Exploring Theater Neuroscience: Using Wearable Functional Near-infrared Spectroscopy to Measure the Sense of Self and Interpersonal Coordination in Professional Actors

Ecologically valid research and wearable brain imaging are increasingly important in cognitive neuroscience as they enable researchers to measure neural mechanisms of complex social behaviors in real-world environments. This article presents a proof of principle study that aims to push the limits of what wearable brain imaging can capture and find new ways to explore the neuroscience of acting. Specifically, we focus on how to build an interdisciplinary paradigm to investigate the effects of taking on a role on an actor's sense of self and present methods to quantify interpersonal coordination at different levels (brain, physiology, behavior) as pairs of actors rehearse an extract of a play prepared for live performance. Participants were six actors from Flute Theatre, rehearsing an extract from Shakespeare's A Midsummers Night's Dream. Sense of self was measured in terms of the response of the pFC to hearing one's own name (compared with another person's name). Interpersonal coordination was measured using wavelet coherence analysis of brain signals, heartbeats, breathing, and behavior. Findings show that it is possible to capture an actor's pFC response to their own name and that this response is suppressed when an actor rehearses a segment of the play. In addition, we found that it is possible to measure interpersonal synchrony across three modalities simultaneously. These methods open the way to new studies that can use wearable neuroimaging and hyperscanning to understand the neuroscience of social interaction and the complex social-emotional processes involved in theatrical training and performing theater.

POS0984 PREVALENCE OF axSpA IN PATIENTS TREATED FOR CHRONIC BACK PAIN IN CHIROPRACTIC CLINICS: THE OREGON CHIROPRACTIC AXIAL SPONDYLOARTHRITIS STUDY (ORCAS) – AN INTERIM ANALYSIS

Background

Non-rheumatology settings such as chiropractor clinics, where chronic back pain (CBP; including chronic back, buttock, or hip pain) patients are first seen, lack consistency in referral of patients to rheumatologists where the underlying cause may be axial spondyloarthritis (axSpA).

Objectives

Primary objective was to estimate the prevalence of axSpA in CBP patients attending four chiropractic clinics in Portland, Oregon, referred to a rheumatology clinic using a referral strategy identifying features of spondyloarthritis (SpA).

Methods

Adults attending one of four chiropractor clinics between Nov 2020 and Nov 2021 for CBP starting before age of 45, without prior diagnosis of SpA were eligible for inclusion. Patients were referred to rheumatologist for diagnostic assessment via phone consultation, if they had inflammatory back pain (IBP) and/or ≥1 of the following features: a family history of SpA, inflammatory bowel disease (IBD), psoriasis, good response to non-steroidal anti-inflammatory drugs, history of heel pain, uveitis, or joint swelling. The subsequent rheumatology assessment included history, C-reactive protein, HLA-B27, x-ray and MRI of the sacroiliac joints. Based on the assessment, patients were categorized as radiographic axSpA, non-radiographic axSpA, peripheral SpA, or no SpA. Endpoints were summarized using descriptive statistics.

Results

A total of 3,103 visits were recorded at four chiropractic offices between Nov 2020 and Nov 2021. Top ten chief complaints are presented in Figure 1. In total, 115 patients were referred by the chiropractors and 84 patients were confirmed to be eligible. Of the 74 patients who provided consent, 59 (79.7%) had IBP, and 66 (89.2%) had at least one clinical SpA feature. At interim data lock, 63 patients were fully assessed by a rheumatologist, of which 7 (11.1%) were HLA-B27 positive and 24 (38.1%) had rheumatologist-evaluated IBP. Eight (12.7%) patients had SpA, 6 (9.5%) were diagnosed as axSpA and fulfilled Assessment of Spondyloarthritis International Society (ASAS) classification criteria, 1 (1.6%) patient was diagnosed as psoriatic arthritis without imaging evidence of axial involvement and fulfilled Classification Criteria for Psoriatic Arthritis, and 1 (1.6%) had undifferentiated peripheral SpA and fulfilled ASAS Classification Criteria.

