Forensic anthropologists and estimates of skeletal completeness: The impacts of training and experience

Forensic anthropologists engage with numerous and diverse stakeholders in their casework. Regarding the recovery of human remains, these stakeholders may be interested in quantifying or qualifying the amount of remains recovered. How forensic anthropologists respond to such questions, whether verbally or in written reporting, has the potential to impact the trajectory of a case. However, communications about skeletal completeness are rarely discussed within the field. Current data-collection procedures recommend the use of inventories. This approach may be less feasible for complicated assemblages involving commingling or high degrees of fragmentation. Numerous methods exist to quantify the amount of skeletal remains present in complex or larger assemblages, but it remains unclear to what extent forensic anthropologists utilize these methods and whether factors like degree of expertise influence analysts' ability to report skeletal completeness consistently and precisely. A study was designed to examine differences between public and professional perceptions of skeletal completeness, presenting images of incomplete bones and skeletal remains. Survey participants were asked to assess the completeness of the remains in each image. Few patterns were observed regarding photographs of skeletal assemblages, but distinct differences were observed among individual bones between respondents with different degrees of expertise. These responses reflect potentially unexamined assumptions underlying assessments of incomplete bones and skeletal assemblages. This highlights the necessity of standardizing how we report estimates of completeness within the forensic anthropology community and how we discuss these results with external stakeholders. Completeness estimates must be either removed from reports and bench notes or annotated and cited clearly, as is standard with other aspects of forensic anthropological analysis. Several methods are summarized, with recommendations for integrating them into casework.

Assessing the association of stigma and HIV service and prevention uptake among men who have sex with men and transgender women in South Africa

HIV prevention for gay, bisexual, and other men who have sex with men (GBMSM) and transgender women (TGW) is critical to reducing health disparities and population HIV prevalence. To understand if different types of stigma impact engagement with HIV prevention services, we assessed associations between stigmas and use of HIV prevention services offered through an HIV prevention intervention. This analysis included 201 GBMSM and TGW enrolled in a prospective cohort offering a package of HIV prevention interventions. Participants completed a baseline survey that included four domains of sexual identity/behavior stigma, HIV-related stigma, and healthcare stigma. Impact of stigma on PrEP uptake and the number of drop-in visits was assessed. No domain of stigma was associated with PrEP uptake. In bivariate analysis, increased enacted sexual identity stigma increased number of drop-in visits. In a logistic regression analysis constrained to sexual identity stigma, enacted stigma was associated with increased drop-in visits (aIRR = 1.30, [95% CI: 1.02, 1.65]). Participants reporting higher enacted stigma were modestly more likely to attend additional services and have contact with the study clinics and staff. GBMSM and TGW with higher levels of enacted stigma may seek out sensitized care after negative experiences in their communities or other healthcare settings.

Utilization of Screening Mammography in Women Before 50: Cross-Sectional Survey Results from the National Health Interview Survey

OBJECTIVE

While the American College of Radiology recommends annual screening mammography starting at age 40 years, the US Preventive Services Task Force (USPSTF) recommends that screening mammography in women younger than age 50 years should involve shared- decision making (SDM) between clinicians and patients, considering benefits and potential harms in younger women. Using a nationally representative cross-sectional survey, we aimed to evaluate patient-reported reasons and predictors of screening mammography utilization in this age group.

METHODS

Respondents aged 40-49 years from the 2018 National Health Interview Survey (NHIS) without a history of breast cancer were included (response rate 64%). Participants reported sociodemographic variables and reasons they did not engage in mammography screening within the last two years. Multiple variable logistic regression analyses were performed to evaluate the association between sociodemographic characteristics and patient-reported screening mammography use, accounting for complex survey sampling design elements.

RESULTS

1,948 women between the ages of 40-49 years were included. Of this group, (758/1948) 46.6% reported receiving a screening mammogram within the last year, and 1196/1948 (61.4%) reported receiving a screening mammogram within the last two years. The most common reasons for not undergoing screening included: "No reason/never thought about it" 744/1948 (38.2%), "Put it off" 343/1948 (17.6%), "Didn't need it" 331/1948 (16.9%), "Doctor didn't order it" 162/1948 (8.3%), and "I'm too young" 63/1948 (5.3%). Multiple variable analyses demonstrated that lack of health insurance was the strongest predictor of mammography non-engagement (p< 0.001).

CONCLUSION

Deficits in shared- decision-making in women younger than 50 years related to mammography utilization exist. Radiologists may be key in addressing this issue among ambulatory care providers and patients, educating about the benefits and harms of screening younger women, particularly in racial/ethnic minorities and uninsured patients, who experience additional barriers to care and SDM discussions.

Epidemiology beyond its limits

In 1995, journalist Gary Taubes published an article in Science titled "Epidemiology faces its limits," which questioned the utility of nonrandomized epidemiologic research and has since been cited more than 1000 times. He highlighted numerous examples of research topics he viewed as having questionable merit. Studies have since accumulated for these associations. We systematically evaluated current evidence of 53 example associations discussed in the article. Approximately one-quarter of those presented as doubtful are now widely viewed as causal based on current evaluations of the public health consensus. They include associations between alcohol consumption and breast cancer, residential radon exposure and lung cancer, and the use of tanning devices and melanoma. This history should inform current debates about the reproducibility of epidemiologic research results.

Development and Validation of Algorithms to Identify COVID-19 Patients Using a US Electronic Health Records Database: A Retrospective Cohort Study

Introduction

In order to identify and evaluate candidate algorithms to detect COVID-19 cases in an electronic health record (EHR) database, this study examined and compared the utilization of acute respiratory disease codes from February to August 2020 versus the corresponding time period in the 3 years preceding.

Methods

De-identified EHR data were used to identify codes of interest for candidate algorithms to identify COVID-19 patients. The number and proportion of patients who received a SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) within ±10 days of the occurrence of the diagnosis code and patients who tested positive among those with a test result were calculated, resulting in 11 candidate algorithms. Sensitivity, specificity, and likelihood ratios assessed the candidate algorithms by clinical setting and time period. We adjusted for potential verification bias by weighting by the reciprocal of the estimated probability of verification.

