. Decisional regret was significantly lower in the PEGASUS group compared to the UC group at 6 months (t =2.06, p = .044, d= -0.51), but this was not sustained at 12 months. In conclusion, the PEGASUS intervention offers some benefits to women considering BR. At times, women experienced less decisional regret, improved health-related quality of life and capability well-being. Findings are discussed in the light of fidelity testing and embedding PEGASUS into practice.

4D-imaging of drip-line radioactivity by detecting proton emission from 54mNi pictured with ACTAR TPC

Proton radioactivity was discovered exactly 50 years ago. First, this nuclear decay mode sets the limit of existence on the nuclear landscape on the neutron-deficient side. Second, it comprises fundamental aspects of both quantum tunnelling as well as the coupling of (quasi)bound quantum states with the continuum in mesoscopic systems such as the atomic nucleus. Theoretical approaches can start either from bound-state nuclear shell-model theory or from resonance scattering. Thus, proton-radioactivity guides merging these types of theoretical approaches, which is of broader relevance for any few-body quantum system. Here, we report experimental measurements of proton-emission branches from an isomeric state in ^54mNi, which were visualized in four dimensions in a newly developed detector. We show that these decays, which carry an unusually high angular momentum, ℓ = 5 and ℓ = 7, respectively, can be approximated theoretically with a potential model for the proton barrier penetration and a shell-model calculation for the overlap of the initial and final wave functions.

Proton radioactivity is useful for studying nuclear structure. Here the authors report two proton emission branches from the 10+ state isomer of 54mNi by using a time projection chamber.

Spectroscopy along Flerovium Decay Chains: Discovery of ^{280}Ds and an Excited State in ^{282}Cn

A nuclear spectroscopy experiment was conducted to study α-decay chains stemming from isotopes of flerovium (element Z=114). An upgraded TASISpec decay station was placed behind the gas-filled separator TASCA at the GSI Helmholtzzentrum für Schwerionenforschung in Darmstadt, Germany. The fusion-evaporation reactions ^{48}Ca+^{242}Pu and ^{48}Ca+^{244}Pu provided a total of 32 flerovium-candidate decay chains, of which two and eleven were firmly assigned to ^{286}Fl and ^{288}Fl, respectively. A prompt coincidence between a 9.60(1)-MeV α particle event and a 0.36(1)-MeV conversion electron marked the first observation of an excited state in an even-even isotope of the heaviest man-made elements, namely ^{282}Cn. Spectroscopy of ^{288}Fl decay chains fixed Q_{α}=10.06(1)  MeV. In one case, a Q_{α}=9.46(1)-MeV decay from ^{284}Cn into ^{280}Ds was observed, with ^{280}Ds fissioning after only 518  μs. The impact of these findings, aggregated with existing data on decay chains of ^{286,288}Fl, on the size of an anticipated shell gap at proton number Z=114 is discussed in light of predictions from two beyond-mean-field calculations, which take into account triaxial deformation.

Enhanced Quadrupole and Octupole Strength in Doubly Magic ^{132}Sn

The first 2^{+} and 3^{-} states of the doubly magic nucleus ^{132}Sn are populated via safe Coulomb excitation employing the recently commissioned HIE-ISOLDE accelerator at CERN in conjunction with the highly efficient MINIBALL array. The ^{132}Sn ions are accelerated to an energy of 5.49  MeV/nucleon and impinged on a ^{206}Pb target. Deexciting γ rays from the low-lying excited states of the target and the projectile are recorded in coincidence with scattered particles. The reduced transition strengths are determined for the transitions 0_{g.s.}^{+}→2_{1}^{+}, 0_{g.s.}^{+}→3_{1}^{-}, and 2_{1}^{+}→3_{1}^{-} in ^{132}Sn. The results on these states provide crucial information on cross-shell configurations which are determined within large-scale shell-model and Monte Carlo shell-model calculations as well as from random-phase approximation and relativistic random-phase approximation. The locally enhanced B(E2;0_{g.s.}^{+}→2_{1}^{+}) strength is consistent with the microscopic description of the structure of the respective states within all theoretical approaches. The presented results of experiment and theory can be considered to be the first direct verification of the sphericity and double magicity of ^{132}Sn.

Hereditary cancer screening: Case reports and review of literature on ten Ashkenazi Jewish founder mutations

BACKGROUND

Historically, three founder mutations in the BRCA1/2 (OMIM 113705; OMIM 600185) genes have been the focus of cancer risks within the Ashkenazi Jewish (AJ) population. However, there are several additional mutations associated with increased susceptibility to cancer in individuals of AJ ancestry.