Figure 1.

Chief complaints reported by patients at chiropractor visits (n=3103)

Conclusion

More than 10% of patients attending chiropractic clinics for musculoskeletal complaints had undiagnosed SpA conditions, with axSpA being the most common. Educational efforts targeted at chiropractors to suspect and refer appropriate cases to rheumatologists are needed.

Table 1.

Demographic and clinical characteristics stratified by diagnosis as confirmed by Rheumatologist

Radiographic axSpA (N = 1)Non-radiographic axSpA (N = 5)Peripheral SpA Including PsA (N= 2)No SpA (N = 55)Age, years (Mean; SD)73 (-)36.8 (6.4)46 (1.4)45.1 (12.1)Sex, Female – n (%)04 (80.0)2 (100)32 (58.2)Family history of spondyloarthritis, Yes – n (%)01 (20.0)1 (50.0)9 (16.4)Chronic back pain duration, years (Mean; SD)49 (-)12.4 (6.0)11 (7.0)15 (10.8)Confirmed during rheumatology visit – n (%) IBP* (4 out of 5 criteria as checked by patient)1 (100)3 (60.0)1 (50.0)27 (49.1) IBP* (4 out of 5 criteria per rheumatologist’s opinion)02 (40.0)022 (40.0) History of plantar fasciitis or Achilles tendinitis04 (80.0)2 (100)14 (25.5) History of peripheral joint swelling001 (50.0)8 (14.6) Positive response to NSAIDs1 (100)1 (20.0)2 (100)21 (38.2) Psoriasis1 (100)01 (50.0)2 (3.6) Inflammatory bowel disease0001 (1.9) Uveitis0001 (1.8) HLA-B27 positive02 (40.0)1 (50.0)4 (7.3) CRP, Above 10.0 mg/L02 (40.0)1 (50.0)1 (1.8) SI Joints X-ray positive for sacroiliitis (modified New York criteria)1 (100)001 (1.8) SI Joints MRI positive for active inflammation1 (100)3 (60.0)00

*According to the Assessment of SpondyloArthritis international Society (ASAS) classification criteria for axSpA

Disclosure of Interests

Sonam Kiwalkar: None declared, Shireesh Bhalerao Consultant of: Eli Lilly and Company, Kim Phung Nguyen: None declared, Rose Quinn: None declared, Dave Perham: None declared, William Malatestinic Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Rebecca Bolce Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Theresa Hunter Employee of: Eli Lilly and Company, Pragya Khurana Consultant of: Eli Lilly and Company; ICON plc has received funding from several pharmaceutical companies involved in the marketing products for treatment of spondyloarthritis., Atul Deodhar Speakers bureau: Janssen, Novartis, Pfizer, UCB, Consultant of: AbbVie, Amgen, Aurinia, Bristol Myers Squibb, Celgene, Eli Lilly, Glaxo Smith & Kline, Janssen, MoonLake, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Bristol Myers Squibb, Celgene, Eli Lilly, Glaxo Smith & Kline, Novartis, Pfizer, UCB

TH-MYCN tumors, but not tumor-derived cell lines, are adrenergic lineage, GD2+, and responsive to anti-GD2 antibody therapy