Results

From January to March 2020, the most commonly used diagnosis codes related to COVID-19 diagnosis were R06 (dyspnea) and R05 (cough). On or after April 1, 2020, the code with highest sensitivity for COVID-19, U07.1, had near perfect adjusted sensitivity (1.00 [95% CI 1.00, 1.00]) but low adjusted specificity (0.32 [95% CI 0.31, 0.33]) in hospitalized patients.

Discussion

Algorithms based on the U07.1 code had high sensitivity among hospitalized patients, but low specificity, especially after April 2020. None of the combinations of ICD-10-CM codes assessed performed with a satisfactory combination of high sensitivity and high specificity when using the SARS-CoV-2 RT-PCR as the reference standard.

Trends in characteristics and outcomes among US adults hospitalised with COVID-19 throughout 2020: an observational cohort study

OBJECTIVES

To examine the temporal patterns of patient characteristics, treatments used and outcomes associated with COVID-19 in patients who were hospitalised for the disease between January and 15 November 2020.

DESIGN

Observational cohort study.

SETTING

COVID-19 subset of the Optum deidentified electronic health records, including more than 1.8 million patients from across the USA.

PARTICIPANTS

There were 51 510 hospitalised patients who met the COVID-19 definition, with 37 617 in the laboratory positive cohort and 13 893 in the clinical cohort.

PRIMARY AND SECONDARY OUTCOME MEASURES

Incident acute clinical outcomes, including in-hospital all-cause mortality.

RESULTS

Respectively, 48% and 49% of the laboratory positive and clinical cohorts were women. The 50- 65 age group was the median age group for both cohorts. The use of antivirals and dexamethasone increased over time, fivefold and twofold, respectively, while the use of hydroxychloroquine declined by 98%. Among adult patients in the laboratory positive cohort, absolute age/sex standardised incidence proportion for in-hospital death changed by -0.036 per month (95% CI -0.042 to -0.031) from March to June 2020, but remained fairly flat from June to November, 2020 (0.001 (95% CI -0.001 to 0.003), 17.5% (660 deaths /3986 persons) in March and 10.2% (580/5137) in October); in the clinical cohort, the corresponding changes were -0.024 (95% CI -0.032 to -0.015) and 0.011 (95% CI 0.007 0.014), respectively (14.8% (175/1252) in March, 15.3% (189/1203) in October). Declines in the cumulative incidence of most acute clinical outcomes were observed in the laboratory positive cohort, but not for the clinical cohort.

CONCLUSION

The incidence of adverse clinical outcomes remains high among COVID-19 patients with clinical diagnosis only. Patients with COVID-19 entering the hospital are at elevated risk of adverse outcomes.

Feasibility, Acceptability, and Design of a Mobile Ecological Momentary Assessment for High-Risk Men Who Have Sex With Men in Hanoi, Vietnam: Qualitative Study

Background

Men who have sex with men (MSM) are at a disproportionate risk for HIV infection and common mental disorders worldwide. In the context of HIV, common mental disorders are important and are frequent drivers of suboptimal prevention and treatment outcomes. Mobile ecological momentary assessments (EMAs), or the repeated sampling of people’s behaviors and psychological states in their daily lives using mobile phones, can clarify the triggers and HIV-related sequelae of depressive-anxious symptoms and contribute toward the design of ecological momentary interventions (EMIs) that cater to the contextually varying needs of individuals to optimize prevention and treatment outcomes.

Objective

This study aims to characterize the feasibility and acceptability of mobile EMA among high-risk MSM in Hanoi, Vietnam. It aims to evaluate the perceived relevance, usability, and concerns of this group with regard to the content and delivery of mobile EMA and the potential of leveraging such platforms in the future to deliver EMIs.

Methods

Between January and April 2018, a total of 46 participants were recruited. The participants completed 6 to 8 mobile EMA surveys daily for 7 days. Surveys occurred once upon waking, 4 to 6 times throughout the day, and once before sleeping. All surveys queried participants’ perceived safety, social interactions, psychological state, and mental health symptoms. The morning survey further queried on sleep and medication use within the past 24 hours, whereas the night survey queried on sexual activity and substance use and allowed participants to share an audio recording of a stressful experience they had that day. At the end of the week, participants were interviewed about their experiences with using the app.

Results

Participants completed an average of 21.7 (SD 12.7) prompts over the 7-day period. Excluding nonresponders, the average compliance rate was 61.8% (SD 26.6%). A thematic analysis of qualitative interviews suggested an overall positive reception of the app and 5 recurring themes, which were centered on the relevance of psychological and behavioral items to daily experiences (eg, mental health symptoms and audio recording), benefits of using the app (eg, increased self-understanding), worries and concerns (eg, privacy), usability (eg, confusion about the interface), and recommendations for future design (eg, integrating more open-ended questions).

Conclusions

Mobile EMA is feasible and acceptable among young MSM in Vietnam; however, more research is needed to adapt EMA protocols to this context and enhance compliance. Most participants eagerly provided information about their mental health status and daily activities. As several participants looked toward the app for further mental health and psychosocial support, EMIs have the potential to reduce HIV and mental health comorbidity among MSM.

Characteristics and outcomes of hospitalised adults with COVID-19 in a Global Health Research Network: a cohort study

OBJECTIVE

To examine age, gender, and temporal differences in baseline characteristics and clinical outcomes of adult patients hospitalised with COVID-19.

DESIGN

A cohort study using deidentified electronic medical records from a Global Research Network.

SETTING/PARTICIPANTS

67 456 adult patients hospitalised with COVID-19 from the USA; 7306 from Europe, Latin America and Asia-Pacific between February 2020 and January 2021.

RESULTS

In the US cohort, compared with patients 18-34 years old, patients ≥65 had a greater risk of intensive care unit (ICU) admission (adjusted HR (aHR) 1.73, 95% CI 1.58 to 1.90), acute respiratory distress syndrome(ARDS)/respiratory failure (aHR 1.86, 95% CI 1.76 to 1.96), invasive mechanical ventilation (IMV, aHR 1.93, 95% CI, 1.73 to 2.15), and all-cause mortality (aHR 5.6, 95% CI 4.36 to 7.18). Men appeared to be at a greater risk for ICU admission (aHR 1.34, 95% CI 1.29 to 1.39), ARDS/respiratory failure (aHR 1.24, 95% CI1.21 to 1.27), IMV (aHR 1.38, 95% CI 1.32 to 1.45), and all-cause mortality (aHR 1.16, 95% CI 1.08 to 1.24) compared with women. Moreover, we observed a greater risk of adverse outcomes during the early pandemic (ie, February-April 2020) compared with later periods. In the ex-US cohort, the age and gender trends were similar; for the temporal trend, the highest proportion of patients with all-cause mortality were also in February-April 2020; however, the highest percentages of patients with IMV and ARDS/respiratory failure were in August-October 2020 followed by February-April 2020.

