Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

Imaging of the temporomandibular joint

Temporomandibular disorders are common, especially in young to middle-aged women, and most settle with supportive treatment. Imaging is indicated for the small percentage of cases that do not respond to conservative management and when the diagnosis is no doubt. The temporomandibular joint (TMJ) is a bilateral synovial articulation between the mandible and skull base. It has an intra-articular disc dividing the joint into superior and inferior compartments and the articular surfaces are lined with fibrocartilage. The normal imaging anatomy of the TMJ is described and illustrated. Different movements occur in each joint compartments: a hinge movement in the inferior joint space and translation or gliding in the superior joint space. Internal derangement is the commonest disorder affecting the TMJ and is most commonly due to disc displacement, followed by osteoarthritis and inflammatory arthritides. The imaging findings, primarily on magnetic resonance imaging (MRI) and computed tomography (CT), of internal derangement and less common disorders of the joint, are reviewed and illustrated. Optimal imaging protocols are discussed with detailed reporting guidelines.

The many faces of periapical inflammation

Dental periapical inflammation is common and can present with a wide variety of symptoms and signs. These include jaw pain and local soft-tissue inflammation, which may be obviously dental in origin; however, the presentation may also be with a painless mass or draining cutaneous sinus, with facial or ear pain or with symptoms of sinusitis, when the dental cause is not clinically obvious. Radiologists are often the first to recognise the dental source of symptoms in these cases. This recognition requires an awareness of the varied manifestations of periapical sepsis and careful systematic review of the teeth and jaws. The causative periapical lesion may be small and subtle, and there is not always a macroscopic defect in the cortical bone between the lesion and surrounding soft-tissue inflammation. The origin of the referral and the initial imaging technique used can vary. Dental periapical inflammation can also be an incidental finding on imaging. In these cases, it should not be mistaken for more sinister pathology and its presence should be conveyed to the referrer so that appropriate dental treatment can be initiated: this is especially important in patients with malignancy in whom radiotherapy is planned. In cases of severe odontogenic soft-tissue sepsis, a review of the airway and major blood vessels is important. We present cases to illustrate the wide range of clinical and radiological manifestations of periapical inflammatory pathology.

Imaging of sleep-disordered breathing in adults

Sleep-disordered breathing (SDB) is a term that includes several chronic conditions in which partial or complete cessation of breathing occurs multiple times throughout the night. Central sleep apnoea (CSA) is uncommon and defined by the episodic cessation of airflow without respiratory effort. Lesions involving the respiratory centre in the brainstem or the origin of the phrenic nerve from the mid-cervical cord are the commonest structural causes of CSA; magnetic resonance imaging (MRI) will demonstrate the lesion and frequently suggest the likely aetiology. In contrast, obstructive sleep apnoea (OSA) is defined as upper airway obstruction despite ongoing respiratory effort. Repetitive episodes of narrowing or closure of the upper airway are the predominant cause leading to snoring and OSA, respectively. OSA affects 33-40% of the adult population and is associated with multiple adverse health consequences, including a significantly increased risk of serious morbidity and mortality. The incidence is increasing proportionally to the worldwide rise in obesity. Imaging, performed primarily without the involvement of radiologists, has been integral to understanding the anatomical basis of SDB and especially OSA. This article will review the pathophysiology, imaging findings, and sequelae of these common conditions. The role of imaging both in suggesting the incidental diagnoses of SDB and in the investigation of these conditions when the diagnosis is suspected or has been established are also discussed.