Neuroblastoma is a commonly lethal solid tumor of childhood and intensive chemoradiotherapy treatment cures ~50% of children with high-risk disease. The addition of immunotherapy using dinutuximab, a monoclonal antibody directed against the GD2 disialoganglioside expressed on neuroblasts, improves survival when incorporated into front-line therapy and shows robust activity in regressing relapsed disease when combined with chemotherapy. Still, many children succumb to neuroblastoma progression despite receiving dinutuximab-based immunotherapy, and efforts to counteract the immune suppressive signals responsible are warranted. Animal models of human cancers provide useful platforms to study immunotherapies. TH-MYCN transgenic mice are immunocompetent and develop neuroblastomas at autochthonous sites due to enforced MYCN expression in developing neural crest tissues. However, GD2-directed immunotherapy in this model has been underutilized due to the prevailing notion that TH-MYCN neuroblasts express insufficient GD2 to be targeted. We demonstrate that neuroblasts in TH-MYCN-driven tumors express GD2 at levels comparable to human neuroblastomas but rapidly lose GD2 expression when explanted ex vivo to establish tumor cell lines. This occurs in association with a transition from an adrenergic to mesenchymal differentiation state. Importantly, not only is GD2 expression retained on tumors in situ, treatment with a murine anti-GD2 antibody, 14G2a, markedly extends survival in such mice, including durable complete responses. Tumors in 14G2a-treated mice have fewer macrophage and myeloid-derived suppressor cells in their tumor microenvironment. Our findings support the utility of this model to inform immunotherapy approaches for neuroblastoma and potential opportunities to investigate drivers of adrenergic to mesenchymal fate decisions.

nSARS-Cov-2, pulmonary edema and thrombosis: possible molecular insights using miRNA-gene circuits in regulatory networks

Background

Given the worldwide spread of the novel Severe Acute Respiratory Syndrome Coronavirus 2 (nSARS-CoV-2) infection pandemic situation, research to repurpose drugs, identify novel drug targets, vaccine candidates have created a new race to curb the disease. While the molecular signature of nSARS-CoV-2 is still under investigation, growing literature shows similarity among nSARS-CoV-2, pulmonary edema, and thromboembolic disorders due to common symptomatic features. A network medicine approach is used to to explore the molecular complexity of the disease and to uncover common molecular trajectories of edema and thrombosis with nSARS-CoV-2.

Results and conclusion

A comprehensive nSARS-CoV-2 responsive miRNA: Transcription Factor (TF): gene co-regulatory network was built using host-responsive miRNAs and it’s associated tripartite, Feed-Forward Loops (FFLs) regulatory circuits were identified. These regulatory circuits regulate signaling pathways like virus endocytosis, viral replication, inflammatory response, pulmonary vascularization, cell cycle control, virus spike protein stabilization, antigen presentation, etc. A unique miRNA-gene regulatory circuit containing a consortium of four hub FFL motifs is proposed to regulate the virus-endocytosis and antigen-presentation signaling pathways. These regulatory circuits also suggest potential correlations/similarity in the molecular mechanisms during nSARS-CoV-2 infection, pulmonary diseases and thromboembolic disorders and thus could pave way for repurposing of drugs. Some important miRNAs and genes have also been proposed as potential candidate markers. A detailed molecular snapshot of TGF signaling as the common pathway, that could play an important role in controlling common pathophysiologies among diseases, is also put forth.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s41544-020-00057-y.

Role of miRNAs in hypoxia-related disorders

Hypoxia is a complex pathophysiological condition. The physiological and molecular responses to this stress have been extensively studied. However, the management of its ill effects still poses a challenge to clinicians. MicroRNAs (miRNAs) are short non-coding RNA molecules that control post-transcriptional gene expression. The regulatory role of miRNAs in hypoxic environments has been studied in many hypoxia-related disorders, however a comprehensive compilation and analysis of all data and the significance of miRNAs in hypoxia adaption is still lacking. This review summarizes the miRNAs related to various hypoxia-related disorders and highlights the computational approaches to study them. This would help in designing novel strategies toward efficient management of hypoxia-related disorders.

Use of ADO II device in a large aorto-pulmonary collateral -an interesting case

A 11month old girl was diagnosed to have a large aorto pulmonary collateral during evaluation for respiratory distress and seizures. Echocardiographic evaluation showed a large collateral from the descending aorta to left lung with ventricular dysfunction (left ventricular ejection fraction of 40%). This was confirmed on computed tomography angiogram (CT) scan. The collateral was closed with Amplatzer Ductal Occluder II device under fluoroscopic guidance. To the best of our knowledge, this is the first reported case of large aorto-pulmonary collateral closed successfully with an Amplatzer Ductal Occluder II device.