CONCLUSIONS

This study provided valuable information on the temporal trends of characteristics and outcomes of hospitalised adult COVID-19 patients in both USA and ex-USA. It also described the population at a potentially greater risk for worse clinical outcomes by identifying the age and gender differences. Together, the information could inform the prevention and treatment strategies of COVID-19. Furthermore, it can be used to raise public awareness of COVID-19's impact on vulnerable populations.

Pediatric BMI changes during COVID-19 pandemic: An electronic health record-based retrospective cohort study

BACKGROUND

Beginning March 2020, the COVID-19 pandemic has disrupted different aspects of life. The impact on children's rate of weight gain has not been analysed.

METHODS

In this retrospective cohort study, we used United States (US) Electronic Health Record (EHR) data from Optum® to calculate the age- and sex- adjusted change in BMI (∆BMI_adj) in individual 6-to-17-year-old children between two well child checks (WCCs). The mean of individual ∆BMI_adj during 2017-2020 was calculated by month. For September-December WCCs, the mean of individual ∆BMI_adj (overall and by subgroup) was reported for 2020 and 2017-2019, and the impact of 2020 vs 2017-2019 was tested by multivariable linear regression.

FINDINGS

The mean [95% Confidence Interval - CI] ∆BMI_adj in September-December of 2020 was 0·62 [0·59,0·64] kg/m², compared to 0·31 [0·29, 0·32] kg/m² in previous years. The increase was most prominent in children with pre-existing obesity (1·16 [1·07,1·24] kg/m² in 2020 versus 0·56 [0·52,0·61] kg/m² in previous years), Hispanic children (0·93 [0·84,1·02] kg/m² in 2020 versus 0·41 [0·36,0·46] kg/m² in previous years), and children who lack commercial insurance (0·88 [0·81,0·95] kg/m² in 2020 compared to 0·43 [0·39,0·47] kg/m² in previous years). ∆BMI_adj accelerated most in ages 8-12 and least in ages 15-17.

INTERPRETATION

Children's rate of unhealthy weight gain increased notably during the COVID-19 pandemic across demographic groups, and most prominently in children already vulnerable to unhealthy weight gain. This data can inform policy decisions critical to child development and health as the pandemic continues to unfold.

FUNDING

Amgen, Inc.

Estimated Prevalence and Incidence of Amyotrophic Lateral Sclerosis and SOD1 and C9orf72 Genetic Variants

INTRODUCTION

Amyotrophic lateral sclerosis (ALS) is a rare neurological disorder characterized by progressive deterioration of motor neurons. Assessment of the size/geographic distribution of the ALS population, including ALS with genetic origin, is needed to understand the burden of the disease and the need for clinical intervention and therapy.

OBJECTIVES

The main objective of this study was to estimate the number of prevalent and incident ALS cases overall and superoxide dismutase 1 (SOD1) and chromosome 9 open reading frame 72 (C9orf72) ALS in 22 countries across Europe (Belgium, France, Germany, Ireland, Italy, Netherlands, Norway, Russia, Spain, Sweden, and UK), North America (USA and Canada), Latin America (Argentina, Brazil, Colombia, Mexico, and Uruguay), and Asia (China, Japan, South Korea, and Taiwan).

METHODS

A comprehensive literature search was conducted to identify population-based studies reporting ALS prevalence and/or incidence rates. Pooled prevalence and incidence rates were obtained using a meta-analysis approach at the country and regional geographic level. A country-level pooled estimate was used when ≥2 studies were available per country and geographic regional pooled estimates were used otherwise. The proportion of cases with a SOD1 or C9orf72 mutation among sporadic (sALS) and familial (fALS) cases were obtained from a previous systematic review and meta-analysis.

RESULTS

Pooled prevalence rates (per 100,000 persons) and incidence rates (per 100,000 person-years) were 6.22 and 2.31 for Europe, 5.20 and 2.35 for North America, 3.41 and 1.25 for Latin America, 3.01 and 0.93 for Asian countries excluding Japan, and 7.96 and 1.76 for Japan, respectively. Significant heterogeneity in reported incidence and prevalence was observed within and between countries/geographic regions. The estimated number of 2020 ALS cases across the 22 countries is 121,028 prevalent and 41,128 incident cases. The total estimated number of prevalent SOD1 cases is 2,876 cases, of which, 1,342 (47%) were fALS and 1,534 (53%) were sALS, and the number of incident SOD1 cases is 946 (434 [46%] fALS and 512 [54%] sALS). The total estimated number of prevalent C9orf72 cases is 4,545 (1,198 [26%] fALS, 3,347 [74%] sALS), and the number of incident C9orf72 cases is 1,706 (450 [26%] fALS and 1,256 [74%] sALS).

DISCUSSION

The estimated number of patients with SOD1 and C9orf72 ALS suggests that although the proportions of SOD1 and C9orf72 are higher among those with fALS, the majority of SOD1 and C9orf72 ALS cases may be found among those with sALS (about 53 and 74%, respectively). These results suggest that classification of fALS based on reported family history does not capture the full picture of ALS of genetic origin.

Mental health in HIV prevention and care: A qualitative study of challenges and facilitators to integration in Vietnam

INTRODUCTION

Globally, men who have sex with men (MSM) experience a disproportionate burden of mental health issues. While HIV service providers may possess the skills and relationships to provision mental health and psychosocial support (MHPSS) to this population, task-sharing models that integrate MHPSS into HIV contexts remain limited. The aim of this study was to explore the sociodemographic, psychological, and structural factors operant at the client and HIV service provider levels that shape MHPSS access and burden among MSM and opportunities for integration in Vietnam.