Imaging of adult nasal obstruction

The commonest causes of nasal obstruction are rhinitis and chronic rhinosinusitis, which affect up to 30% and 14% of the adult population, respectively. The global financial burden is huge, estimated at $5 billion for rhinitis and $8.6 billion for chronic rhinosinusitis per annum in the USA. On referral for imaging, computed tomography (CT) is indicated initially when there is a suboptimal response to medical treatment of these mucosal diseases or there are "red flags," such as persistent unilateral obstruction, epistaxis, pain, and orbital or neurological symptoms. A mass visible at rhinoscopy or endoscopy in the nose or nasopharynx and lymphadenopathy are further indications. The anterior (cartilaginous) nose plays a key role in the aetiology of nasal obstruction as it accounts for 50-75% of the total resistance to airflow in the upper airway. It has been ignored in the imaging literature, but extensively evaluated by clinicians using a range of methods, including CT. Oblique reconstructions perpendicular to the parabolic curve of lamellar airflow provide accurate assessment of the anterior nose. A thorough and systematic approach to assessing the nose addresses the discrepancy between imaging and clinical evaluation of structural causes of nasal obstruction, especially septal deviation, reported in the surgical literature. Nasal tumours are a very uncommon cause of nasal obstruction; magnetic resonance imaging is commonly performed to assess their full extent and improve the specificity of diagnosis.

Imaging of odontogenic sinusitis

The aetiological relationship between dental disease and procedures and mucosal disease within the maxillary sinus has received extensive attention in the recent otolaryngological and dental literature. In contrast, the concept of an odontogenic cause for sinusitis is not well appreciated by radiologists. Review of the maxillary dentition, the alveolar process, and the relationship of the tooth roots to the floor of the maxillary sinus should be an integral part of interpretation of imaging of the paranasal sinuses. The pathogenesis, clinical presentation, and imaging features of rhinogenic and odontogenic sinusitis are discussed and compared. Clinical definitions of rhinosinusitis are explained and the huge impact on healthcare of this disease is briefly discussed. Periapical inflammatory lesions, post-extraction oroantral communication, and procedures used to augment the alveolar process prior to placement of dental implants are the commonest causes of odontogenic sinusitis. Current estimates are that an odontogenic cause for maxillary sinusitis is present in 25-40% of cases. The incidence of odontogenic sinusitis is rising, extension outside the maxillary sinus is common, and the diagnosis is often delayed, resulting in inappropriate and failed treatment. Differentiation of rhinological and odontogenic causes of sinusitis is usually difficult on clinical grounds and imaging plays a key role in the distinction.

Imaging of IgG4-related disease of the head and neck

IgG4-related disease is a systemic, inflammatory disorder typically involving multiple organ systems. Several eponymous conditions described previously in the clinical and radiology literature are now recognised to be part of the IgG4-related disease spectrum. This includes multiple manifestations in the head and neck region, which are the subject of this review. Imaging can occasionally suggest the specific diagnosis of IgG4 disease. More commonly, it will be included in a limited differential diagnosis that requires clarification with the aid of image-guided biopsy. There are strict histopathological criteria for the diagnosis of IgG4-related disease.

Anatomical and genetic study of an ancient animal tooth showing brachyodont and hypsodont mixed taxonomical characteristics

A non-human dental piece was found in a Roman Empire tomb dated the 3rd century A.C. in Zaragoza (Spain). The morphology of this piece showed mixed brachyodont (carnivores) and hypsodont (herbivores) characteristics. As a result, the taxonomical assignation of the piece was impossible. Therefore, a protocol based on the DNA sequence of the cytochrome c oxidase subunit 1 mitochondrial region (COI) was applied. For this purpose, a pair of primers able to amplify this region in a large variety of animals was designed. The results point to a species of the Genus Bos (Family Bovidae). This assignation was later confirmed by these quencing of a short fragment of the mitochondrial D-loop region. A complete morphological description of the tooth is presented together with the DNA sequence study and comparison protocol.

Effects of the relationship between ⁶⁵Zn and blood cells. A dynamic and morphological study

We have studied the dynamic pathway of ⁶⁵Zn and its autoradiographic location in blood cells, even at the ultra-structural level. We have found evidence that tends to confirm the old biochemical postulates about the capacity of this isotope to displace iron in the haemoglobin molecule. Recently, the bibliography has demonstrated that ⁵⁷Co is also able to perform this displacement, but unlike ⁶⁵Zn it does not invalidate the Redox function of the molecule. In the case of ⁶⁵Zn, the mentioned displacement invalidates this function because the radionuclide can only use valence 2. We have also contributed evidence of erythrocytes destruction by the spleen after the incorporation of ⁶⁵Zn, as well as the clearly marked degradation of haematic pigments inside the spleen.