A description of transversely isotropic sound absorbing porous materials by transfer matrices

A description of wave propagation in transversely isotropic porous materials saturated by air with a recent reformulation of the Biot theory is carried out. The description is performed in terms of a transfer matrix method (TMM). The anisotropy is taken into account in the mechanical parameters (elastic constants) and in the acoustical parameters (flow resistivity, tortuosity, and characteristic lengths). As an illustration, the normal surface impedance at normal and oblique incidences of transversely isotropic porous layers is predicted. Comparisons are performed with experimental results.

Mapping of a major QTL for pre-harvest sprouting tolerance on chromosome 3A in bread wheat

Quantitative trait loci (QTL) analysis was conducted for pre-harvest sprouting tolerance (PHST) in bread wheat for a solitary chromosome 3A, which was shown to be important for this trait in earlier studies. An inter-varietal mapping population in the form of recombinant inbred lines (RILs) developed from a cross between SPR8198 (a PHS tolerant genotype) and HD2329 (a PHS susceptible cultivar) was used for this purpose. The parents and the RIL population were grown in six different environments and the data on PHS were collected in each case. A framework linkage map of chromosome 3A with 13 markers was prepared and used for QTL analysis. A major QTL (QPhs.ccsu-3A.1) was detected on 3AL at a genetic distance of approximately 183 cM from centromere, the length of the map being 279.1 cM. The QTL explained 24.68% to 35.21% variation in individual environments and 78.03% of the variation across the environments (pooled data). The results of the present study are significant on two counts. Firstly, the detected QTL is a major QTL, explaining up to 78.03% of the variation and, secondly, the QTL showed up in all the six environments and also with the pooled data, which is rather rare in QTL analysis. The positive additive effects in the present study suggest that a superior allele of the QTL is available in the superior parent (SPR8198), which can be used for marker-aided selection for the transfer of this QTL allele to obtain PHS-tolerant progeny. It has also been shown that the red-coloured grain of PHS tolerant parent is not associated with the QTL for PHST identified during the present study, suggesting that PHS tolerant white-grained cultivars can be developed.

Structural characterization, expression analysis and evolution of the red/far-red sensing photoreceptor gene, phytochrome C (PHYC), localized on the 'B' genome of hexaploid wheat (Triticum aestivum L.)

Phytochromes are a family of red/far-red light perceiving photoreceptors. The monocot phytochrome family is represented by three members, PHYA, PHYB and PHYC. We have isolated and characterized the first PHY gene member (TaPHYC) from common wheat, Triticum aestivum var. CPAN1676. It codes for a species of the photoreceptor, phyC, which is known to be light-stable in all plants analyzed so far. A sequence of 7.2 kb has been determined, which includes 3.42 kb of coding region. This is the second full-length PHYC gene sequenced from a monocot (first was from rice). TaPHYC gene shares structural similarities with the rice PHYC containing four exons and three introns in the coding region. The 5' UTR is 1.0-kb-long and harbors an upstream open reading frame (URF) encoding 28 aa. Southern blot analysis of TaPHYC indicates that it represents single locus in the wheat genome, although the possibility of additional loci cannot be completely ruled out. Chromosomal localization using nullisomic-tetrasomic lines of Triticum aestivum var. Chinese Spring places TaPHYC on chromosome 4B. PHYC represents a constitutively expressed gene in all the organs tested and under light/dark conditions. However, PHYC was found to be developmentally regulated showing maximal expression in 3-day-old dark-grown seedlings, which declined thereafter. In silico analysis has also been done to compare TaPHYC gene with the partial sequences known from other wheat species and cultivars. The presence of a topoisomerase gene immediately downstream of the PHYC gene, both in rice and wheat genomes, presents yet another example of synteny in cereals and its possible significance has been discussed.

