Genetics of phenological development and implications for seed yield in lentil

Understanding phenology, its genetics and agronomic consequences, is critical for crop adaptation. Here we aim at (1) characterising lentil response to photoperiod with a focus on five loci: the lentil ELF3 ortholog Sn, two loci linked to clusters of lentil FT orthologs and two loci without candidates in chromosomes 2 and 5 (exp. 1: 36 lines, short and long day in phytotron); (2) establishing phenology-yield relationship (exp. 2: 25 lines, 11 field environments). A vintage perspective, where we quantify time trends in phenotype over three decades of breeding, links both experiments. Yield increased linearly from older to newer varieties at 29 kg ha-1 yr-1 or 1.5% yr-1, correlated negatively with flowering time in both winter- and summer-rainfall regimes, and decoupled from biomass in favourable environments. Time to flowering shortened from older to newer varieties at -0.56 % yr-1 in the field, and -0.42 % yr-1 (short day) and -0.99 % yr-1 (long day) in the phytotron. Early-flowering lines of diverse origin carried multiple early alleles for the five loci, indicating that at least some of these loci affect phenology additively. Current germplasm primarily features the early flowering haplotype for an FTb cluster region, hence the potential to increase phenological diversity with yield implications.

Hypoxia stimulates angiogenesis and a metabolic switch in human parathyroid adenoma cells

Hypoxia, a primary stimulus for angiogenesis, is important for tumour proliferation and survival. The effects of hypoxia on parathyroid tumour cells, which may also be important for parathyroid autotransplantation in patients, are, however, unknown. We, therefore, assessed the effects of hypoxia on gene expression in parathyroid adenoma (PA) cells from patients with primary hyperparathyroidism. Cell suspensions from human PAs were cultured under normoxic or hypoxic conditions and then subjected to cDNA expression analysis. In total, 549 genes were significantly upregulated and 873 significantly downregulated. The most highly upregulated genes (carbonic anhydrase 9 (CA9), Solute carrier family 2A1 (SLC2A1) and hypoxia-inducible lipid droplet-associated protein (HIG2)) had known involvement in hypoxia responses. Dysregulation of oxidative phosphorylation and glycolysis pathway genes were also observed, consistent with data indicating that cells shift metabolic strategy of ATP production in hypoxic conditions and that tumour cells predominantly utilise anaerobic glycolysis for energy production. Proliferation- and angiogenesis-associated genes linked with growth factor signalling, such as mitogen-activated protein kinase kinase 1 (MAP2K1), Jun proto-oncogene (JUN) and ETS proto-oncogene 1 (ETS1), were increased, however, Ras association domain family member 1 (RASSF1), an inhibitor of proliferation was also upregulated, indicating these pathways are unlikely to be biased towards proliferation. Overall, there appeared to be a shift in growth factor signalling pathways from Jak-Stat and Ras signaling to extracellular signal-regulated kinases (ERKs) and hypoxia-inducible factor (HIF)-1α signalling. Thus, our data demonstrate that PAs, under hypoxic conditions, promote the expression of genes known to stimulate angiogenesis, as well as undergoing a metabolic switch.

What is Elective Oncologic Surgery in the Time of COVID-19? A Literature Review of the Impact of Surgical Delays on Outcomes in Patients with Cancer

Background

The impact of the COVID-19 pandemic has spread beyond those infected with SARS-CoV-2. Its widespread consequences have affected cancer patients whose surgeries may be delayed in order to minimize exposure and conserve resources.

Methods

Experts in each surgical oncology subspecialty were selected to perform a review of the relevant literature. Articles were obtained through PubMed searches in each cancer subtype using the following terms: delay to surgery, time to surgery, outcomes, and survival.

Results

Delays in surgery > 4 weeks in breast cancer, ductal carcinoma in situ, T1 pancreatic cancer, ovarian cancer, and pediatric osteosarcoma, negatively impacted survival. Studies on hepatocellular cancer, colon cancer, and melanoma (Stage I) demonstrated reduced survival with delays > 3 months.