METHODS

We report three patients who exemplify the need to keep these additional founder mutations in mind when pursuing hereditary cancer genetic testing of individuals in this population. All gene sequences in this paper were aligned to reference sequences based on human genome build GRCh37/UCSC hg19.

RESULTS

review of the literature discusses that the combined risk is 12.36%-20.83% forhaving 1 of the 10 hereditary cancer AJ founder mutations in the BRCA1, BRCA2, CHEK2 (OMIM 604373), APC (OMIM 611731), MSH2 (OMIM 609309), MSH6 (OMIM 600678), and GREM1 (OMIM 603054) genes for individuals of AJ ancestry.

CONCLUSION

We recommend testing for all 10 of these AJ founder cancer susceptibility mutations for individuals within this population as standard screening in order to ensure appropriate cancer risk management and cascade testing.

Lifetime Measurements of Excited States in ^{172}Pt and the Variation of Quadrupole Transition Strength with Angular Momentum

Lifetimes of the first excited 2^{+} and 4^{+} states in the extremely neutron-deficient nuclide ^{172}Pt have been measured for the first time using the recoil-distance Doppler shift and recoil-decay tagging techniques. An unusually low value of the ratio B(E2:4_{1}^{+}→2_{1}^{+})/B(E2:2_{1}^{+}→0_{gs}^{+})=0.55(19) was found, similar to a handful of other such anomalous cases observed in the entire Segré chart. The observation adds to a cluster of a few extremely neutron-deficient nuclides of the heavy transition metals with neutron numbers N≈90-94 featuring the effect. No theoretical model calculations reported to date have been able to explain the anomalously low B(E2:4_{1}^{+}→2_{1}^{+})/B(E2:2_{1}^{+}→0_{gs}^{+}) ratios observed in these cases. Such low values cannot, e.g., be explained within the framework of the geometrical collective model or by algebraic approaches within the interacting boson model framework. It is proposed that the group of B(E2:4_{1}^{+}→2_{1}^{+})/B(E2:2_{1}^{+}→0_{gs}^{+}) ratios in the extremely neutron-deficient even-even W, Os, and Pt nuclei around neutron numbers N≈90-94 reveal a quantum phase transition from a seniority-conserving structure to a collective regime as a function of neutron number. Although a system governed by seniority symmetry is the only theoretical framework for which such an effect may naturally occur, the phenomenon is highly unexpected for these nuclei that are not situated near closed shells.

A Case of the 7p22.2 Microduplication: Refinement of the Critical Chromosome Region for 7p22 Duplication Syndrome

We report a 14-year-old Hispanic male with a microduplication of the chromosome 7p22.2 band detected through microarray analysis. He had a history of developmental delay and mild intellectual disability, asthma, myopia, proportionate short stature, dysmorphic features, and Achilles tendon release. This appears to be the first report of a patient with a microduplication of only the chromosome 7p22.2 band and is now the smallest reported duplication to date to include features in common with the chromosome 7p22 duplication syndrome.

Partial Deletion of Chromosome 1p31.1 Including only the Neuronal Growth Regulator 1 Gene in Two Siblings

We present two siblings with a partial deletion of chromosome 1p31.1 involving only the neuronal growth regulator 1 (NEGR1) gene. The siblings had a history of neuropsychiatric and behavioral problems, learning difficulties, hypotonia, mild aortic root dilatation, hypermobility, and scoliosis. This is the first clinical report of a microdeletion of chromosome 1p31.1 involving only the NEGR1 gene.

Growth Charts for Prader-Willi Syndrome During Growth Hormone Treatment

The purpose of the current study was to develop syndrome-specific standardized growth curves for growth hormone-treated Prader-Willi syndrome (PWS) individuals aged 0 to 18 years. Anthropometric growth-related measures were obtained on 171 subjects with PWS who were treated with growth hormone for at least 40% of their lifespan. They had no history of scoliosis. PWS standardized growth curves were developed for 7 percentile ranges using the LMS method for weight, height, head circumference, weight/length, and BMI along with normative 3rd, 50th, and 97th percentiles plotted using control data from the literature and growth databases. Percentiles were plotted on growth charts for comparison purposes. Growth hormone treatment appears to normalize stature and markedly improves weight in PWS compared with standardized curves for non-growth hormone-treated PWS individuals. Growth chart implications and recommended usage are discussed.