Investigation of the phase velocities of guided acoustic waves in soft porous layers

A new experimental method for measuring the phase velocities of guided acoustic waves in soft poroelastic or poroviscoelastic plates is proposed. The method is based on the generation of standing waves in the material and on the spatial Fourier transform of the displacement profile of the upper surface. The plate is glued on a rigid substrate so that it has a free upper surface and a nonmoving lower surface. The displacement is measured with a laser Doppler vibrometer along a line corresponding to the direction of propagation of plane surface waves. A continuous sine with varying frequencies was chosen as excitation signal to maximize the precision of the measurements. The spatial Fourier transform provides the wave numbers, and the phase velocities are obtained from the relationship between wave number and frequency. The phase velocities of several guided modes could be measured in a highly porous foam saturated by air. The modes were also studied theoretically and, from the theoretical results, the experimental results, and a fitting procedure, it was possible to determine the frequency behavior of the complex shear modulus and of the complex Poisson ratio from 200 Hz to 1.4 kHz, in a frequency range higher than the traditional methods.

Agrobacterium tumefaciens-mediated transformation of Indian mulberry, Morus indica cv. K2: a time-phased screening strategy

An efficient and reproducible protocol for the production of transgenic plants was developed for Morus indica cv. K2 by Agrobacterium tumefaciens-mediated transformation. The hypocotyls, cotyledon, leaf and leaf callus explants precultured for 5 days on regeneration medium were co-cultivated with a bacterial suspension at 10(9) cells/ml for 3 days in the dark. Infectivity of A. tumefaciens strain LBA4404 was more than that of strains GV2260 and A281, and among the various plasmids tried, pBI121 and pBI101:Act1 transformed nearly 100% of the explants followed closely by p35SGUSINT. About 90-100% of the explants tested positive in the beta-glucuronidase (GUS) histochemical assay performed after 3 days of co-cultivation. This high level of transient expression, however, decreased to 20-25% after 15 days. Gus activity was most stable in the callus explants, which emerged as the explant of choice for transformation. The transformed explants were selected on 50-75 mg/l kanamycin for 1 month, and 25-50% of the explants developed adventitious buds. On the basis of kanamycin-resistant shoots produced from the total number of explants inoculated, the transformation efficiency was 44%. After 1 month, 40% of these shoots displayed high gus activity as assessed by the GUS fluorometric assay. On a selection-free root induction medium, 80% of the shoots developed roots and 90% of the potted plantlets acclimatized to the growth room conditions. The 3-month-old regenerates showed gus and nptII(neomycin phosphotransferase II) gene activity as assayed by the GUS fluorometric assay and nptII enzyme assay, followed by PCR polymerase chain reaction (54.5%) analysis after 6-months. Transgene integration into the nuclear genome of 1-year-old regenerates was confirmed in 10 of the 18 transformants tested by Southern analysis. The transformation efficiency as defined by the number of transgenic plants produced from the total number of explants co-cultivated was 6%.

Regeneration from leaf protoplasts of Arabidopsis thaliana ecotype estland

Protoplasts (2 x 10(7)/g fresh wt) were isolated from leaves of A. thaliana ecotype estland, with a viability of more than 90%. Protoplasts cultured in calcium alginate beads or layers showed division while culture in liquid or agarose beads failed to elicit any division. Effect of culture density showed highest frequency of division occurring at 5 x 10(5) while no division was seen when cultured at a density of 5 x 10(4). Culture in MS medium resulted in higher division frequency and better sustenance of microcolonies as compared to B5 medium. Under optimized conditions, macrocolonies were formed at a frequency of 1.8%. Shoot regeneration was seen in 50% of microcalli transferred to shoot induction medium for regeneration. Shoots were rooted and plantlets transferred to pots. The plants produced flowers and were fertile.