Conclusion

Studies have shown that short-term surgical delays can result in negative impacts on patient outcomes in multiple cancer types as well as in situ carcinoma. Conversely, other cancers such as gastric cancer, advanced melanoma and pancreatic cancer, well-differentiated thyroid cancer, and several genitourinary cancers demonstrated no significant outcome differences with surgical delays.

SAT-436 Long-Term Analysis of Weight Change Following Thyroidectomy

Introduction: Weight gain is a common source of apprehension for patients undergoing thyroidectomy. However, contradictory reports exist regarding the presence and degree of weight gain following thyroid surgery and all known studies have short term follow-up This study evaluated weight changes following total thyroidectomy (TT) and lobectomy (L) over an extended time period. Methods: Retrospective analysis was performed of weight changes following surgery for patients who underwent TT or L (n=387) as compared with those undergoing parathyroidectomy for primary hyperparathyroidism (n=201) in a tertiary referral hospital between 2007-2012. Clinical, demographic and pre- and postoperative weight data was collected with a median follow-up of 55.6 months. Results: Postoperative weight change was observed at 1, 6, 12, and 36-months in patients who underwent TT (μ=+0.21kg, μ=+1.33kg, μ=+0.59kg, μ=+0.60kg; p<0.05) and at 6-months for patients who underwent L (μ=+0.93kg, p<0.05) compared with those who underwent parathyroidectomy. Patients having TT and L showed a general trend of weight gain compared to the control group up to 108-months post-operation; however, this weight gain was non-significant (p<0.05). Significant postoperative weight gain was observed in patients who had TT (1-month μ=+0.40kg, 6-months μ=+2.14kg, and 12-months μ=+1.40kg) and L (6-months μ=+1.04kg) for benign conditions compared with the parathyroidectomy group. Patients who had TT gained 0.40kg more than L patients at 12-months post-op (p<0.05), but no significant difference existed at other time points up to 108-months. Tukey HSD post-hoc analysis showed weight gain in benign, thyroiditis, and thyroid cancer patient groups was not significantly different from 6-months to 108-months post-operation. Furthermore, neither race nor sex was correlated with weight gain. Relative risks with 95% CI for weight gain following TT and L compared to control are: 1-month TT=1.74, 0.96-3.14, L=1.59, 0.58-2.58; 6-month TT=1.27, 0.85-1.89, L=1.42, 0.85-2.11; 12-month TT=1.44, 0.92-2.28, L=1.34, 0.86-2.36; 24-month TT=1.17, 0.82-1.67, L=1.22, 0.69-1.60. In the group of patients who gained greater than 2kg, those who underwent TT had significant weight increase compared to the parathyroidectomy group at 6-months postoperatively (Mann-Whitney U, p=0.011). In the subgroup of patients with weight gain greater than 2kg, those who had L did not have significant weight increase at any time point. Conclusion: Weight change following TT when compared with parathyroidectomy is significant shortly after surgery. However, these changes are not significant at long-term follow-up.

SUN-503 Thyroid Storm Followed by ATD Induced Agranulocytosis in Late Pregnancy: A Management Dilemma

Background:

Management of Graves’ disease (GD) in pregnancy presents challenges. Thionamide Antithyroid drugs are the treatment for GD hyperthyroidism with goal of achieving mild but persistent hyperthyroidism and avoiding over-treatment in pregnancy. ATD Induced Agranulocytosis is a rare but serous side effect and presents management dilemmas.

Clinical Case:

A 37-year-old woman with history of Graves’ disease was admitted to our hospital at gestational age of 34 weeks with fever, palpitations and diarrhea. Burch-Wartofsky Point Scale was 35 concerning for impending thyroid storm. She had been diagnosed with hyperthyroidism 6 weeks into her pregnancy, initially treated with PTU which was then changed to methimazole in 2nd trimester. A work up for infection and PE was negative. Non-compliance was suspected, methimazole was resumed, and hydrocortisone and propranolol were added. After 2 days, her vital signs and free hormone levels normalized. Her methimazole dose was decreased and she was discharged home in a stable condition.