Epiphora and Eye Symptoms from Adjuvant Docetaxel-Based Regimens for Early Breast Cancer: An Interim Analysis

Background: Many women receiving adjuvant chemotherapy for early breast cancer (EBC) report a variety of ocular symptoms. Epiphora has been reported in up to 26% of women receiving 5-fluorouracil-based chemotherapy and in patients (pts) receiving docetaxel in the metastatic setting; with lacrimal duct obstruction being a potential cause. The incidence, severity and duration of epiphora in pts receiving docetaxel-based chemotherapy in the adjuvant setting is unknown.Methods: Commencing in 12/07, 100 consecutive pts without pre-existing epiphora who receive adjuvant docetaxel -based chemotherapy regimens at 2 cancer centres for EBC will be included. All pts receive standard chemotherapy doses and dexamethasone pre-medication as appropriate for the regimen. Pts will have three ophthalmological assessments by a single ophthalmologist per centre: prior to cycle 1 (C1), mid-way through regimen (interim) and 3m post completion. A CT-Dacryocystogram (CT-DCG) will be performed at baseline and 3 months after completion of chemotherapy. At each chemotherapy visit pts will complete an eye symptom questionnaire, FACT-Taxane, and incidence and severity of eye symptoms will be recorded.Results: We have currently recruited 81 pts (mean age 52y (range 32-76), 41 (51%) premenopausal, 40 (49%) postmenopausal; 72 patients having completed chemotherapy, 51 have undergone second CT_DCG. Chemotherapy given was TAC (46), TCH (16), TC (12), FEC-T (7). At baseline, asymptomatic lacrimal duct obstruction on CT-DCG and duct irrigation was seen in 17 (21%) and 15 (19%) pts, respectively. Of 51 pts who have had post-chemotherapy assessment, 17 (33%) and 13 (25%) had degree of obstruction on CT-DCG and irrigation, respectively. Incidence of several eye symptoms is shown below.Incidence of eye symptoms After cycle 1 n=82Interim n=75Last cycle n=71Follow-up n=56Epiphora19.5%65.3%70.4%8.9%Altered eye sensation2.4%18.7%21.1% Blepharospasm 2.7%4.2% Blurring3.7%21.3%22.5%7.1%Dry eyes 8%8.5%3.6%Eye irritation 4%7%3.6%Gritty eyes 1.3%1.4% Itchy eyes12.2%21.3%22.5%7.1%Photophobia 1.3%1.4% Red eyes1.2%1.3%1.4% Sticky eyes 5.3%9.9% Stinging4.9%6.7%9.9%7.1% Patient reported interference with driving, reading and other visual tasks occurred from 2-12% pts after C1, increased to 25-76% at last cycle but decreased to 9-11% by 3m after chemotherapy.Conclusions: This is the first prospective study evaluating incidence of epiphora and other eye symptoms secondary to adjuvant docetaxel-based chemotherapy. A significant proportion of asymptomatic pts had objective lacrimal duct pathology prior to treatment. Incidence of all eye symptoms increased promptly following commencement of chemotherapy and impacted on visual tasks in an increasingly higher proportion of pts over time. At 3 months review, incidence of eye symptoms was reduced despite a higher rate of objective duct pathology than at baseline. Further studies are needed to identify the drug(s) and mechanism by which eye symptoms are caused; with focus on prophylactic interventions.This study was supported by a study grant from Sanofi-Aventis.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1119.

The illusive phantom: Does primary care meet patient need following limb loss?

PURPOSE

Anecdotal evidence suggests that General Practitioners (GPs) vary in their understanding of phantom pain and associated factors in amputees. This has implications in that the GP's conception of the problem will determine what treatment or referral is offered.

METHOD

The present study aimed to explore GP's knowledge and understanding of phantom limb pain using a postal questionnaire. A sample of 129 GPs responded resulting in a response rate of 38%.