Germins and germin like proteins: an overview

Molecular investigations during wheat germination have revealed unique developmentally regulated proteins, designated as germins, which show remarkable resistance to broad specificity proteases and to dissociation in SDS. Germins in cereals have an oxalate oxidase activity, which generates H2O2 from the oxidative breakdown of oxalate thereby playing a significant role in plant development and defense. Germin like proteins (GLPs) exhibit sequence and structural similarity with the cereal germins but mostly lack oxalate oxidase activity. Germins and germin like proteins (GLPs) are a class of developmentally regulated glycoproteins characterized by a beta-barrel core structure, a signal peptide, and are associated with the cell wall. GLPs exhibit a broad range of diversity in their occurrence and activity in organisms ranging from myxomycetes, bryophytes, pteridophytes, gymnosperms and angiosperms. Germins and GLPs are thought to play a significant role during zygotic and somatic embryogenesis (wheat and Pinus, respectively), salt stress (barley and Mesembryanthemum crystallinum), pathogen elicitation (wheat and barley), and heavy metal stress, etc. Characterization and cloning of some of the genes encoding germins and GLPs has facilitated a better understanding of their regulation and raised their potential of biotechnological application.

Teratomas in infancy and childhood

A 10-year-experience with 42 cases of teratomas in paediatric age group is presented. The commonest type of teratoma was sacrococcygeal followed by ovarian and retroperitoneal teratomas. An analysis of clinical profile, malignant potential, management, prognostic factors and follow up is discussed with review of literature.

Choledochal cyst: a 10-year experience

A retrospective study of 11 cases of choledochal cyst over a period of 10 years is presented. There were 8 females and 3 males in a ratio of 2.67:1. The classical triad of jaundice, mass and abdominal pain was seen in none of our patients. Ultrasonography was diagnostic in 9 out of 11 (80%) patients. Surgical procedures performed were, complete excision of the cyst with Roux en Y hepaticojejunostomy (nine cases), internal drainage of the cyst (one case) and excision of the extrahepatic cyst with Roux en Y hepaticojejunostomy in one case of Type IV choledochal cyst. One patient died in the immediate postoperative period. Others have remained well upto 10 years follow-up. We recommend total cyst excision with hepaticojejunostomy as the treatment of choice.

Reaction of human lungs to aspirated animal fat (ghee): a clinicopathological study

We report the clinical findings and pathological lung changes in four children following a cultural practice of forced feeding with animal fat (ghee) during infancy. The clinical presentation was of acute or chronic chest infection which failed to respond to antimicrobial therapy. The radiographic features ranged from extensive bronchopneumonia to collapse/consolidation and bronchiectasis. The light microscopy findings included diffuse mononuclear interstitial pneumonia, intraalveolar desquamation of pneumocytes, lipid granuloma formation, lung atelectasis and bronchiectasis. In the two children with longstanding reactions, the striking feature was the minimal lipid engulfment by the macrophages, the continuation of the mononuclear interstitial pneumonia, bronchiectasis and minimal lung fibrosis. In these two older children, the lung lymphatics were probably the main channels for drainage of the aspirated ghee.

Actinomycosis of the vallecula: report of a case and review of the literature

A rare case of actinomycosis presenting primarily as a mass in the vallecula is described. The patient was a healthy, 65-year-old Saudi, lady who was not immunocompromised and had no other primary pathology in the oral cavity. The clinical presentation and management of the case are discussed and the relevant literature reviewed.

Head and neck cancer in a referral center in Asir region

This study looks at the incidence of head and neck cancer in the Southwest Region of the Kingdom of Saudi Arabia (Asir Region). There were a total of 204 newly diagnosed patients seen at Asir Central Hospital between 1987 and 1992; 113 males and 91 females. All were Saudi patients. Frequency at various sites with reference to sex and age was determined and comparison with local and international published reports was made. To the best of our knowledge, this is the first paper in the Kingdom to look at head and neck cancer as a distinct entity. In this study, skin cancer was the most common among males followed by oral and pharyngeal cancers. Among females, thyroid cancer was the most common followed by skin and oral cancers. Some preventive measures are discussed.