METHODS

Between June and August 2018, semi-structured interviews were conducted with 20 MSM and 13 service providers at out-patient clinics (OPCs) and community-based organizations (CBOs) in Hanoi, Vietnam. Interviews explored participants' understandings of and experiences with the signs, causes, and appropriate treatments for mental health concerns; and perceived barriers to MHPSS integration in HIV contexts. Data were coded thematically and analyzed in MAXQDA.

RESULTS

Most MSM did not view their mental distress as constituting illness or as warranting clinical attention. Specifically, terms like "mental illness" were often associated with being "crazy" or immoral, while symptoms of distress were interpreted as having to do with everyday difficulties associated with being MSM and/or HIV-positive. Due to mental health stigma, MSM were reluctant to access services while service providers were similarly reluctant to query about needs. Few service providers knew where to refer patients for MHPSS, and none had done so previously. Most service providers reported lacking the human capital, expertise, and funding to address MHPSS needs.

CONCLUSIONS

Our findings suggest that aside from mental health stigma, future integration strategies must address competing demands and incentivization structures, limitations in existing mental health infrastructure and funding, misperceptions around MHPSS needs and symptoms, and opportunities to streamline MHPSS with existing CBO activities to strengthen community wellbeing.

The influence of candidates' physical attributes on assessors' ratings in clinical practice

BACKGROUND

Assessments of physician competence in the work-place are common and often contribute to high-stakes assessments. Previous research suggests that assessors' judgements can be influenced by candidates' physical attributes. We investigated whether simulated candidates' scores were influenced by assessor bias based on tattoos, hair colour, and a regional accent.

METHODS

We used an experimental, video-based, single-blinded, randomised, internet-based design. We created videos of simulated medical intern performances of a clinical examination at four different standards of competence. Four videos were also created of simulated candidates performing at a 'clear pass' standard, with either no stereotypical attribute (CPX), purple hair (CPH), tattoos (CPT) or a Liverpool English accent (CPA). Assessors were randomly assigned to watch five videos including the "clear pass" candidate without an attribute and one of the "clear pass" candidates with an attribute and asked to give an overall global grade for each candidate. We compared the global grades for the clear pass candidates with and without attributes.

RESULTS

Ninety-eight assessors were included in the analysis. The total scores for the candidates with stereotyped attributes were not significantly lower than the candidate with no attribute. Assessors showed moderate levels of agreement between the global grades awarded for all the candidates. The global grades awarded to candidate with a stereotypical attribute were not significantly lower than for those without.

CONCLUSIONS

The presence of tattoos, purple hair, or a regional accent did not systematically negatively influence the grade or score awarded by assessors to candidates in observed clinical examination scenarios.

Multilevel Factors Affecting Time to Cancer Diagnosis and Care Quality in Botswana

BACKGROUND

Cancer incidence is increasing in Africa, and the majority of patients are diagnosed with advanced disease, limiting treatment options and survival. We sought to understand care patterns and factors contributing to delayed diagnosis and treatment initiation among patients with cancer in Botswana.

PATIENTS AND METHODS

We recruited 20 patients who were enrolled in a prospective cancer cohort in Botswana to a qualitative substudy that explored cancer care pathways and factors affecting cancer care access and quality. We conducted an in-depth interview with each participant between October 2014 and January 2015, using a a structured interview guide with questions about initial cancer symptoms, previous consultations, diagnosis, and care pathways. Medical records were used to confirm dates or treatment details when needed.

RESULTS

Individual and interpersonal factors such as cancer awareness and social support facilitated care-seeking behaviors. However, patients experienced multiple delays in diagnosis and treatment because of provider and health system barriers. Health system factors, such as misdiagnosis, understaffed facilities, poor referral communication and scheduling, and inadequate laboratory reporting systems, affected access to and quality of cancer care.

CONCLUSION

These findings highlight the need for interventions at the patient, provider, and health system levels to improve cancer care quality and outcomes in Botswana. Results also suggest that widespread cancer education has potential to promote early diagnosis through family and community networks. Identified barriers and facilitators suggest that interventions to improve community education and access to diagnostic technologies could help improve cancer outcomes in this setting.

IMPLICATIONS FOR PRACTICE

The majority (54%) of patients with cancer in Botswana present with advanced-stage cancer despite universal access to free health care, limiting the options for treatment and decreasing the likelihood of positive treatment outcomes. To reduce time from symptom onset to cancer treatment initiation, causes of delay in cancer care trajectories must be identified. The narratives of the patients interviewed for this study give insight into psychosocial factors, outlooks on disease, lower-level provider delays, and health system barriers that contribute to substantial delays for patients with cancer in Botswana. Identification of problems and barriers is essential for development of effective interventions to mitigate these factors, in order to improve cancer outcomes in this population.

Cortical nociceptive processes are reduced by visual alpha-band entrainment in the human brain

BACKGROUND

Acute noxious stimuli induce a suppression of cortical alpha activity, yet little is known about whether increasing alpha activity affects the processing of noxious stimuli. We have previously shown that visual alpha stimulation reduces experimental pain. Here, we demonstrate that increasing alpha power causes a reciprocal suppression of acute nociceptive processing.

METHODS

We attempted to increase cortical alpha activity through visual entrainment at 8 Hz, 10 Hz and 12 Hz to investigate the influence on the electrophysiological pain response. Moderately painful laser-heat stimuli were delivered following 10 minutes of visual entrainment across the alpha range.

RESULTS

Alpha power increased significantly relative to the 1 Hz control condition following 8 Hz and 10 Hz visual stimulation. Significant reductions in the P2 peak amplitude of the laser-evoked potential were found following visual entrainment at 10 Hz; the frequency stimulation resulting in the largest reduction in pain perception. Source analysis revealed that, following the 10 Hz stimulation, sources of increased alpha power and decreased nociceptive processing overlapped in precuneus and posterior cingulate cortex, with further reductions in nociceptive processing in insula cortex.

CONCLUSIONS

As far as we are aware, this is the first study to provide direct evidence that experimental induction of increased alpha power suppresses the cortical processing of acute pain.