Five days after her discharge, she presented with sore throat, fever and chills. She had an absolute neutrophil count (ANC) of 0 and a positive rapid strep test. ATD Induced Agranulocytosis was suspected. Her labs showed elevated fT3 of 4.5(nl 1.7–3.7), normal fT4 and suppressed TSH with <0.01(nl 0.3–4.9). A CT scan of the neck showed no evidence of retropharyngeal or thyroid abscess. Methimazole was stopped and she was started on glucocorticoids (initially betamethasone for fetal lung maturity, then switched to prednisone) and cholestyramine. She was also started on Cefepime and G-CSF for her neutropenia. A thyroid ultrasound showed enlarged and hypervascular gland. TSI was 157%(nl. <122%), and thyroglobulin 155 ng/ml (nl. <33 ng/ml). After 4 days, her ANC started to recover. Simultaneously, she started to show worsening thyrotoxicosis but remined hemodynamically stable. A decision to induce labor was then made and was successfully done on the 6^th day of her admission. Post-delivery, PTU was started at low dose along with SSKI to prepare her for total thyroidectomy which was done on day 3 post-delivery. Post-thyroidectomy, she had an uncomplicated course and was discharged on levothyroxine. Her child did well with no evidence of thyroid disease.

Conclusion:

We present a unique case of thyrotoxicosis in late pregnancy complicated by ATD Induced Agranulocytosis. Given the high risk of thyroid surgery during pregnancy, our multi-disciplinary team approach opted for labor induction, followed by preparation for thyroidectomy and subsequent surgery. Individualization of management approach using a multi-disciplinary team with emphasis on maternal and fetal well-being is of paramount importance with such challenging presentations.

MON-532 Characterization of the Angiogenic Factor SFRP2 in Papillary Thyroid Carcinoma

Over the last decade, there has been an average annual increase of 3.1% in thyroid cancer diagnosis in the U.S. Papillary thyroid carcinoma (PTC) accounts for 80% of all thyroid cancer diagnoses. However, few molecular markers exist to identify clinically aggressive phenotypes. The angiogenic factor, secreted frizzled-related protein 2 (SFRP2), is associated with a poor prognosis in several malignancies including breast cancer and melanoma. The role of SFRP2 in PTC has yet to be investigated. The aims of this study were to determine the differential expression of SFRP2 in PTC, benign thyroid adenomas, normal thyroid tissue (from patients without cancer), and normal adjacent tissue (NAT) (non-cancerous tissue from patients with PTC) and investigate the role of SFRP2 in tumor development in two PTC cell lines, PTC classical variant (PTC-CV) and PTC follicular variant (PTC-FV), upon treatment with a humanized anti-SFRP2 monoclonal antibody (hSFRP2 mAb). Immunohistochemistry (IHC) was performed using human tissue protein microarrays including 226 PTC, 79 benign adenomas, 112 NAT, and 30 normal thyroid tissue samples. In-vitro proliferation and apoptosis experiments were performed on MDA-T41 (PTC-CV) and MDA-T68 (PTC-FV) cell lines by treating with hSFRP2 mAb, Xolair IgG control, and a vehicle control. SFRP2 expression was significantly higher in PTC compared with benign adenomas and normal thyroid (mean expression scores 9, 6, and 1, respectively; p<0.05). SFRP2 expression was significantly higher in NAT than normal thyroid (mean expression score 4 and 0, respectively, p<0.05). Apoptotic rates were increased by 40% and 62% in the PTC-CV hSFRP2 mAb treatment group compared with the Xolair and vehicle treatment groups, respectively (p<0.05). Apoptotic rates were increased by 126% and 59% in the PTC-FV hSFRP2 mAb treatment group compared with the Xolair and vehicle treatment groups, respectively (p<0.05). Treatment with hSFRP2 mAb had no significant effect on proliferation in either cell line. In conclusion, SFRP2 expression is significantly higher in PTC than in benign adenomas and normal thyroid tissue. SFRP2 expression in NAT is significantly higher than in normal thyroid tissue and not significantly different from benign adenomas. SFRP2 expression in nonmalignant tissue adjacent to PTC could be due to expression in the tumor microenvironment. Treatment with a novel hSFPR2 mAb increases apoptotic rates in two different PTC cell lines. These data suggest that SFPR2 is involved in tumorigenesis of PTC.