The 7q11.23 Microduplication Syndrome: A Clinical Report with Review of Literature

We report a 14-year-old adolescent girl with selective mutism (SM) and a 7q11.23 microduplication detected by chromosomal microarray (CMA) analysis and reviewed the literature from 18 published clinical reports. Our patient had specific phobias, SM, extreme anxiety, obesity, cutis marmorata, and a round appearing face with a short neck and over folded ears. We reviewed the published clinical, cognitive, behavioral, and cytogenetic findings grouped by speech and language delay, growth and development, craniofacial, clinical, and behavior and cognitive features due to the 7q11.23 microduplication. This microduplication syndrome is characterized by speech delay (91%), social anxiety (42%), attention deficit hyperactivity disorder (ADHD, 37%), autism spectrum disorder (29%), and separation anxiety (13%). Other findings include abnormal brain imaging (80%), congenital heart and vascular defects (54%), and mild intellectual disability (38%). We then compared the phenotype with Williams-Beuren syndrome (WBS) which is due to a deletion of the same chromosome region. Both syndromes have abnormal brain imaging, hypotonia, delayed motor development, joint laxity, mild intellectual disability, ADHD, autism, and poor visuospatial skills but opposite or dissimilar findings regarding speech and behavioral patterns, cardiovascular problems, and social interaction. Those with WBS are prone to have hyperverbal speech, lack of stranger anxiety, and supravalvular aortic stenosis while those with the 7q11.23 microduplication have speech delay, SM, social anxiety, and are prone to aortic dilatation.

New Short-Lived Isotope ^{221}U and the Mass Surface Near N=126

Two short-lived isotopes ^{221}U and ^{222}U were produced as evaporation residues in the fusion reaction ^{50}Ti+^{176}Yb at the gas-filled recoil separator TASCA. An α decay with an energy of E_{α}=9.31(5)  MeV and half-life T_{1/2}=4.7(7)  μs was attributed to ^{222}U. The new isotope ^{221}U was identified in α-decay chains starting with E_{α}=9.71(5)  MeV and T_{1/2}=0.66(14)  μs leading to known daughters. Synthesis and detection of these unstable heavy nuclei and their descendants were achieved thanks to a fast data readout system. The evolution of the N=126 shell closure and its influence on the stability of uranium isotopes are discussed within the framework of α-decay reduced width.

Distal Partial Trisomy 15q26 and Partial Monosomy 16p13.3 in a 36-Year-Old Male with Clinical Features of Both Chromosomal Abnormalities

We report a 36-year-old Caucasian male identified with distal partial trisomy 15q and partial monosomy 16p from an unbalanced chromosome translocation detected by microarray and FISH analysis. He had a history of developmental delay and intellectual disability, chronic anemia, tall and slender stature, thoracic scoliosis and lumbar lordosis, and dysmorphic features. The distal partial trisomy 15q included the insulin-like growth factor 1 receptor gene involved with growth, while genes in the distal partial monosomy 16p region are involved with alpha hemoglobin production, intellectual disability, dysmorphic features, and acromegaly. The chromosome derivative found in our patient contains genes known to play a role in his phenotype.

The 15q11.2 BP1-BP2 microdeletion syndrome: a review

Patients with the 15q11.2 BP1–BP2 microdeletion can present with developmental and language delay, neurobehavioral disturbances and psychiatric problems. Autism, seizures, schizophrenia and mild dysmorphic features are less commonly seen. The 15q11.2 BP1–BP2 microdeletion involving four genes (i.e., TUBGCP5, CYFIP1, NIPA1, NIPA2) is emerging as a recognized syndrome with a prevalence ranging from 0.57%–1.27% of patients presenting for microarray analysis which is a two to four fold increase compared with controls. Review of clinical features from about 200 individuals were grouped into five categories and included developmental (73%) and speech (67%) delays; dysmorphic ears (46%) and palatal anomalies (46%); writing (60%) and reading (57%) difficulties, memory problems (60%) and verbal IQ scores ≤75 (50%); general behavioral problems, unspecified (55%) and abnormal brain imaging (43%). Other clinical features noted but not considered as common were seizures/epilepsy (26%), autism spectrum disorder (27%), attention deficit disorder (ADD)/attention deficit hyperactivity disorder (ADHD) (35%), schizophrenia/paranoid psychosis (20%) and motor delay (42%). Not all individuals with the deletion are clinically affected, yet the collection of findings appear to share biological pathways and presumed genetic mechanisms. Neuropsychiatric and behavior disturbances and mild dysmorphic features are associated with genomic imbalances of the 15q11.2 BP1–BP2 region, including microdeletions, but with an apparent incomplete penetrance and variable expressivity.

