In Vivo Measurements of Fibrin Formation and Fibrinolysis in Operable Breast Cancer

Fibrin formation and fibrinolysis were estimated in 89 breast cancer patients by measurement in plasma of Fibrin Fragment Bβ 15-42 and Fibrinopeptide A (FPA), serum Fibrin(ogen) Degradation Products (FDPs) and plasminogen activator by Fibrin Plate Lysis Assay. Results were compared with (a) 26 patients with benign breast diseases; and (b) 45 healthy factory workers. FPA, FDP and Bβ 15-42 Levels were elevated in both breast cancer patients and benign disease patients, but there were no significant differences between these two groups. Cancer stage, patient age and smoking habits did not affect these results, but Oestrogen Receptor (ER) positive patients had higher Bβ 15-42 values than ER negative patients (p = 0.017). These results show that fibrin formation is enhanced preoperatively in patients with either benign or malignant breast disease. The fibrinolytic response to activated coagulation may be relatively deficient in breast cancer. The roles of malignancy, stress and other factors in the causation of these abnormalities require further assessment.

Spring fire effects on two Aristida/Bothriochloa native pastures in central Queensland, Australia

Controlled burns are commonly used to suppress woody plant regrowth and to remove accumulated unpalatable pasture from rangelands and occasionally to alter pasture composition in native pastures in central Queensland, Australia. Outcomes can be somewhat unpredictable and short-term, and reliable evidence is needed to confirm the likely long-term efficacy of such fires. We imposed a regime of repeated spring burns on native Aristida/Bothriochloa pastures growing in two contrasting eucalypt woodlands of central Queensland to determine the effects on pasture composition, ground cover, landscape stability and woody plant recruitment, all in the absence of grazing. The sites selected were a silver-leaved ironbark (Eucalyptus melanophloia F.Muell.) woodland and a poplar box (E. populnea F.Muell.) woodland. Weather conditions precluded spring burns in 3 years out of 7 at the silver-leaved ironbark site and in 2 years out of 8 at the poplar box site. The burn intensity was variable, and frequent fires produced a marked change in abundance of only a few pasture species. Depending on the site, fires significantly increased the frequency of Enneapogon spp., Bothriochloa bladhii (Retz.) S.T.Blake and Dichanthium sericeum (R.Br.) A.Camus and reduced the frequency of some minor components such as Cymbopogon spp., Panicum effusum R.Br., Cenchrus ciliaris L. and, ephemerally, that of some forbs. Contrary to expectation, only Aristida calycina R.Br. declined in abundance among the many Aristida species present, and the abundance of Heteropogon contortus (L.) P.Beauv. ex Roem. & Schult. barely increased under regular spring fires. The total germinable seeds of herbaceous species in the soil each spring was significantly reduced by burning in the previous spring. Repeated spring fires rarely reinforced any initial change induced by burning, and slightly lowered average ground cover as well as various indices of landscape stability and ecosystem functionality. Changes produced were not always consistent across the two communities. Though prescribed burning is often important for maintaining grazing productivity and landscape values, very regular use is not recommended.

De novo loss of function mutations in KIAA2022 are associated with epilepsy and neurodevelopmental delay in females

Intellectual disability (ID) affects about 3% of the population and has a male gender bias. Of at least 700 genes currently linked to ID, more than 100 have been identified on the X chromosome, including KIAA2022. KIAA2022 is located on Xq13.3 and is expressed in the developing brain. The protein product of KIAA2022, X‐linked Intellectual Disability Protein Related to Neurite Extension (XPN), is developmentally regulated and is involved in neuronal migration and cell adhesion. The clinical manifestations of loss‐of‐function KIAA2022 mutations have been described previously in 15 males, born from unaffected carrier mothers, but few females. Using whole‐exome sequencing, we identified a cohort of five unrelated female patients with de novo probably gene damaging variants in KIAA2022 and core phenotypic features of ID, developmental delay, epilepsy refractory to treatment, and impaired language, of similar severity as reported for male counterparts. This study supports KIAA2022 as a novel cause of X‐linked dominant ID, and broadens the phenotype for KIAA2022 mutations.

First report of monomicrobial Candida parapsilosis necrotizing fasciitis

Candida parapsilosis is an emerging pathogen worldwide. It commonly causes soft tissue infection; however, to our knowledge there has been no previous report of monomicrobial necrotizing soft tissue infection (NSTI) secondary to C. parapsilosis. We report the first case of NSTI caused by C. parapsilosis in an immunocompromised renal transplant patient, with the diagnosis proven both histologically and microbiologically. Our patient required aggressive surgical intervention and antifungal therapy, with postoperative survival at 90 days.