Genetic background influences tumour development in heterozygous Men1 knockout mice

Multiple endocrine neoplasia type 1 (MEN1), an autosomal dominant disorder caused by MEN1 germline mutations, is characterised by parathyroid, pancreatic and pituitary tumours. MEN1 mutations also cause familial isolated primary hyperparathyroidism (FIHP), a milder condition causing hyperparathyroidism only. Identical mutations can cause either MEN1 or FIHP in different families, thereby implicating a role for genetic modifiers in altering phenotypic expression of tumours. We therefore investigated the effects of genetic background and potential for genetic modifiers on tumour development in adult Men1+/- mice, which develop tumours of the parathyroids, pancreatic islets, anterior pituitary, adrenal cortex and gonads, that had been backcrossed to generate C57BL/6 and 129S6/SvEv congenic strains. A total of 275 Men1+/- mice, aged 5-26 months were macroscopically studied, and this revealed that genetic background significantly influenced the development of pituitary, adrenal and ovarian tumours, which occurred in mice over 12 months of age and more frequently in C57BL/6 females, 129S6/SvEv males and 129S6/SvEv females, respectively. Moreover, pituitary and adrenal tumours developed earlier, in C57BL/6 males and 129S6/SvEv females, respectively, and pancreatic and testicular tumours developed earlier in 129S6/SvEv males. Furthermore, glucagon-positive staining pancreatic tumours occurred more frequently in 129S6/SvEv Men1+/- mice. Whole genome sequence analysis of 129S6/SvEv and C57BL/6 Men1+/- mice revealed >54,000 different variants in >300 genes. These included, Coq7, Dmpk, Ccne2, Kras, Wnt2b, Il3ra and Tnfrsf10a, and qRT-PCR analysis revealed that Kras was significantly higher in pituitaries of male 129S6/SvEv mice. Thus, our results demonstrate that Kras and other genes could represent possible genetic modifiers of Men1.

DNA Mismatch Repair Deficiency Promotes Genomic Instability in a Subset of Papillary Thyroid Cancers

BACKGROUND

Efficient DNA damage repair by MutL-homolog DNA mismatch repair (MMR) enzymes, MLH1, MLH3, PMS1 and PMS2, are required to maintain thyrocyte genomic integrity. We hypothesized that persistent oxidative stress and consequent transcriptional dysregulation observed in thyroid follicles will lead to MMR deficiency and potentiate papillary thyroid tumorigenesis.

METHODS

MMR gene expression was analyzed by targeted microarray in 18 papillary thyroid cancer (PTC), 9 paracarcinoma normal thyroid (PCNT) and 10 normal thyroid (NT) samples. The findings were validated by qRT-PCR, and in follicular thyroid cancers (FTC) and follicular thyroid adenomas (FTA) for comparison. FOXO transcription factor expression was also analyzed. Protein expression was assessed by immunohistochemistry. Genomic integrity was evaluated by whole-exome sequencing-derived read-depth analysis and Mann-Whitney U test. Clinical correlations were assessed using Fisher's exact and t tests.

RESULTS

Microarray and qRT-PCR revealed reduced expression of all four MMR genes in PTC compared with PCNT and of PMS2 compared with NT. FTC and FTA showed upregulation in MLH1, MLH3 and PMS2. PMS2 protein expression correlated with the mRNA expression pattern. FOXO1 showed lower expression in PMS2-deficient PTCs (log2-fold change -1.72 vs. -0.55, U = 11, p < 0.05 two-tailed). Rate of LOH, a measure of genomic instability, was higher in PMS2-deficient PTCs (median 3 and 1, respectively; U = 26, p < 0.05 two-tailed). No correlation was noted between MMR deficiency and clinical characteristics.

CONCLUSIONS

MMR deficiency, potentially promoted by FOXO1 suppression, may explain the etiology for PTC development in some patients. FTC and FTA retain MMR activity and are likely caused by a different tumorigenic pathway.