48Ca+249Bk fusion reaction leading to element Z = 117: long-lived α-decaying 270Db and discovery of 266Lr

The superheavy element with atomic number Z=117 was produced as an evaporation residue in the (48)Ca+(249)Bk fusion reaction at the gas-filled recoil separator TASCA at GSI Darmstadt, Germany. The radioactive decay of evaporation residues and their α-decay products was studied using a detection setup that allowed measuring decays of single atomic nuclei with half-lives between sub-μs and a few days. Two decay chains comprising seven α decays and a spontaneous fission each were identified and are assigned to the isotope (294)117 and its decay products. A hitherto unknown α-decay branch in (270)Db (Z = 105) was observed, which populated the new isotope (266)Lr (Z = 103). The identification of the long-lived (T(1/2) = 1.0(-0.4)(+1.9) h) α-emitter (270)Db marks an important step towards the observation of even more long-lived nuclei of superheavy elements located on an "island of stability."

Shell-structure and pairing interaction in superheavy nuclei: rotational properties of the z=104 nucleus (256)rf

The rotational band structure of the Z=104 nucleus (256)Rf has been observed up to a tentative spin of 20ℏ using state-of-the-art γ-ray spectroscopic techniques. This represents the first such measurement in a superheavy nucleus whose stability is entirely derived from the shell-correction energy. The observed rotational properties are compared to those of neighboring nuclei and it is shown that the kinematic and dynamic moments of inertia are sensitive to the underlying single-particle shell structure and the specific location of high-j orbitals. The moments of inertia therefore provide a sensitive test of shell structure and pairing in superheavy nuclei which is essential to ensure the validity of contemporary nuclear models in this mass region. The data obtained show that there is no deformed shell gap at Z=104, which is predicted in a number of current self-consistent mean-field models.

Toxocara in the mouse: a model for parasite-altered host behaviour?

The objective of this paper is to critically evaluate the significance of parasite-altered host behaviour in the Toxocara mouse model particularly in the light of the Manipulation Hypothesis. Murine behaviours were examined in both outbred and inbred strains of mice infected with different doses of Toxocara canis ova. Behaviours investigated included activity, exploration, response to novelty, anxiety, learning, memory and social behaviour. Subsequent modifications to the behaviour of infected mice were investigated with respect to dose administered and larval accumulation in the brain. There was substantial variation in the number of larvae recovered from brains of individual mice, which received similar doses of Toxocara ova. Furthermore, the numbers of larvae recovered at different doses differed significantly between an outbred and inbred strain of mouse. Alterations in infected host behaviour occurred and were related to the number of larvae recovered from the brain. For social behaviour in outbred mice, a high infection in the brain reduced levels of aggressive behaviour and increased levels of flight and defensive behaviours. In contrast, outbred mice with a low infection in the brain displayed a greater level of risk behaviour in respect of predator odour and the light/dark box compared to control or high infection mice. Post-infection, outbred mice were more immobile whereas inbred mice showed reduced immobility and increased digging and climbing. Impaired learning ability was observed in outbred mice with moderate and high levels of infection in the brain compared to control and low infection mice. Toxocara infection has an impact upon a diverse range of murine behaviours with little evidence for a specific and hence an adaptive alteration. Many of the effects on murine host behaviour by Toxocara are likely to be pathological side effects of infection rather than as a consequence of adaptive host-manipulation. Observed changes in murine behaviour may be relevant to human toxocariasis.

Relationship between three intensity levels of Toxocara canis larvae in the brain and effects on exploration, anxiety, learning and memory in the murine host

Outbred LACA mice were administered low (100 ova), medium (1000 ova), high (3000 ova) and trickle (4x250 ova) doses of Toxocara canis ova and the effect of infection was examined with respect to the number of larvae recovered from the brain and their behaviour. Recovery of larvae from the brain was generally low with the % recovery expressed in terms of the total dose administered being highest for the 3000 dose (6.1%) and 1000 dose (6%), followed by the 100 (4.4%) and trickle (3.5%) doses. The variation in larval recoveries was large between individual mice receiving similar doses. The level of infection in the brain was lower in mice receiving a multiple as opposed to an equivalent single dose of ova. Mice were then divided into three larval intensity groupings based upon the number of larvae recovered from their brain. The ranges for the groups were as follows: low intensity group, 0-15 larvae; moderate intensity group, 27-55 larvae; high intensity group, 66-557 larvae. Three behavioural tests were carried out on control and infected mice. Exploration and response to novelty was examined using a 'T' maze and learning was investigated by means of a water-finding task. Anxiety was measured using an elevated plus maze apparatus. Infected mice were less explorative and less responsive to novelty in the 'T' maze and this was particularly pronounced for the heavily infected mice. In the elevated plus maze, infected mice displayed reduced levels of anxiety to aversive and exposed areas of the maze, particularly in the case of the moderate and high intensity mice. There was evidence for impaired learning ability in the water task apparatus for moderate and high intensity mice. In general, the effects of infection on behaviour were more pronounced in the moderate and high intensity groups compared to the low intensity group.