RESULTS

The results suggest that GPs underestimate the prevalence, intensity and duration of phantom and residual limb pain. Moreover, inconsistencies in the reasons given for referral to specialist services for the management of phantom pain were reported.

CONCLUSION

These findings have serious implications for the management of phantom limb pain, disability and psychological distress in amputees in that GPs not only provide first line treatment, but are also the gatekeepers for referral to other services. Given this, the role of other professionals within the primary health care team may prove an additional resource for providing both support and accurate information to amputees in the community.

The relationship between catastrophizing and disability in amputees experiencing phantom pain

PURPOSE

In recent years, researchers have noted that catastrophizing predicts both self-reported and objective measures of disability in a variety of chronic pain conditions. The present study sought to examine this in a working-age amputee population experiencing phantom pain.

METHOD

Participants completed a postal questionnaire incorporating measures of pain, disability and coping. A response rate of 62% resulted in 315 completed data sets being incorporated into the study.

RESULTS

Utilizing the three subscales of the Sickness Impact Profile, catastrophizing uniquely predicted 11% of the variance in overall level of disability, 6% in physical disability and 13% in psychosocial disability after accounting for demographic, amputation and pain-related variables.

CONCLUSION

The findings suggest that catastrophizing is a significant predictor of self-reported disability in an amputee population. This population have lifetime rehabilitation needs in that prostheses have to be remade on a regular basis. The service provided tends to focus on physical rehabilitation with the goal of providing amputees with limbs that most closely resemble the appearance and function of the intact limb. This study provides tentative support for development of an intervention that specifically targets catastrophizing.

Development of the dynamic structure (force lines) of the middle ear ossicles in human foetuses

OBJECTIVES

To study the ontogenic development of the organisation of the human middle ear ossicles structure.

MATERIAL AND METHODS

46 human temporal bones of ages varying from 32 days post-conception to newborns.

RESULTS

The development of the structural organisation of the malleus begins at 16 weeks via two cortical fascicles situated in the neck; at 21 weeks they extend towards the head, at 23 weeks to the lateral process and at 24 weeks to the handle. In the handle, the force lines are transmitted via three cardinal fascicles, two of them via the cortical fascicle and one via the centre, which starts after 29 weeks' development and is consolidated after 31 weeks. In the incus the force lines start at 16 weeks via two cortical fascicles situated in the long process, which progressively extend in a rostro-caudal direction between 17 and 20 weeks. At 21 weeks they occupy the whole extension of the long process and at 22 weeks the fusion of both cortical fascicles begins. From 30 weeks onwards it is strengthened by the crossing of bone trabeculae from one cortical to another. Two fascicles come out of the incus body, surrounding the medullary cavity and going in the direction of the short process. In the beginning, the stapes have two cortical fascicles in their crura. The remodelling process makes the internal cortical fascicle disappear and after 31 weeks all the force lines run through the external cortical fascicle. The tympanic membrane of the stapes footplate undergoes a remodelling process and after 28 weeks bony trabeculae are deposited. In newborns (40 weeks), the ossicles' structure is cavitary and has not been completed. The fan-shaped trabecular fascicle, which starts in the articular facets of the malleus and the incus, still has to develop.

Bilateral Leydig Cell Tumor in a Six-Year-Old Intersex Goat Affected by Polled Intersex Syndrome

A 6-year-old, sterile, Blanca Celtibérica breed adult doe was referred to our faculty. The doe had external female genitalia, a short anogenital distance, and normally shaped udders. Masculinization signs in the head shape and male behavior were also noted at the time of referral. Genetic analysis demonstrated normal 2n = 60 XX karyotype and an absence of the sex-determining region Y (SRY). The animal was homozygous for a DNA deletion responsible for the Polled Intersex Syndrome (PIS). A uterus and 2 uterine horns were present at the postmortem examination. Gartner's ducts and degenerated Wolffian derivatives persisted. There were 2 intra-abdominal testicle-like structures, one of which consisted of epididymal and deferent ducts. An advanced Leydig cell tumor, resulting in almost total destruction of the intratesticular structures, was also observed. Leydig cell tumors usually produce testosterone. Thus, these histologic findings are compatible with the evident virilization.