Culture-negative Bartonella endocarditis in a patient with renal failure: the value of molecular methods in diagnosis

Members of the genus Bartonella are increasingly recognised as a cause of culture-negative endocarditis, particularly in those patients with underlying risk factors (e.g., homelessness and alcoholism (B. quintana) or valvulopathy and cat ownership (B. henselae). The aortic and mitral-valves are most commonly involved. Here, a case is reported of culture-negative right-sided endocarditis, without any of the above risk factors, due to Bartonella sp. in a 69-year-old man who presented with acute renal failure. The diagnosis was made using a broad-range 16S rRNA polymerase chain reaction (PCR) technique and direct automated sequencing on a peripheral blood sample, which was subsequently confirmed serologically. A review of the literature on Bartonella endocarditis is also presented. Molecular laboratory methods using peripheral blood or blood cultures may be very useful in the diagnosis of causal agents in culture-negative endocarditis and add further support to the recently inclusion of molecular (PCR) diagnosis, as a major Duke's criterion, for the diagnosis of infective endocarditis.

Assessment of recurrent laryngeal nerve function during thyroid surgery

INTRODUCTION

There is disparity in the reported incidence of temporary and permanent recurrent laryngeal nerve (RLN) palsy following thyroidectomy. Much of the disparity is due to the method of assessing vocal cord function. We sought to identify the incidence and natural history of temporary and permanent vocal cord palsy following thyroid surgery. The authors wanted to establish whether intraoperative nerve monitoring and stimulation aids in prognosis when managing vocal cord palsy.

METHODS

Prospective data on consecutive thyroid operations were collected. Intraoperative nerve monitoring and stimulation, using an endotracheal tube mounted device, was performed in all cases. Endoscopic examination of the larynx was performed on the first postoperative day and at three weeks.

RESULTS

Data on 102 patients and 123 nerves were collated. Temporary and permanent RLN palsy rates were 6.1% and 1.7%. Most RLN palsies were identified on the first postoperative day with all recognised at the three-week review. No preoperative clinical risk factors were identified. Although dysphonia at the three-week follow-up visit was the only significant predictor of vocal cord palsy, only two-thirds of patients with cord palsies were dysphonic. Intraoperative nerve monitoring and stimulation did not predict outcome in terms of vocal cord function.

CONCLUSIONS

Temporary nerve palsy rates were consistent with other series where direct laryngoscopy is used to assess laryngeal function. Direct laryngoscopy is the only reliable measure of cord function, with intraoperative monitoring being neither a reliable predictor of cord function nor a predictor of eventual laryngeal function. The fact that all temporary palsies recovered within four months has implications for staged procedures.

Serum total hCGβ level is an independent prognostic factor in transitional cell carcinoma of the urothelial tract

Background:

Serum total human chorionic gonadotrophin β subunit (hCGβ) level might have prognostic value in urothelial transitional cell carcinoma (TCC) but has not been investigated for independence from other prognostic variables.

Methods:

We utilised a clinical database of patients receiving chemotherapy between 2005 and 2011 for urothelial TCC and an independent cohort of radical cystectomy patients for validation purposes. Prognostic variables were tested by univariate Kaplan–Meier analyses and log-rank tests. Statistically significant variables were then assessed by multivariate Cox regression. Total hCGβ level was dichotomised at < vs ⩾2 IU l⁻¹.

Results:

A total of 235 chemotherapy patients were eligible. For neoadjuvant chemotherapy, established prognostic factors including low ECOG performance status, normal haemoglobin, lower T stage and suitability for cisplatin-based chemotherapy were associated with favourable survival in univariate analyses. In addition, low hCGβ level was favourable when assessed either before (median survival not reached vs 1.86 years, P=0.001) or on completion of chemotherapy (4.27 vs 0.42 years, P=0.000002). This was confirmed in multivariate analyses and in patients receiving first- and second-line palliative chemotherapy, and in a radical cystectomy validation set.

Conclusions:

Serum total hCGβ level is an independent prognostic factor in patients receiving chemotherapy for urothelial TCC in both curative and palliative settings.

Wing shape and size of the western corn rootworm (Coleoptera: Chrysomelidae) is related to sex and resistance to soybean-maize crop rotation

The western corn rootworm, Diabrotica virgifera virgifera LeConte, is a major pest of maize in the United States and more recently, Europe. Understanding the dispersal dynamics of this species will provide crucial information for its management. This study used geometric morphometric analysis of hind wing venation based on 13 landmarks in 223 specimens from nine locations in Illinois, Nebraska, Iowa, and Missouri, to assess whether wing shape and size differed between rotated and continuously grown maize where crop rotation-resistant and susceptible individuals are found, respectively. Before assessing differences between rotation-resistant and susceptible individuals, sexual dimorphism was investigated. No significant difference in wing (centroid) size was found between males and females; however, females had significantly different shaped (more elongated) wings compared with males. Wing shape and (centroid) size were significantly larger among individuals from rotated maize where crop-rotation resistance was reported; however, cross-validation of these results revealed that collection site resistance status was an only better than average predictor of shape in males and females. This study provides preliminary evidence of wing shape and size differences in D. v. virgifera from rotated versus continuous maize. Further study is needed to confirm whether wing shape and size can be used to track the movement of rotation-resistant individuals and populations as a means to better inform management strategies.