SIGNIFICANCE

While it is known that visual stimulation can increase the brain's oscillatory alpha rhythms, here, we show that this increase in alpha power occurs alongside reduced cortical processing of nociception, as measured with EEG. This establishes an objective marker of alpha entrainment-based analgesia that may be useful in the development of neuromodulatory treatments for clinical pain.

Varus thrust during walking and the risk of incident and worsening medial tibiofemoral MRI lesions: the Multicenter Osteoarthritis Study

OBJECTIVE

To determine the association of varus thrust during walking to incident and worsening medial tibiofemoral cartilage damage and bone marrow lesions (BMLs) over 2 years in older adults with or at risk for osteoarthritis (OA).

METHOD

Subjects from the Multicenter Osteoarthritis Study (MOST) were studied. Varus thrust was visually assessed from high-speed videos of forward walking trials. Baseline and two-year MRIs were acquired from one knee per subject and read for cartilage loss and BMLs. Logistic regression with generalized estimating equations was used to estimate the odds of incident and worsening cartilage loss and BMLs, adjusting for age, sex, race, body mass index (BMI), and clinic site. The analysis was repeated stratified by varus, neutral, and valgus alignment.

RESULTS

1007 participants contributed one knee each. Varus thrust was observed in 29.9% of knees. Knees with thrust had 2.17 [95% CI: 1.51, 3.11] times the odds of incident medial BML, 2.51 [1.85, 3.40] times the odds of worsening medial BML, and 1.85 [1.35, 2.55] times the odds of worsening medial cartilage loss. When stratified by alignment, varus knees also had significantly increased odds of these outcomes.

CONCLUSION

Varus thrust observed during walking is associated with increased odds of incident and worsening medial BMLs and worsening medial cartilage loss. Increased odds of these outcomes persist in varus-aligned knees.

Glomerular Lesions in Proteinuric Miniature Schnauzer Dogs

Miniature Schnauzer dogs are predisposed to idiopathic hypertriglyerceridemia, which increases risk for diseases such as pancreatitis and gallbladder mucocele. Recently, elevated triglyceride concentrations have been associated with proteinuria in this breed, although it is difficult to determine which abnormality is primary. Retrospective review of renal tissue from 27 proteinuric Miniature Schnauzers revealed that 20 dogs had ultrastructural evidence of osmophilic globules consistent with lipid in glomerular tufts. Seven of these dogs had lipid thromboemboli in glomerular capillary loops that distorted their shape and compressed circulating erythrocytes. Triglyceride concentrations were reported in 6 of these 7 dogs, and all were hypertriglyceridemic. In addition, glomerular lipidosis (defined as accumulation of foam cells within peripheral capillary loops) was identified in a single dog. The remaining 12 dogs had smaller amounts of lipid that could only be identified ultrastructurally. Neither signalment data nor clinicopathologic parameters (serum albumin, serum creatinine, urine protein-to-creatinine ratio, and blood pressure) differed among the various types of lipid lesions. During the time course of this study, all dogs diagnosed with glomerular lipid thromboemboli were Miniature Schnauzers, underscoring the importance of recognizing these clear spaces within capillary loops as lipid.

Fetal Development: Voice Processing in Normotensive and Hypertensive Pregnancies

Recent observation of maternal voice recognition provides evidence of rudimentary memory and learning in healthy term fetuses. However, such higher order auditory processing has not been examined in the presence of maternal hypertension, which is associated with reduced and/or impaired uteroplacental blood flow. In this study, voice processing was examined in 40 fetuses (gestational ages of 33 to 41 weeks) of hypertensive and normotensive women. Fetuses received 2 min of no sound, 2 min of a tape-recorded story read by their mothers or by a female stranger, and 2 min of no sound while fetal heart rate was recorded. Results demonstrated that fetuses in the normotensive group had heart rate accelerations during the playing of their mother's voice, whereas the response occurred in the hypertensive group following maternal voice offset. Across all fetuses, a greater fetal heart rate change was observed when the amniotic fluid index was above compared to below the median (i.e., 150 mm), indicating that amniotic fluid volume may be an independent moderator of fetal auditory sensitivity. It was concluded that differential fetal responding to the mother's voice in pregnancies complicated by maternal hypertension may reflect functional elevation of sensorineural threshold or a delay in auditory system maturation, signifying functional differences during fetal life or subtle differences in the development of the central nervous system.

Histologic and Ultrastructural Studies of Juvenile Onset Renal Disease in Four Rottweiler Dogs

Juvenile onset renal disease is described in 2 male and 2 female young Rottweiler dogs. Histologic changes in all dogs were cystic dilatation of Bowman's space, mesangial hypercellularity, and glomerulosclerosis. Three dogs also had glomerular crescents and moderate to severe interstitial fibrosis. Electron microscopy revealed glomerular basement membranes of variable thickness, with extensive splitting or lamellation of the lamina densa. These ultrastructural findings are similar to those found in people and in other breeds of dogs with inherited defects in type IV collagen.

Extramedullary Plasmacytoma of the Salivary Gland in Two Syrian Hamsters (Mesocricetus auratus)

Two Syrian hamsters developed marked swelling of the ventral neck. Histologic examination of both masses revealed that the submaxillary salivary glands were effaced by large numbers of neoplastic plasma cells. In one hamster, neoplastic cells had infiltrated the adjacent lymph node. The neoplastic cells expressed CD79a antigen and were negative for CD3, lambda, and kappa light chains. Ultrastructural features of neoplastic cells in the salivary gland of one hamster included abundant cytoplasmic rough endoplasmic reticulum profiles, and peripherally displaced nuclei that contained marginated heterochromatin, consistent with plasma cells. Salivary gland plasmacytomas are extremely rare in humans and have not previously been reported in nonhuman species. The occurrence of such neoplasms in two hamsters suggests that this species may be predisposed to developing tumors of this type.