Influence of mouse strain, infective dose and larval burden in the brain on activity in Toxocara-infected mice

Outbred LACA mice and inbred NIH mice were administered low (100 ova), medium (1000 ova), high (3000 ova) and trickle (4x250 ova) doses of Toxocara canis ova and the effect of infection on activity was examined with respect to: (i) the dose of ova administered and (ii) the number of larvae recovered from the brain. Larval recovery from the brain was significantly reduced in NIH mice compared to LACA mice for the 1000, 3000 and trickle doses. Mice from each strain were divided into larval intensity groupings based upon the number of larvae recovered from their brain. Activity for each mouse was measured pre- and post-infection by observing its behaviour in the home cage. Activity was assessed by monitoring six different independent categories of murine behaviour - ambulation, grooming, rearing, digging, climbing and immobility. Within each behavioural category, the duration of time spent at each behaviour per mouse within one thousandth of a second, the number of short bouts performed and the number of long bouts of behaviour performed were recorded over a 20 min period. Activity of LACA and NIH mice differed prior to infection. LACA mice spent more time immobile compared to NIH mice, which ambulated and climbed more. Variations in activity were also observed between groups of mice prior to infection. The effect of infection differed by strain, by dose and by larval intensity. Post-infection LACA mice became more immobile and ambulated less. NIH mice showed reduced immobility, but while ambulation decreased digging and climbing increased post-infection. Short bouts of activity remained unchanged among LACA mice post-infection but showed an increase for some behaviours in NIH mice.

Cell signaling and the regulation of muscle-specific gene expression by myocyte enhancer-binding factor 2

Skeletal muscle is an extremely adaptable tissue. Underlying the biochemical adaptation invoked by changes in activity or during development are dramatic alterations in gene expression. Recent advances in our understanding of the molecular machinery that regulates gene expression in muscle is allowing insight into the pathways that control muscle growth and differentiation. We review developments concerning how cellular signaling pathways induce genetic reprogramming in skeletal muscle.

Post-translational control of the MEF2A transcriptional regulatory protein

Myocyte enhancer factor 2 (MEF2) transcriptional regulatory proteins are key regulators of muscle-specific gene expression and also play a general role in the cellular response to growth factors, cytokines and environmental stressors. To identify signaling pathway components that might mediate these events, the potential role of MAP kinase and PKC signaling in the modulation of MEF2A phosphorylation and transcriptional activity were therefore studied. In transient transfection reporter assays, activated p38 MAP kinase potently increased MEF2A trans -activating potential, PKC[delta] and [epsiv] isotypes enhanced MEF2A transactivation to a lesser extent, while the ERK1/2 and JNK/SAPK pathways were without effect. A GAL4-based assay system showed that p38 MAP kinase and PKC[delta] target the MEF2A transactivation domain. We also observed an increase in p38 MAP kinase activity in congruence with the increase in MEF2A expression in differentiating primary muscle cells. COS cells overexpressing MEF2A alone or with one of the kinases were metabolically labeled with [32P]orthophosphate and MEF2A was immunoprecipitated using specific anti-MEF2A antibodies. MEF2A from cells co-transfected with activated p38 MAP kinase showed a decreased electrophoretic mobility due to phosphorylation. Subsequent phosphopeptide mapping and phosphoamino acid analysis indicated the appearance of several phoshopeptides due to p38 MAP kinase activation of MEF2A which were due to phosphorylation on serine and threonine residues. These studies position MEF2A as a nuclear target for the p38 MAP kinase signaling pathway.

The mixed nerve silent period is prolonged during a submaximal contraction sustained to failure

The purpose of this study was to determine the effect of a sustained contraction of vastus lateralis on the silent period (SP) in the surface electromyogram (EMG) following direct neural stimulation. Five men and 5 women performed isometric knee extension at 30% maximal voluntary contraction (MVC) to the limit of endurance. During the contraction, EMG increased, and superimposed twitch amplitude and time to peak tension decreased, but the SP duration did not change. After 10 min of recovery, MVC had returned to its initial value, and the potentiated twitch amplitude was 70% of initial value, but the SP was now 11% shorter. Based on these results, we hypothesize that during a sustained contraction of 30% MVC, the increase in central drive may have been offset by inhibitory input from the periphery, but after 10 min of recovery the SP was shortened because of increased central drive. This aspect of the SP's behavior should be taken into account whenever it is employed as a diagnostic tool.