Dental panoramic tomography: An approach for the general radiologist

Dental panoramic tomography is commonly presented to radiologists with no dental training for interpretation. An overview of the technique, basic anatomy and nomenclature and common pathology is presented with examples to show the anatomy and nomenclature, the artefacts and common pathology.

Opaque maxillary antrum: a pictorial review

The demonstration of an opaque antrum on a plain radiograph or cross-sectional imaging leads to consideration of an extensive differential diagnosis. Relevant clinical details narrow the differential and include the patient's age, signs and symptoms, a history of recent trauma, prior surgery or dental treatment. Computed tomography remains the most useful technique in coming to a specific diagnosis. Magnetic resonance imaging adds specificity in a few selected situations and is required in conjunction with CT in the staging of malignant tumours.

Superior canal dehiscence: review of a new condition

A new cause of sound and pressure induced vertigo, superior canal dehisence, is described. Auditory manifestations include hyperacusis to bone-conducted sounds and conductive hearing loss with normal acoustic reflexes. The diagnosis is reached by a directed history, documentation of upward and torsional nystagmus evoked by sound and pressure, and radiology. Acoustic reflexes and VEMP (vestibular evoked myogenic potentials) aid in the identification of patients with an apparent conductive loss with normal acoustic reflexes or have an asymptomatic dehiscense on radiology. Treatment involves avoidance of the precipitating stimuli. Surgical treatment, by resurfacing the dehiscence, is considered in patients with more severe symptoms.

Abnormalities of contrast sensitivity and electroretinogram following sevoflurane anaesthesia

BACKGROUND AND OBJECTIVE

We tested the hypothesis that disturbances of the visual pathway following sevoflurane general anaesthesia (a) exist and persist even after clinical discharge criteria have been met and (b) are associated with decreased contrast sensitivity.

METHODS

We performed pattern and full-field flash electroretinograms (ERG) in 10 unpremedicated ASA I patients who underwent nitrous oxide/sevoflurane anaesthesia. ERG and contrast sensitivity were recorded preoperatively, immediately after discharge from the recovery room and 2 h after discontinuation of sevoflurane. The time at which the Post Anaesthesia Discharge Score first exceeded 9 was also noted. Data were analysed using paired, one-tailed t-tests and Pearson's correlation coefficient.

RESULTS

On the full-field photopic ERG, b-wave latency was greater at each postoperative time point (31.6+/-1.1 and 30.8+/-1.1 ms) compared to preoperatively (30.1+/-1.1 ms, P < 0.001 and P = 0.03, respectively). Oscillatory potential latencies were greater on discharge from the recovery room compared with preanaesthetic values (23.1+/-3.1 vs. 22.4+/-3.3 ms, P = 0.01) and returned to baseline by 2 h after emergence from anaesthesia. Also at 2 h after emergence from anaesthesia: (a) P50 latency on the pattern ERG was greater than at baseline (81.5+/-17.9 vs. 51.15+/-22.6ms, P = 0.004); (b) N95 amplitude was less compared to preanaesthetic values (2.6+/-0.5 vs. 3.3+/-0.4 microV, P = 0.003) and (c) contrast sensitivity was less compared to baseline values (349+/-153 vs. 404+/-140, P = 0.048). A positive correlation was demonstrated between contrast sensitivity and both N95 amplitude and b-wave latency (r = 0.99 and r = -0.55 at significance levels of P < 0.005 and P < 0.05, respectively).

CONCLUSIONS

Postoperative ERG abnormalities and associated decreases in contrast sensitivity are consistently present in patients who have undergone nitrous oxide/sevoflurane anaesthesia. These abnormalities persist beyond the time at which standard clinical discharge criteria have been met.

Postoperative changes in the full-field electroretinogram following sevoflurane anaesthesia

BACKGROUND AND OBJECTIVE

We tested the hypothesis that disturbances of the visual pathway persist following general anaesthesia, even after normal clinical discharge criteria have been met.