Bilharzial and nonbilharzial bladder cancer in Asir: A comparative clinicopathological study

A total of 48 bladder cancer patients out of 96 consecutive genitourinary cancer cases were divided into bilharzial and nonbilharzial groups on a histological basis in order to investigate the impact of bilharziasis on tumor behavior. Despite being a bilharzial endemic area, only 10/48 (21%) of our patients had bilharzial cancer (BC) of whom 8 (80%) had squamous cell carcinoma (SCC) and 2 (20%) had adenocarcinoma. Out of 38 patients with nonbilharzial cancer (NBC), 35 (92%) had transitional cell carcinoma (TCC), and 3 (8%) had SCC. BC in males presented at a younger age than NBC (P<0.05). All ten patients with BC presented with deeply invasive (T3 and T4) tumors as compared to 22/38 (58%) with NBC (P<0.05). Comparison of clinical and laboratory features in both groups in both groups did not reveal any significant difference. We conclude that in the Asir region, TCC is the most common bladder cancer. However, with bilharziasis, bladder cancer tends to be of the squamous type and presents at an earlier age and at an advanced stage.

Rhinocerebral aspergillosis

Aspergillosis is increasingly being recognised as a common fungal infection of the paranasal sinuses. Although the disease is almost endemic in neighbouring Sudan, there are few reported cases from the Kingdom of Saudi Arabia. We report four cases of sinus aspergillosis with involvement of the skull bases and/or intracranial spread; a condition we have termed rhinocerebral aspergillosis. Invasive aspergillosis in our subgroup of patients occurs in otherwise healthy patients with normal immune status, quite unlike most reported cases in the western literature. The causative agent in all our patients was identified as aspergillus flavus, similar to patients reported from Sudan. This is again at variance with the case reports from other geographical locations, where aspergillus fumigatus is the commonest causative agent. Saudi Arabia would appear to represent a distinct geographical enclave, together with Sudan, where rhinocerebral aspergillosis of the sinuses and skull base may be more common than has previously been realised.

Impact of schistosomiasis on urinary bladder cancer in the southern province of Saudi Arabia: review of 60 cases

The histopathologic findings reported in 254 consecutive urinary bladder biopsies were reviewed. Evidence of urinary schistosomiasis was identified in 88 biopsies (35%) and malignant neoplasms were diagnosed in 60 cases (24%). Nine out of 60 (15%) cases of bladder cancer had urinary bladder schistosomiasis and the remaining 51 cases (85%) had no clinical evidence of schistosomiasis. Transitional cell carcinoma was the commonest type of urinary bladder cancer (70%) followed by squamous cell carcinoma (20%) adenocarcinoma (8%) and rhabdomyosarcoma (2%). The mean age of the patients included was 60 +/- 15 years and the male:female ratio was 9:1. Comparison of our findings to those reported from other provinces of Saudi Arabia and from other countries, including those with known high incidence of schistosomiasis, is included.

Embryonal rhabdomyosarcoma within a choledochal cyst

The authors describe a 6-year-old girl in whom they found an embryonal rhabdomyosarcoma in a choledochal cyst; they found no previous reports of such an association. The patient presented with recurrent jaundice and loss of weight and appetite. A large abdominal mass was palpable. Ultrasonography and computed tomography revealed a large subhepatic mass, which contained multiple septations and mural masses delineating cystic areas. The common hepatic duct opened directly into the mass, and the intrahepatic radicles were dilated. Intraoperative cholangiography revealed that the cysts in the mass were continuous with the hepatic and intrahepatic radicles. The mass was completely excised, and a Roux-en-Y hepaticojejunostomy was performed. Postoperative adjunct chemotherapy and radiotherapy were instituted.

Serum lactate dehydrogenase isoenzymes in breast tumours

Total serum LDH and its isoenzymes were estimated in 10 female controls and 30 cases of breast lump (22 malignant, 6 benign and 2 breast abscess). In breast malignancy, there was a significant elevation of total LDH and LDH-3, LDH-4 and LDH-5 isoenzymes with a significant fall in LDH-1 and LDH-2 percentage value. Following therapy, there was a significant elevation in LDH-1 and LDH-2 towards normal with a significant fall in total serum LDH and LDH-4 and LDH-5 isoenzymes. The estimation was found to be helpful in assessing the response of patient to the therapy given.