Hypertensive Encephalopathy in Cats with Reduced Renal Function

The clinical, hemodynamic, and pathologic features of hypertensive encephalopathy in two cats with reduced renal mass are described. The cats developed a progressive syndrome of lethargy, ataxia, blindness, stupor, and seizures following an abrupt increase in blood pressure associated with a surgical reduction in renal mass. The cats had severe gross brain edema, evidenced by cerebellar changes of caudal coning and cranial displacement over the corpora quadrigemina and cerebral changes of widening and flattening of the gyri. Histologically, interstitial edema was most pronounced in the cerebral white matter. Hypertensive vascular lesions were present as hyaline arteriolosclerosis in one cat and hyperplastic arteriolosclerosis in the other. Rare foci of parenchymal microhemorrhages and necrosis were also observed. Systemic hypertension (especially severe or rapidly developing) accompanied by neurologic signs and the pathologic findings of diffuse brain edema with cerebral arteriolosclerosis are consistent with an etiologic diagnosis of hypertensive encephalopathy.

Variation among Pathologists in the Histologic Grading of Canine Cutaneous Mast Cell Tumors with Uniform Use of a Single Grading Reference

Ten veterinary pathologists independently assigned histologic grades to the same 60 canine cutaneous mast cell tumors using the Patnaik classifications. The degree of agreement in grading among the pathologists was compared with the degree of agreement among the same pathologists in a previous study, in which each pathologist used the reference for grading that he/she uses routinely. Mean agreement improved significantly from 50.3% to 62.1% with uniform use of the Patnaik classifications ( P = 0.00001), suggesting that there is value in uniform application of a single grading scheme for canine cutaneous mast cell tumors. Agreement among pathologists was still not 100%, suggesting that a more objective grading scheme should be developed and that other histologic indicators of prognosis should be investigated.

Predictors of Timely Access of Oncology Services and Advanced-Stage Cancer in an HIV-Endemic Setting

This study explored predictors of timely oncology care and whether being engaged in the medical system for HIV care improved time to access. According to records and interviews of cancer patients in Botswana, the median time from first symptom to specialized oncology care was 13 months. HIV status did not affect time to oncology care; however, advanced cancer stage and use of traditional medicine/healers was associated with earlier oncology access.

Background.

Three-quarters of cancer deaths occur in resource-limited countries, and delayed presentation contributes to poor outcome. In Botswana, where more than half of cancers arise in HIV-infected individuals, we sought to explore predictors of timely oncology care and evaluate the hypothesis that engagement in longitudinal HIV care improves access.

Methods.

Consenting patients presenting for oncology care from October 2010 to September 2014 were interviewed and their records were reviewed. Cox and logistic models were used to examine the effect of HIV and other predictors on time to oncology care and presentation with advanced cancer (stage III or IV).

Results.

Of the 1,146 patients analyzed, 584 (51%) had HIV and 615 (54%) had advanced cancer. The initial clinic visit occurred a mean of 144 days (median 29, interquartile range 0–185) after symptom onset, but subsequent mean time to oncology care was 406 days (median 160, interquartile range 59–653). HIV status was not significantly associated with time to oncology care (adjusted hazard ratio [aHR] 0.91, 95% confidence interval [CI] 0.79–1.06). However, patients who reported using traditional medicine/healers engaged in oncology care significantly faster (aHR 1.23, 95% CI 1.09–1.40) and those with advanced cancer entered care earlier (aHR 1.48, 95% CI 1.30–1.70). Factors significantly associated with advanced cancer included income <$50 per month (adjusted odds ratio [aOR] 1.35, 95% CI 1.05–1.75), male sex (aOR 1.45, 95% CI 1.12–1.87), and pain as the presenting symptom (aOR 1.39, 95% CI 1.03–1.88).

Conclusion.

Longitudinal HIV care did not reduce the substantial delay to cancer treatment. Research focused on reducing health system delay through coordination and navigation is needed.

Implications for Practice:

The majority (54%) of patients in this large cohort from Botswana presented with advanced-stage cancer despite universal access to free health care. Median time from first symptom to specialized oncology care was 13 months. For HIV-infected patients (51% of total), regular longitudinal contact with the health system, through quarterly doctor visits for HIV management, was not successful in providing faster linkages into oncology care. However, patients who used traditional medicine/healers engaged in cancer care faster, indicating potential for leveraging traditional healers as partners in early cancer detection. New strategies are urgently needed to facilitate diagnosis and timely treatment of cancer in low- and middle-income countries.

Chronic Kidney Disease in Aged Cats: Clinical Features, Morphology, and Proposed Pathogeneses

Chronic kidney disease (CKD) is the most common metabolic disease of domesticated cats, with most affected cats being geriatric (>12 years of age). The prevalence of CKD in cats exceeds that observed in dogs, and the frequency of the diagnosis of CKD in cats has increased in recent decades. Typical histologic features include interstitial inflammation, tubular atrophy, and fibrosis with secondary glomerulosclerosis. In contrast to people and dogs, primary glomerulopathies with marked proteinuria are remarkably rare findings in cats. Although a variety of primary renal diseases have been implicated, the disease is idiopathic in most cats. Tubulointerstitial changes, including fibrosis, are present in the early stages of feline CKD and become more severe in advanced disease. A variety of factors-including aging, ischemia, comorbid conditions, phosphorus overload, and routine vaccinations-have been implicated as factors that could contribute to the initiation of this disease in affected cats. Factors that are related to progression of established CKD, which occurs in some but not all cats, include dietary phosphorus intake, magnitude of proteinuria, and anemia. Renal fibrosis, a common histologic feature of aged feline kidneys, interferes with the normal relationship between peritubular capillaries and renal tubules. Experimentally, renal ischemia results in morphologic changes similar to those observed in spontaneous CKD. Renal hypoxia, perhaps episodic, may play a role in the initiation and progression of this disease.

Relationship between oxidative stress and haematological indices in patients with diabetes in the Ghanaian population

Background

Persistent hyperglycaemia is a hallmark of Diabetes Mellitus (DM). It causes increased production of free radicals, especially reactive oxygen species (ROS), — resulting in oxidative stress. Reactive Oxygen Species have been implicated in the development of haematological complications in patients with diabetes. Superoxide Dismutase (SOD) is one of the most effective antioxidant enzyme defense systems against free radicals.

Methods

From February through May 2014, we assessed the relationship between oxidative stress and haematological profiles among individuals with and without diabetes. A cross sectional study of 66 case patients and 44 age-matched controls were recruited from the National Diabetes Management and Research Centre (NDMRC), Korle-Bu Teaching Hospital, Accra, Ghana. Blood samples were obtained from study participants with consent. We determined the haematological profiles of study participants and measured their oxidative stress levels using a standardized kit for SOD activity.