Epigenetic modifications in poorly differentiated and anaplastic thyroid cancer

Well-differentiated thyroid cancer accounts for the majority of endocrine malignancies and, in general, has an excellent prognosis. In contrast, the less common poorly differentiated thyroid carcinoma (PDTC) and anaplastic thyroid carcinoma (ATC) are two of the most aggressive human malignancies. Recently, there has been an increased focus on the epigenetic alterations underlying thyroid carcinogenesis, including those that drive PDTC and ATC. Dysregulated epigenetic candidates identified include the Aurora group, KMT2D, PTEN, RASSF1A, multiple non-coding RNAs (ncRNA), and the SWI/SNF chromatin-remodeling complex. A deeper understanding of the signaling pathways affected by epigenetic dysregulation may improve prognostic testing and support the advancement of thyroid-specific epigenetic therapies. This review outlines the current understanding of epigenetic alterations observed in PDTC and ATC and explores the potential for exploiting this understanding in developing novel therapeutic strategies.

Dissection of Levels II Through V Is Required for Optimal Outcomes in Patients with Lateral Neck Lymph Node Metastasis from Papillary Thyroid Carcinoma

BACKGROUND

Completeness of surgical resection is an important determinant of outcomes in patients with papillary thyroid carcinoma and regional lymph node metastasis. The extent of therapeutic lateral neck dissection remains controversial. This study aims to assess the impact of modified radical neck dissection of levels II to V in a large patient series.

STUDY DESIGN

Retrospective analysis of consecutive patients with papillary thyroid carcinoma who underwent lateral neck dissection at a single institution from June 1, 2006 to December 31, 2014 was performed.

RESULTS

A total of 241 lateral neck dissections were performed in 191 patients (118 [62%] women; median age 46 years [range 6 to 87 years]; median follow-up 14.3 months [range 0.1 to 107 months]). Overall, 202 initial neck dissections (195 modified radical neck dissections and 7 less extensive dissections) were performed. Among these initial dissections, 137 (68.8%), 132 (65.7%), 105 (52.0%), and 33 (16.9%) had positive lymph nodes in levels II, III, IV, and V, respectively. Ipsilateral lymph node persistence or recurrence occurred after 22 (10.9%) initial dissections, at level II in 10 (45.5%), level III in 8 (36.4%), level IV in 7 (31.8%), and level V in 3 (13.6%). Thirty-nine reoperative lateral neck dissection were performed, including 18 cases of persistence and recurrence after our initial dissections. In reoperative dissections, positive lymph nodes were confirmed in levels II, III, IV, and V in 18 (46.2%), 10 (25.6%), 13 (33.3%), and 5 (12.8%) dissections, respectively. Temporary nerve injury occurred in 6 (3.0%) initial and 4 (10.3%) reoperative dissections, respectively. There were no permanent nerve injuries.

CONCLUSIONS

Omitting levels II and V during lateral neck dissection for papillary thyroid carcinoma potentially misses level II disease in two-thirds of patients and level V disease in one-fifth of patients. Formal modified radical neck dissection is necessary to avoid the morbidity of reoperative surgery.

Proliferation rates of multiple endocrine neoplasia type 1 (MEN1)-associated tumors

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant disorder characterized by the combined occurrence of parathyroid and adrenocortical tumors, and neuroendocrine tumors (NETs) of the pancreas and pituitary. The pancreatic NETs are predominantly gastrinomas and insulinomas, and the pituitary NETs are mostly prolactinomas and somatotrophinomas. We postulated that the different types of pancreatic and pituitary NETs may be partly due to differences in their proliferation rates, and we therefore assessed these in MEN1-associated tumors and gonadal tumors that developed in mice deleted for an Men1 allele (Men1(+/-)). To label proliferating cells in vivo, Men1(+/-) and wild-type (Men1(+/+)) mice were given 5-bromo-2-deoxyuridine (BrdU) in drinking water from 1-12 wk, and tissue sections were immunostained using anti-BrdU and hormone-specific antibodies. Proliferation in the tumors of Men1(+/-) mice was significantly (P < 0.001) increased when compared with the corresponding normal Men1(+/+) tissues. Pancreatic, pituitary and adrenocortical proliferation fitted first- and second-order regression lines in Men1(+/+) tissues and Men1(+/-) tumors, respectively, R(2) = 0.999. Apoptosis was similar in Men1(+/-) pancreatic, pituitary, and parathyroid tumors when compared with corresponding normal tissues, decreased in Men1(+/-) adrenocortical tumors, but increased in Men1(+/-) gonadal tumors. Mathematical modeling of NET growth rates (proliferation minus apoptosis rates) predicted that in Men1(+/-) mice, only pancreatic β-cells, pituitary lactotrophs and somatotrophs could develop into tumors within a murine lifespan. Thus, our studies demonstrate that Men1(+/-) tumors have low proliferation rates (<2%), second-order kinetics, and the higher occurrence of insulinomas, prolactinomas, and somatotrophinomas in MEN1 is consistent with a mathematical model for NET proliferation.