The relationship between numbers of larvae recovered from the brain of Toxocara canis-infected mice and social behaviour and anxiety in the host

The effect of the nematode Toxocara canis on social behaviour and anxiety levels of adult male outbred (LACA) mice was examined following infection with a single dose of 2000 ova. The actual number of larvae recovered from the brain of each individual mouse was determined after behavioural testing. The effect of the parasite on mouse behaviour was analysed by both the initial dose administered (i.e. infected versus control) and the degree of infection in the brain. There was substantial variation in the number of larvae recovered from the brains of the individual mice and the magnitude of behavioural change was associated with the level of infection. Examination of social behaviour for both analyses revealed that the infection reduced levels of aggressive behaviour and increased levels of flight and defensive behaviours. High infection in the brain induced the greatest degree of behavioural change which decreased in mice with lower infections. In contrast the analysis of anxiety levels in mice by initial dose administered revealed no difference between infected and control mice. Mice with low infection in the brain, however, displayed a greater level of risk behaviour by spending more time in the vicinity of a predator odour and in the light area of a light/dark paradigm than control or high infection mice. The results suggest that the behaviour of mice infected with T. canis is influenced by the number of larvae accumulated in the brain. This may have important consequences for the conclusions drawn on the effect of this parasite on murine behaviour.

Generalization from single sentence to multisentence production in severely aphasic patients

Multisentence production was examined in three nonfluent aphasic patients who had undergone a single sentence production training program using a computerized visual communication system (C-VIC). Patients were required to describe videotaped vignettes in English and using C-VIC. C-VIC allowed for an investigation of production abilities previously impossible to measure in severely aphasic patients, since C-VIC does not require internal generation of appropriate lexical items or phonological and articulatory realization. Results are discussed in the context of language production models in an attempt to determine the breakdown(s) in the production system that result in difficulty in trying to produce multiple sentences.

Survey of sexual concerns among organ transplant recipients

This study identified frequency of sexual dysfunction, degree of satisfaction with sexual relationship, differences in sexual function, overall satisfaction and life quality, and desire for and receipt of instruction regarding sexual dysfunction in kidney, pancreas/kidney, and liver transplant recipients. Of the 768 adult recipients surveyed by mailed questionnaire, 39% responded. Intimate relationships were reported by 69.9%; 66.7% indicated satisfaction with their relationship. Twenty-six percent were not sexually active. Transplant groups did not differ significantly regarding satisfaction, sexual function, or quality of life. Satisfaction groups differed significantly regarding intimacy and expected future life and health quality. Frequency of intercourse, desire, orgasm, erection dysfunctions, and the acceptance of partners' advances related to relationship satisfaction. Sixty-seven percent received no instruction concerning sexuality or fertility. Education efforts could validate and support sexual identity among this patient population.

Remediating production of tense morphology improves verb retrieval in chronic aphasia

Production of tense markers in C-VIC, a computerized visual communication system, was utilized as a treatment for three patients with severe expressive aphasia. Patients practiced constructing C-VIC tense marked sentences and then producing English equivalents. After training, all patients demonstrated significant improvements in English verb retrieval and production of correct tense morphology. Generalization of morphological rules for past tense production was seen for regular, but not irregular verbs. These results support the LaPointe and Dell (1989) extension of the Garrett (1975, 1992) model specifying a search through so-called verb phrase notion stores as a process mediating transition from functional to positional levels, but also suggest an additional constraint on the output of the verb notion store search.

Category and attribute knowledge deterioration in Alzheimer's disease

A prevalent theory regarding the deterioration of semantic memory in Alzheimer's disease is that it is a bottom-up process. If this is true, performance on tests of attribute knowledge should decline more rapidly than performance on tests of categorical knowledge as dementia severity increases. In the present study, a convincing pattern of findings to either support or reject the theory failed to emerge. This raised questions regarding the ability to separate attribute and categorical knowledge, and whether one can be tested without influence of the other. Questions also were raised regarding the additional cognitive processes needed to complete tasks of semantic memory.

Chromosomal analysis of sperm from men with idiopathic infertility using sperm karyotyping and fluorescence in situ hybridization

OBJECTIVE

To determine if idiopathic infertile men having oligozoospermia, asthenozoospermia, or teratozoospermia have an elevated risk of transmitting chromosomal abnormalities to their offspring.

DESIGN

Sperm chromosomal complements from five somatically normal infertile men were assayed using the human sperm-hamster oocyte fusion system and the disomy frequencies for chromosomes 1, 12, and the sex chromosomes were determined using fluorescence in situ hybridization.

SETTING

Infertile men and normal donors were volunteers in an academic research environment.

PATIENTS

Five men with the appropriate semen characteristics were recruited among patients concerned about their infertility.

INTERVENTIONS

Sperm fused with hamster oocytes resulting in sperm chromosomes or the sperm nuclei were prepared for fluorescence in situ hybridization.