Results

Higher white blood cell (WBC) counts were seen in the diabetes cohort (p-value = 0.023). The SOD activity tended to be lower in diabetes patients (p–value = 0.144 however) while higher neutrophil levels seemed to correlate with SOD activity (R = 0.249; R² = 6.2 %; p-value = 0.049). There did not appear to be a correlation between fasting blood glucose (FBG) and SOD activity (R = −0.044; p-value = 0.727).

Conclusion

The study reports similar oxidative stress levels, as measured by SOD activity, in diabetic and non-diabetic adults. The SOD activity did not appear to correlate with FBG and several other haematological parameters. Further study would be required to investigate the relationship between these haematological indices and diabetic micro- and macro-vascular complications in our population.

World Small Animal Veterinary Association Renal Pathology Initiative: Classification of Glomerular Diseases in Dogs

Evaluation of canine renal biopsy tissue has generally relied on light microscopic (LM) evaluation of hematoxylin and eosin-stained sections ranging in thickness from 3 to 5 µm. Advanced modalities, such as transmission electron microscopy (TEM) and immunofluorescence (IF), have been used sporadically or retrospectively. Diagnostic algorithms of glomerular diseases have been extrapolated from the World Health Organization classification scheme for human glomerular disease. With the recent establishment of 2 veterinary nephropathology services that evaluate 3-µm sections with a panel of histochemical stains and routinely perform TEM and IF, a standardized objective species-specific approach for the diagnosis of canine glomerular disease was needed. Eight veterinary pathologists evaluated 114 parameters (lesions) in renal biopsy specimens from 89 dogs. Hierarchical cluster analysis of the data revealed 2 large categories of glomerular disease based on the presence or absence of immune complex deposition: The immune complex-mediated glomerulonephritis (ICGN) category included cases with histologic lesions of membranoproliferative or membranous patterns. The second category included control dogs and dogs with non-ICGN (glomerular amyloidosis or focal segmental glomerulosclerosis). Cluster analysis performed on only the LM parameters led to misdiagnosis of 22 of the 89 cases-that is, ICGN cases moved to the non-ICGN branch of the dendrogram or vice versa, thereby emphasizing the importance of advanced diagnostic modalities in the evaluation of canine glomerular disease. Salient LM, TEM, and IF features for each pattern of disease were identified, and a preliminary investigation of related clinicopathologic data was performed.

Level of male infertility in the Ghanaian city of Tema

Infertility among couples is a sensitive issue in Ghana; females are mostly blamed. Most male infertility cases are generally due to low sperm counts (oligozoospermia), poor sperm quality - characterised by poor sperm motility (asthenozoospermia) - or a combination of both (oligoasthenozoospermia). This is a retrospective study from January 1995 to December 2005 which determined the level and type of male infertility in and around the city of Tema. Seminal fluid analysis reports of male clients who visited the Adom Medical Laboratory in Tema were extracted from laboratory data and analysed. Our study involved 2795 males in the age range of 24-36 years. In 1995, 75% of the total samples analysed had sperm concentrations ranging from 21 to 350 million sperms/ml and showed a decreasing trend to 41% in 2005. Samples with sperm concentrations below 20 million sperms/ml in 1995 increased from 20.5% to 57.6% in 2005; those with active motility > 45% decreased from 27 (30.7%) in 1995 to zero (0%) in 2005, whilst samples with > 50% non-motile sperms increased from 47 (53.4%) in 1995 to 449 (87.7%) in 2005. Male infertility in the samples analysed was due to a combination of oligozoospermia and asthenozoospermia.

Effect of Plasmodium falciparum malaria parasites on haematological parameters in Ghanaian children

Malaria is hyper-endemic in Ghana. Haematological alterations in the disease pathology may offer complimentary criteria to improve clinical and microscopy diagnosis. Our primary outcome was to evaluate haematological parameters in children with Plasmodium falciparum infections and report their predictive risk and diagnostic performance for malaria infections in Ghana. Haematological data, including thin and thick blood films were examined for children less than 12 years of age in a multicenter-based active case finding approach. Haematological changes were common in P. falciparum infected children and more pronounced in severe malaria cases. More so, a unit increase in parasiteamia increased the odds for severe malaria infection by 93 % [OR, 95 % CI: 1.93 (1.28-2.91); P value = 0.02]. In multivariate regression, low haemoglobin was a significant haematological change in predicting P. falciparum infections [OR, 95 % CI: 3.20 (1.26-7.09); P value = 0.001]. Low haemoglobin levels <11 g/dl was the most reliable indicator for P. falciparum infections [with a sensitivity of (64 %), specificity (71 %), positive predictive value (83 %) and likelihood ratio (2.2)]-even when evaluated in combination with leucocytosis, lymphocytopaenia and high neutrophil counts >7,500 µL. In malaria endemic settings, low haemoglobin concentration (<11 g/dl) in children with febrile illness should prompt a more diligent search for the malarial parasite to limit the misuse and abuse of anti-malarial drugs.

Human papillomavirus genotypes in a subset of head and neck squamous cell carcinoma

BACKGROUND

Squamous cell carcinoma originating from the oral cavity, lip, larynx and pharynx are grouped under head and neck squamous cell carcinomas (HNSCC).

OBJECTIVE

To report on human papillomavirus (HPV) genotypes involved in HNSCC.

STUDY DESIGN

A retrospective review of archival HNSCC specimens and patient demographic and clinical data accessioned between January, 2007 and December, 2009 in the Department of Pathology, Korle-Bu Teaching Hospital, Accra, Ghana.

RESULTS

Cases from 58 males and 20 females included 29 from the oral cavity, 33 from the larynx, 11 from the pharynx and 5 from the parotid gland. HPV DNA was found in 15 (19.23%) of the tumors with 12 being HPV-16, 2 HPV-18 and 1 dual infection with HPV-16 and HPV-18, giving HPV-16 prevalence of 86.7%. Higher prevalence of HPV DNA was found in males than females. There was a trend towards subjects younger than 58 years being more likely to have HPV-positive tumors.The 15 HPV-positive cases were distributed in location as 8 of 33 (24.2%) from the larynx, 4 of 29 (13.8%) from the oral cavity, and 2 of 11 (18.2%) from the pharynx and 1 of 5 (20%) from the parotid gland.