MEN1 gene replacement therapy reduces proliferation rates in a mouse model of pituitary adenomas

Multiple endocrine neoplasia type 1 (MEN1) is characterized by the combined occurrence of pituitary, pancreatic, and parathyroid tumors showing loss of heterozygosity in the putative tumor suppressor gene MEN1. This gene encodes the protein menin, the overexpression of which inhibits cell proliferation in vitro. In this study, we conducted a preclinical evaluation of MEN1 gene therapy in pituitary tumors of Men1(+/-) mice, using a recombinant nonreplicating adenoviral serotype 5 vector that contained the murine Men1 cDNA under control of a cytomegalovirus promoter (Men1.rAd5). Pituitary tumors in 55 Men1(+/-) female mice received a transauricular intratumoral injection of Men1.rAd5 or control treatments, followed by 5-bromo-2-deoxyuridine (BrdUrd) in drinking water for four weeks before magnetic resonance imaging (MRI) and immunohistochemical analysis. Immediate procedure-related and 4-week mortalities were similar in all groups, indicating that the adenoviral gene therapy was not associated with a higher mortality. Menin expression was higher in the Men1.rAd5-treated mice when compared with other groups. Daily proliferation rates assessed by BrdUrd incorporation were reduced significantly in Men1.rAd5-injected tumors relative to control-treated tumors. In contrast, apoptotic rates, immune T-cell response, and tumor volumes remained similar in all groups. Our findings establish that MEN1 gene replacement therapy can generate menin expression in pituitary tumors, and significantly reduce tumor cell proliferation.

An assessment of between-recti distance and divarication in patients with and without abdominal aortic aneurysm

INTRODUCTION

The study assessed whether there is a greater incidence of divarication of the recti and whether between-recti distance is greater in patients with abdominal aortic aneurysm (AAA).

PATIENTS AND METHODS

The study consisted of two parts: a radiological and a clinical assessment. All patients with a confirmed AAA on computerised tomography were included and compared with patients in whom AAA was excluded with imaging. Between-recti distance was measured using a computerised image viewer and clinical divarication was assessed by a surgical registrar or consultant.

RESULTS

In the radiological part of the study, 108 patients with AAA were compared with 84 with colorectal cancer. Median between-recti distance was 38 mm (range, 25-59 mm) in the AAA group and 27 mm (range, 20-44.5 mm) in the non-AAA group (P=0.006). AAA diameter did not correlate with between-recti distance. The clinical study included 50 patients (25 AAA). The groups were well matched, with only a greater incidence of diabetes in the AAA group (20% vs 0%; P=0.018). AAA patients were more likely to have clinically detected divarication of the recti (76% vs 36%; P=0.004).

CONCLUSIONS

Patients with AAA have greater radiological and clinical evidence of divarication. It is suggested that patients with divarication be screened for AAA.

A meta-analysis of 21 178 patients undergoing open or endovascular repair of abdominal aortic aneurysm

Background

Several studies have compared outcomes after elective open and endovascular approaches to abdominal aortic aneurysm (AAA) surgery, with varying results.

Methods

A random-effects meta-analysis was undertaken to compare operative outcomes, postoperative complications, 30-day mortality and long-term patient survival after surgery. Endpoints were compared using odds ratios (ORs), weighted mean differences (WMDs) or log hazard ratios (HRs) as appropriate.