MAIN OUTCOME MEASURE

Structural and numerical abnormalities assessed by sperm karyotypes and the disomy frequency determined by fluorescence in situ hybridization analysis.

RESULTS

The infertile men showed increased frequencies of numerical abnormalities and total abnormalities as determined by sperm karyotyping. Analysis of sperm nuclei by fluorescence in situ hybridization indicated a significant increase in the frequency of disomy for chromosome 1 and XY disomy.

CONCLUSIONS

Sperm from infertile men may contain an increased frequency of chromosomal abnormalities.

Advance directives and the patient self-determination act

Advance directives cover a wide variety of situations concerning the advance planning for medical care. Advance directives have existed for approximately 20 years; however, their forms and uses are presently expanding and evolving. This article presents advance directives, their various forms and uses, and reviews the current data on how well they achieve their desired goal. The Patient Self Determination Act, which was designed to promote the acknowledgment and completion of advance directives, is also discussed, as well as practical suggestions for the current and future uses for advance directives.

Familial complex chromosomal rearrangement resulting in duplication/deletion of 6q14 to 6q16

A familial complex chromosomal rearrangement (CCR) was ascertained through a mentally retarded, dysmorphic individual. Carriers of the CCR have the karyotype 46,XX or XY, t(6;15)(q16;q21), ins(3;6)(q12;q14q16), and malsegregation of the CCR resulted in loss of the segment 6q14 to 6q16 in the proband, and in an additional copy of the same segment in three members of the extended family. The proband has features similar to other reported cases with deletion of 6q1. The individuals with duplication of 6q14 to 6q16 have moderate mental retardation, short stature, obesity, microcephaly, brachycephaly, a short smooth philtrum, central hair whorl, simian creases, 5th finger brachydactyly and skeletal disproportion. In the 4-generation family, CCR carriers have a 20% empiric risk of phenotypically abnormal livebirths.

Complete heart block in the pediatric patient

Care for the pediatric patient with CHB focuses on signs and symptoms associated with respiratory failure and shock. Differences in size among pediatric patients--and in anatomy, physiology, and possible causes--should be considered. In children, cardiac arrest is usually secondary to respiratory arrest. Respiratory arrest should be anticipated in a pediatric patient with (1) decreased level of consciousness, (2) poor muscle tone, (3) increased respiratory rate or respiratory effort (nasal flaring, intercostal, subcostal, and suprasternal retractions); or (4) cyanosis. Shock is the failure of the cardiovascular system to perfuse vital organs adequately. Organ perfusion is determined by cardiac output, which in turn results from the heart rate times stroke volume. In CHB the slowing of heart rate can significantly decrease cardiac output, so the signs and symptoms of shock--especially level of consciousness, peripheral circulation, and blood pressure--must continually be reassessed.

Lipidic peptides. V: Penicillin and cephalosporin acid conjugates with increased lipophilic character

Lipophilic, double-ester derivatives of beta-lactam antibiotics with methylene, ethylene, and propylene spacers were prepared by crown-ether-assisted coupling of halogenoalkyl esters of 2-(tert-butoxycarbonylamino)decanoic acid to either penicillin G or cefuroxime. The hydroxyethyl ester of penicillin G and the tert-butoxypropyl ester of cefuroxime were also prepared. The lipophilic, double-ester conjugates, the hydroxyethyl ester of penicillin G, and the tert-butoxypropyl ester of cefuroxime showed weak or no antibiotic activity in vitro, as expected. The lipophilic penicillin G conjugates and the tert-butoxypropyl ester of cefuroxime were active in vivo against a nonpenicillinase-producing strain of Staphylococcus aureus after subcutaneous administration. The penicillin G double ester with propylene spacer and the tert-butoxypropyl ester of cefuroxime were inactive in vitro, a fact indicating that both compounds were hydrolyzed in vivo, as desired. After oral administration, the lipophilic, double-ester conjugate of penicillin G with methylene spacer and the tert-butoxypropyl ester of cefuroxime were active.

Cri du chat syndrome due to meiotic recombination in a pericentric inversion 5 carrier

A female infant presented at birth with hypotonia, growth retardation, distinctive facies, multiple congenital anomalies, and a high-pitched mewing cry characteristic of cri du chat syndrome. Chromosome studies from both peripheral blood and fibroblasts showed a 46,XX,5p- karyotype. Parental chromosome studies revealed that the mother carried an apparently balanced pericentric inversion of one chromosome no. 5, 46,XX,inv(5)(p14q35). Meiotic crossing-over in the mother within the inverted segment of chromosome 5 gave rise to the unbalanced karyotype, 46,XX,rec(5)dup q, inv(5)(p14q35)mat in the infant. A small terminal segment of the long arm of chromosome 5 (q35-pter) is duplicated with a deletion of the short arm of chromosome 5 (p14-pter), accounting for the features of cri du chat syndrome. Fewer than 1 in 200 of cri du chat syndrome cases are due to recombination aneusomy arising from a parental inversion of chromosome 5. Some of these cases, however, do not have typical cri du chat syndrome, reflecting significant duplication of 5q material. These cases are reviewed with the present case, and recombination behaviour leading to chromosome imbalance is discussed.