METHODS

We performed full-field flash electroretinography in the right eye of 10 unpremedicated ASA I patients who underwent N2O/sevoflurane anaesthesia. Electroretinograms were recorded preoperatively, immediately after discharge from the recovery room and 2 h after discontinuation of sevoflurane. The time at which postanaesthesia discharge score first exceeded 9 was also noted. Data were analysed using paired, one-tailed Student's t-test.

RESULTS

Latency of the b-wave on the photopic electroretinogram was greater at each postoperative time point (30.5 +/- 0.9 and 30 +/- 1.3 ms), compared to preoperative values (29.2 +/- 0.8 ms, P < 0.001 and P = 0.04, respectively). The A-B amplitude of the b-wave was less postoperatively (220.3 +/- 52.7 and 210.3 +/- 42.7 pV) compared to values before operation (248.1 +/- 57.6 microV, P = 0.03 and P = 0.01, respectively). Oscillatory potential latencies were greater at each postoperative time point (21.4 +/- 0.5 and 20.8 +/- 0.6 ms) compared to before operation (20.4 +/- 0.4 ms, P < 0.001 and P = 0.03, respectively). Oscillatory potential amplitudes were less at the first postoperative time point (17.5 +/- 6.1 microV), compared to preoperative values (22 +/- 6.4 microV, P = 0.04).

CONCLUSIONS

Postoperative electroretinogram abnormalities are consistently present in patients who have undergone N2O/sevoflurane anaesthesia. These abnormalities persist beyond the time at which standard clinical discharge criteria have been met.

Morphometric study of testis of Wistar rat after open-ended vasectomy

The effects on the testis of open-ended vasectomy in the Wistar rat have been assessed morphometrically and evaluated statistically at 1, 4, 12, and 24 weeks after operation, and compared to those in sham-operated controls. The open-ended technique, ie, without ligation of the epididymal end of the cut ductus deferens, allowed drainage of sperm into the spermatic cord. During the period of our study, it did not affect the structure of the testis; although the germinal epithelium, basement membrane, and the stroma and cells of the interstitial space all showed variations when compared to the control group, these were not statistically significant.

MRI in the assessment of internal derangement and pain within the temporomandibular joint: a pictorial essay

In this pictorial essay we aim to illustrate the normal temporomandibular joint (TMJ) and the common abnormalities of the osseous, cartilaginous and soft tissue components. These include disc (meniscus) displacement, deformities and perforations, abnormalities of disc and condylar movement, joint effusions, synovial proliferation, condylar deformity and erosions, degenerative change and abnormal retrodiscal enhancement.

Ligand modulation of glial activation: cell permeable, small molecule inhibitors of serine-threonine protein kinases can block induction of interleukin 1 beta and nitric oxide synthase II

Activated glia (astrocytes and microglia) and their associated neuroinflammatory sequelae have been linked to the disease progression of several neurodegenerative disorders, including Alzheimer's disease. We found that the experimental anti-inflammatory drug K252a, an inhibitor of calmodulin regulated protein kinases (CaMKs), can block induction of both the oxidative stress related enzyme iNOS and the proinflammatory cytokine IL-1 beta in primary cortical glial cultures and the microglial BV-2 cell line. We also found that the profile of CaMKIV and CaMKII isoforms in primary cortical glial cultures and BV-2 cells is distinct from that found in neurons. Knowledge of cellular mechanisms and high throughput screens of a pharmacologically focused chemical library allowed the discovery of novel pyridazine-based compounds that are cell permeable ligand modulators of gene regulating protein kinases involved in the induction of iNOS and IL-1 beta in activated glia. Pyridazine-based compounds are attractive for the development of new therapeutics due to the retention of the remarkable pharmacological properties of K252a and related indolocarbazole alkaloids, and presence of enhanced functional selectivity in a comparatively simple structure amenable to diverse synthetic chemistries.