Results

Forty-two studies comprising 21 178 patients (10 855 open; 10 323 endovascular) were included. In the elective setting (20 715 patients), the endovascular method was associated with a shorter stay in intensive care (WMD − 36 h; P &lt; 0·001) and a shorter total postoperative stay (WMD − 5·4 days; P &lt; 0·001). Cardiac (OR 1·76; P = 0·002) and respiratory (OR 4·01; P &lt; 0·001) complications were more common after open surgery. In the endovascular group, 30-day mortality was lower (OR 0·46; P &lt; 0·001). Endovascular surgery was also associated with an improved long-term aneurysm-related mortality (HR 0·39; P &lt; 0·001). For ruptured AAA (463 patients), the less invasive operation was associated with a reduced stay in intensive care (WMD − 100·4 h; P = 0·005) and a significantly lower 30-day mortality (OR 0·45; P = 0·005).

Conclusions

The endovascular repair of AAA offers a clear benefit in terms of reduction in postoperative adverse events and 30-day mortality. In the longer term, it is also associated with a reduction in aneurysm-related mortality, but not in all-cause mortality.

The mechanisms of Ni2+ ions sorption by AlPO4

Sorption of Ni2+ ions by AlPO4 is studied as a function of concentrations and temperature at pH 7. Potentiometric titration, dissolution and FTIR studies are employed to determine the mechanism of the process of the uptake of Ni2+ ions which is found to be both the ion exchange and the surface precipitation of the corresponding metal phosphates. Freundlich equation is found applicable to the sorption data, and is employed to evaluate the thermodynamic parameters deltaH(o) and deltatS(o).

Sorption mechanism of Co2+ ions by AlPO4

Sorption studies were conducted for Co2+ ions on AlPO4 at different concentrations and temperatures. Sorption of Co2+ was found to increase with increase in concentration and temperature. To determine the mechanism of the sorption process, dissolution of AlPO4 in the presence of Co2+ ions and desorption studies were performed which indicated the mechanism of sorption to be the ion exchange followed by precipitation. FTIR studies were also employed to confirm the proposed mechanism.

Activation of cerebellar climbing fibres to rat cerebellar posterior lobe from motor cortical output pathways

1. The activation of climbing fibres projecting to the posterior lobe cerebellar cortex by focal stimulation of the cerebral corticofugal pathway was investigated in anaesthetised rats. Large climbing fibre responses were evoked in parts of crus II and paramedian lobule by stimulation of corticofugal fibres. Lesions of the pyramidal tract just rostral to the inferior olive substantially reduced these responses, suggesting that they were not mediated by relays in the rostral brainstem. 2. By comparison of latencies of climbing fibre responses evoked from different locations in the corticofugal pathway, the conduction velocities of the corticofugal fibres that mediate the responses were estimated to be 1.9 +/- 0.3 m s(-1) (mean +/- S.E.M.). The fastest conducting corticofugal fibres were estimated to conduct significantly faster (18.7 +/- 2.3 m s(-1)). 3. Climbing fibre responses with similar form and cerebellar distribution were evoked from sites in the pyramidal tract rostral and caudal to the inferior olive. This suggests that at least a proportion of the fibres that activate climbing fibres are corticospinal fibres. 4. Lesions of the dorsal column nuclei did not affect the climbing fibre responses evoked in crus II, and produced a relatively small reduction of the responses in the paramedian lobule. This implies that the climbing fibre responses were not exclusively mediated via the dorsal column nuclei. 5. Corticofugal evoked climbing fibre responses were mapped across the cerebellar hemisphere. At some sites they were co-localised with responses evoked by limb afferents. On the basis of limb afferent inputs and other work, these zones were tentatively identified as being functionally equivalent to the c1, c2 and d zones described in the cat.

Abductor paralysis and external oblique transfer

Eighteen patients with hip abductor paralysis owing to poliomyelitis underwent external oblique muscle transfer. Five male and 13 female patients with a mean age of 15 years 5 months (range, 10-23 years) with an average follow-up of 5 years (range, 2-11 years) were studied. An improvement in gait with decreased limp and swaying and increased ability to walk long distances was seen in 17 patients. Nine patients became free of their assistive ambulatory devices. Subjective improvement was observed in 16 patients (the improved appearance being the main element of satisfaction). According to a detailed scoring system, six excellent, six good, three fair, and three poor results were identified. There was very good correlation between the scoring system and the final outcome, making it a valuable predictive point system. The transfer was suitable for flail lower limb as well.