Canadian multicenter randomized clinical trial of chorion villus sampling and amniocentesis. chromosome mosaicism in CVS and amniocentesis samples

Data on 1040 chorionic villus and 969 amniotic fluid samples were collected from women studied in the Canadian Multicentre Randomized Clinical Trial of Chorion Villus Sampling and Amniocentesis. Cytogenetic results were obtained from 98.0 per cent of chorionic villus samples and from 99.9 per cent of amniotic fluid samples. Level I mosaicism (a single cell with an abnormal karyotype) occurred frequently in both chorionic villus and amniotic fluid samples and appeared to have no clinical significance. Level II mosaicism occurred in 0.9 per cent of CVS mesenchyme and 1.5 per cent of amniotic fluid cultures and in general was not perceived to be of sufficient concern to warrant cytogenetic follow-up studies. Level III mosaicism was reported in 18 CVS cases (15 cytotrophoblast, 1 mesenchyme, and 2 with both cell methods) and in one amniotic fluid case. In all cases but one (fetus with trisomy 18), level III mosaicism was confined to the placenta. Maternal cell contamination occurring with a frequency of 6.4 per cent in the mesenchyme analyses was a concern. This study supports the final report of the Canadian Multicentre Randomized Clinical Trial of Chorion Villus Sampling and Amniocentesis. Cytogenetic analysis of chorionic villus samples appears to be an acceptable alternative to the analysis of amniotic fluid samples. However, because of mosaicism and maternal cell contamination concerns, the examination of both cytotrophoblast preparations and mesenchyme cultures from chorionic villus samples is recommended.

A familial interstitial deletion of the long arm of chromosome 21

A mother and daughter with an interstitial deletion of the chromosome segment 21q11 to 21q21.3 have similar minor dysmorphism and mild mental retardation. These two patients are compared to others in the literature with deletion of the same region of chromosome 21. Molecular analysis of DNA from our patients localizes the DNA segments D21S1, D21S11, D21S8, and D21S22 within the deleted region.

Sex chromosome mosaicism not detected at amniocentesis

Amniocentesis was performed because of a fetal abdominal wall defect, and a 45,X karyotype was obtained. A near-normal male infant with no features of Turner syndrome was delivered. The karyotype of the infant was 45,X/46,X,dic(Y)(q11), with each of the cell lines present in approximately 50 per cent of the lymphocytes and fibroblasts examined.

Proteolytic activities of human Campylobacter pylori and ferret gastric Campylobacter-like organism

The levels of proteolytic activity in cell washes, lysates and pellets of C. pylori and gastric Campylobacter-like organisms isolated from humans and ferrets, respectively, have been studied using porcine mucus glycoprotein and bovine haemoglobin substrates. The total haemoglobin degrading activity, expressed by 10(12)-10(13) cfu of either organism, was no greater than 3 micrograms chymotrypsin equivalents. The mucolytic specific activity (rate of mucus peptide bond hydrolysis by bacterial protein) of the fractions tested from both organisms did not exceed 2nmol/min/mg protein. This value is 1000-fold lower than expected from published data. Electrophoretic profiles suggested that the mucolytic activity assessed by fluorimetry was insufficient to alter the quaternary structure of mucus and hence may not significantly contribute to the undermining of gastric mucus integrity.

An interstitial deletion of the long arm of chromosome 13

A case of an interstitial deletion of chromosome 13, identified as 46,XY,del(13)(q22q31), is reported in a child with psychomotor retardation, prominent low-set ears, epicanthus, hypertelorism, broad nasal bridge, hypoplastic fifth fingers and abnormal dermatoglyphics. This patient is compared to others in the literature with a similar deletion.

Basic cytogenetics for office practice

There is a wide range of clinical problems, from the relatively common to the extremely rare, that result from alterations in the chromosome complement. These numerical and structural abnormalities of the chromosomes can be detected readily by cell culture and analysis in the cytogenetics laboratory, and the chromosome complement is defined by means of a simple nomenclature. The family physician can expect to see patients with potential chromosome abnormalities from infancy to adulthood and may request that the appropriate cytogenetic investigation be undertaken. The diagnosis of chromosome disorders allows more accurate patient counselling and improved patient care.