Nurses' judgements of self-neglect: a factorial survey

Self-neglect can be understood as the failure to engage in those activities which a given culture deems necessary to maintain a socially accepted standard of personal and household hygiene and carry out activities needed to maintain health status. Self-neglect is bound up in a discourse which equates dirt with disease and in which transgressions of self-care norms can be labelled as a medical syndrome. The notion of self-neglect as a social construction is the theoretical perspective which provides the framework for the study reported here. Judgements regarding self-neglect may be social judgements influenced by professional socialisation and cultural values. The belief that different groups of nurses may have different constructions of self-neglect will be investigated and the factors which influence these judgements will be explored in three groups of nurses. The inclusion of nursing students will allow some picture to emerge as to whether judgements develop over time or are relatively constant across the career path, albeit within the limitations of a non-longitudinal design.

The vasectomized testis

We have performed a qualitative study on effects of vasectomy on the testicular structure. Vasectomy performed with the traditional technique changes testicular structure. At first, the injuries are slight and restricted, but gradually, and in a time-dependent manner, become more severe and extensive. Ultrastructure studies indicate that the spermatogonia and Sertoli's cells are the most resistant to vasectomy, and are even observed in some regenerating testes lacking a complete germinal epithelium. Morphometric studies revealed a decrease in epithelial depth, an increase in the thickness of the basement membrane and in surface of the interstitial space, all significant (P < 0.01) with respect to the control. However, the percentage of the interstitial tissue occupied by cells, did not show any significant difference. We propose that the increase of intraluminal pressure is the essential factor that provokes testicular atrophy.

Leucocyte entry and endothelial E-selectin expression following intradermal Propionibacterium acnes administration

Immune responses in porcine skin to intradermal inoculation of heat-killed Propionibacterium acnes (HKPA), the major bacterial agent associated with human inflammatory acne, were studied. Pigs were chosen as experimental animals because their skin is similar in structure and composition to that of man and because the use of genetically inbred pigs enables leucocytes to be transferred between animals without eliciting rejection responses. Two pigs were sensitized intradermally with 10 mg of HKPA and were challenged 2 weeks later with doses ranging from 1-100 microg of HKPA in various intradermal sites on the ventral aspect of the abdomen. Four further pigs, previously sensitized with Bacillus Calmette-Guérin (BCG) but not HKPA, were challenged with purified protein derivative (PPD) of bovine tuberculin and HKPA. Entry of(51)Cr-labelled peripheral blood lymphocytes (PBLs) over 48 h was studied in all the challenge sites. Peak PBL entry occurred at 4 h, remaining sustained up to 24 h. There was a dose-dependent effect of HKPA on the level of PBL entry, which was antigen-specific, as few leucocytes were seen in PPD-challenge sites in HKPA-sensitized pigs or in HKPA-challenged sites in BCG-sensitized pigs. There was also a substantial influx of(111)Indium-labelled neutrophils into the lesions. Lymphocytes present were predominantly of the CD3(+)CD2(+)T-cell subset, although gammadelta TCR(+)cells were present also, particularly after 24 h. E-selectin was markedly upregulated on dermal endothelium in the P. acnes sites. The histological infiltration and kinetics were similar to those reported in human inflammatory acne.

[Experimental vasectomy: comparison of epididymal structure with various surgical techniques]

OBJECTIVE

To analyze the effects of different surgical techniques of vasectomy on the epididymal structure.

METHODS

Experimental vasectomies were performed in dogs using the conventional and open-ended techniques. The animals were orchidectomized 1 to 12 months after vasectomy and the epididymal structure was analyzed.

RESULTS

The epididymal structure of dogs submitted to the conventional technique showed marked ectasia, reinforced basement membrane, loss of stereocilia in the principal cells, and formation of spermatic granulomas in interstitial tissue. At 12 months the principal cells showed signs of degenerative changes. In the different time periods analyzed in the study, no changes were observed in the epididymal structure of dogs submitted to the open-ended technique.

CONCLUSIONS

The changes observed in the principal cells are ascribable to the increased intraluminal pressure produced by ligation of both ends of the vas deferens (conventional technique), since no changes were found in the epididymal structure of dogs submitted to the open-ended technique, at least in the different time periods analyzed in the study.