Ilizarov lengthening in centralized fibula

Tibial hemimelia often produces major limb length problems (1,6,9,15) as well as foot deformity. The decision to perform reconstructive surgery depends on the expected leg-length discrepancy, the anomalies of the foot, and the status of the knee (4,6,8,15). Congenital bone deficiencies usually have a constant rate of growth inhibition (8), and leg lengthening is often associated with more complications (5,13). The complication rate is also increased with the increased leg-length discrepancy (5). In tibial hemimelia with functioning quadriceps (types I and II) and a functional foot, centralization of the fibula onto the talus and synostosis with the proximal tibia is an accepted reconstructive procedure (1,4,6,7,9,15). However, when the transplanted fibula produces a functional limb for the patient, the correction of leg-length inequality would be a challenge. This is a report of such a case.

Hamstring tendon transfer for quadriceps femoris paralysis

Fifteen cases of paralysis of the quadriceps muscles secondary to poliomyelitis were managed by hamstring tendon transfers with an average follow-up of 48 months. Results of 13.5% excellent, 73% good, and 13.5% fair were obtained, according to an objective scoring system. Significant improvement in gait pattern, relief from brace use, or "hand-on-thigh" ambulation was seen in all cases. A mean extension lag of 30 degrees was observed in patients examined in the sitting position. Lack of active terminal knee flexion, prohibiting comfortable floor sitting, was the main untoward effect and the source of complaint in four patients.

Four brief reports on long-term results of intradiscal chymopapain

Five- to 12-year statistics for 842 patients treated with intradiscal chymopapain are presented by four observers. While the results are presented in different formats, long-term satisfactory results can be reported for 81% of the patients, with a range of 71%-83%.

Nonsurgical management of spontaneous intracerebral hematoma

This report describes our experience with the use of osmotic diuretics, governed by continuous monitoring of intracranial pressure (ICP), as the primary treatment for 12 consecutive patients suffering from an acute, supratentorial intracerebral hematoma. In all cases the hematoma, as shown by computed tomographic scan, had a long axis of greater than 4.0 cm. ICP and cerebral perfusion pressure were successfully maintained within the assigned limits in all patients, and in none was surgical evacuation required. There was one death during the 6-month follow-up period. With appropriate weighting to differences in admission status, statistical comparison of the patient outcome in the present series with that reported by McKissock et al. suggests that ICP monitoring can improve the outcome of conservatively (and perhaps surgically) treated patients.

Clinical applications of computerized fluoroscopy: the extracranial carotid arteries

Preliminary results obtained with a new computerized fluoroscopic apparatus in examination of the extracranial carotid arteries are described. All patients had clinical signs of symptoms of extracranial occlusive vascular disease. In most cases, image quality was sufficient to display patency of the internal carotid arteries, with excellent correlation between intravenous and conventional angiography. While the new technique is not totally noninvasive, it does eliminate many of the risks and costs of conventional arteriography.

Office treatment of craniocerebral trauma

The first physician to see a victim of craniocerebral trauma must provide necessary first aid and then rapidly assess the type and extent of injury. The level of consciousness is the most important guide to severity of injury, and frequent appraisal is essential until the critical period is determined to have passed.

Proteins from human cerebrospinal fluid: binding with nucleic acids

Cerebrospinal fluid (CSF) contains two groups of proteins that bind tightly to DNA and to polyriboguanylic acid, respectively. In certain diseases the amounts of a given nucleic acid bound by a constant volume of CSF may increase, while in others the amount of such proteins may be reduced. Binding of polyriboguanylic acid increased in CSF samples from patients with brain tumors, stroke, multiple sclerosis, and communicating hydrocephalus, but it significantly decreased in CSF samples from patients with obstructive hydrocephalus. These increases may or may not be proportional to the rise in total CSF proteins characteristic for these diseases. Elevated binding of DNA was observed in samples from patients with hydrocephalus, epilepsy, and cortical atrophy. The technique described may be applicable to the diagnosis of a variety of diseases of the central nervous system.