Reptilian chemistry: characterization of dianeackerone, a secretory product from a crocodile

The major volatile component in the paracloacal glandular secretion of the adult African dwarf crocodile (Osteolaemus tetraspis) was isolated and characterized as a 19-carbon aromatic ketone, dianeackerone (3,7-diethyl-9-phenyl-2-nonanone). This ketone is absent from the secretion of immatures. Careful examination of dianeackerone samples isolated from individual adults revealed that this ketone occurs as both the (3S, 7S) and (3S, 7R) stereoisomers, with different individuals presenting strikingly different ratios of the isomeric forms. Our initial suspicion that the stereoisomeric dianeackerones might be indicators of gender proved untenable, leaving the role of these glandular constituents a challenge for future study.

Reptilian chemistry: characterization of a family of dianeackerone-related steroidal esters from a crocodile secretion

The African dwarf crocodile, Osteolaemus tetraspis (Crocodilidae, Reptilia), possesses a pair of skin glands, the paracloacal glands, the secretion of which is thought to be used to mark nest sites or attract mates. Ten aromatic steroidal esters were isolated from this secretion and characterized on the basis of NMR spectroscopic investigations, electrospray ionization-MS analyses, and chemical degradation. These esters, which account for more than 90% of the paracloacal glandular secretion, are derived from either cholesterol or cholestanol, esterified with a C-20 or C-22 acid closely related to dianeackerone, the only significant volatile compound found in this secretion.

Alpha-galactosyl-mediated activation of porcine endothelial cells: studies on CD31 and VE-cadherin in adhesion and signaling

BACKGROUND

Ligation of alpha-galactosyl epitopes on endothelial cells by naturally occurring human antibodies causes hyperacute rejection in porcine-to-human xenotransplantation. The alpha-galactosyl-specific lectin Bandeiraea simplicifolia isolectin B4 (IB4) has been reported to trigger endothelial "gap" formation and tyrosine phosphorylation of an unidentified 130-kDa protein. We have studied two 130-kDa junctional adhesion molecules, CD31 and VE-cadherin, in porcine aortic endothelial cells (PAECs) during IB4-mediated activation. The cellular distribution of these molecules, their susceptibility to tyrosine phosphorylation, and their capacity to bind IB4 or natural human antibodies have been determined.

METHODS

Porcine CD31 and VE-cadherin were cloned. Recombinant proteins and monoclonal antibodies were prepared. The distribution and phosphorylation of CD31 and VE-cadherin in confluent PAECs activated with IB4 or human serum were studied by confocal microscopy and Western blotting, respectively.

RESULTS

IB4 caused rapid redistribution of CD31 and VE-cadherin away from cell junctions and tyrosine-phosphorylation of CD31 but not VE-cadherin. A monoclonal antibody to CD31 also triggered tyrosine phosphorylation of this molecule, but brief exposure of PAECs to normal human serum did not. Tyrosine-phosphorylated CD31 complexed with SHP2 and other unidentified phosphoproteins. Both IB4 and natural human antibodies bound to porcine CD31 but not to VE-cadherin. Cell adhesion tests showed that porcine and human CD31 are functionally incompatible.

CONCLUSIONS

Endothelial cell retraction during IB4-mediated activation of PAECs is associated with rapid loss of CD31 and VE-cadherin from cell junctions. CD31 becomes strongly tyrosine-phosphorylated and forms a cell signaling complex, which may have a significant role in the response of the xenograft vascular endothelium.

[Effects of experimental vasectomy on testicular structure: ultrastructural study]

We have performed experimental vasectomies in dogs in order to study effects of vas deferens ligature with close technique, on the testicular ultrastructure. We point out the existence of alterations: structural changes of the seminiferous epithelium, great extracellular spaces which are generated for the premature exfoliation of germinal cells, degeneration of the germinal shock cells, the appearance of immature germinal cells and multinucleate spermatids in every stages of the spermatogenesis, the fall of mature spermatozoid number, thickening of basal membrane, relative increase in the Sertoli's cells size as well as their phagocytic function, and existence of spermaphagos unfasted into tubular lumen. The Leydig's interstitial islets show an absolutely normal cellular and vascular configuration.