CONCLUSION

Oncogenic HPV infection was found in 19.23% of HNSCCs, with genotype 16 predominating. HPV-related HNSCC tended to occur at younger age compared to non-HPV-related HNSCC. The commonest site for HPV-associated HNSSC in Ghana is the larynx, rather than the oropharynx as reported in other studies. Host factors may be responsible for the site difference and more work is required to further elucidate this.

Metabolic and embryonic responses to terrestrial incubation of Fundulus grandis embryos across a temperature gradient

This study simulated terrestrial incubation and measured rates of embryogenesis, nitrogen elimination, heart rate, lactate production, maximum length of time a hatch could be delayed and developmental responses of terrestrially incubated Gulf killifish Fundulus grandis embryos at temperatures ranging from 20 to 30° C. Temperature had a positive relationship with rate of embryogenesis, but a negative relationship with extent of extended incubation. The 30° C treatment reached embryonic maturity 6 days before the 20° C treatment. Embryos hatched between intervals of 240 and 336, 144 and 288, 96 and 240 and 96 and 192 h after reaching developmental maturity for the 20, 23, 26 and 30° C treatments. Significantly higher concentrations of total nitrogen, in the form of ammonia and urea, were recorded in the 20 and 30° C treatments. While temperature significantly influenced lactate and ATP concentrations, no significant influence of time of incubation was detected. Terrestrial embryos displayed an ability to develop quickly during embryogenesis and prolong incubation for an extended period of time after reaching embryonic maturity. This adaptation may be a life-history trait used to minimize asynchronous hatching, cannibalism and cohort size heterogeneity.

Prevalence of hepatitis d infection in patients with hepatitis B virus-related liver diseases in Accra, Ghana

BACKGROUND

Hepatitis D virus (HDV), a defective RNA virus which depends on hepatitis B virus (HBV) for its replication and expression, appears to be highly pathogenic and modifies the natural history of HBV infection. Two types of infection, co-infection and super-infection are recognised. During infection, anti-delta antibodies appear in serum and can be detected by Enzyme linked Immunosorbent Assay (ELISA).

OBJECTIVE

We determined the prevalence of hepatitis D infection amongst HBsAg-positive patients with HBV-related liver diseases in Accra, Ghana using an Enzyme linked Immunosorbent assay (ELISA) method.

METHODS

We collected blood samples from 53 patients with hepatitis B-related liver diseases. The sera were analysed using a commercially available kit, the EIA-ANTI-HDV, a third generation ELISA kit (Globe Diagnostics, Italy).

RESULTS

There were 39 males (73.6%) and 14 females (26.4%) giving a male:female ratio of about 3:1.The mean age of patients was 38.6 years (range, 15-75). Six patients were reactive for anti-delta antibodies, yielding a HDV sero-prevalence of 11.3%. A higher proportion of males were anti-HDV positive (9.4%) compared to females (1.9%) but the difference was not statistically significant (p=0.350). Anti-HDV was detected in 4(22.2%) patients with chronic hepatitis B, 1(7.6%) with cirrhosis of the liver and 1(5.3%) with hepatocellular carcinoma.

CONCLUSION

The prevalence of HDV infection amongst patients with liver disease in Accra with HBV-related liver diseases appears to be high compared to developed countries but similar to several developing countries. No significant difference exists in gender prevalences. A concerted public health effort is required to reduce this high prevalence rate.

Histomorphometry of feline chronic kidney disease and correlation with markers of renal dysfunction

Chronic kidney disease is common in geriatric cats, but most cases have nonspecific renal lesions, and few studies have correlated these lesions with clinicopathological markers of renal dysfunction. The aim of this study was to identify the lesions best correlated with renal function and likely mediators of disease progression in cats with chronic kidney disease. Cats were recruited through 2 first-opinion practices between 1992 and 2010. When postmortem examinations were authorized, renal tissues were preserved in formalin. Sections were evaluated by a pathologist masked to all clinicopathological data. They were scored semiquantitatively for the severity of glomerulosclerosis, interstitial inflammation, and fibrosis. Glomerular volume was measured using image analysis; the percentage of glomeruli that were obsolescent was recorded. Sections were assessed for hyperplastic arteriolosclerosis and tubular mineralization. Kidneys from 80 cats with plasma biochemical data from the last 2 months of life were included in the study. Multivariable linear regression (P < .05) was used to assess the association of lesions with clinicopathological data obtained close to death. Interstitial fibrosis was the lesion best correlated with the severity of azotemia, hyperphosphatemia, and anemia. Proteinuria was associated with interstitial fibrosis and glomerular hypertrophy, whereas higher time-averaged systolic blood pressure was associated with glomerulosclerosis and hyperplastic arteriolosclerosis.

Dopamine pathway loss in nucleus accumbens and ventral tegmental area predicts apathetic behavior in MPTP-lesioned monkeys

Apathy, primarily defined as a lack of motivation, commonly occurs in people with Parkinson disease (PD). Although dysfunction of basal ganglia pathways may contribute to apathy, the role of dopamine remains largely unknown. We investigated the role of dopaminergic pathways in the manifestation of apathetic behaviors by measuring the effects of the selective dopaminergic neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) on monkeys' willingness to attempt goal directed behaviors, distinct from their ability to perform tasks. Fifteen macaques received variable doses of MPTP, had PET scans with [(11)C]-dihydrotetrabenazine (DTBZ), [(11)C]-2β-3β-4-fluorophenyltropane (CFT), and [(18)F]-fluorodopa (FD) and performed tasks to assess apathetic behaviors and motor impairment. At 8 weeks post-MPTP, primates were euthanized and stereological cell counts and dopamine measurements were done. Apathy scores were compared to motor scores, in vitro and in vivo dopaminergic measures. Apathy scores increased following MPTP and correlated with DTBZ (r(S) = -0.85), CFT (r(S) = -0.87), and FD (r(S) = -0.85) specific uptake in nucleus accumbens (NAcc,) and dopaminergic cell counts in ventral tegmental area (VTA, r(S) = -0.80). Dopaminergic cell loss in VTA provided significant predictive power for apathy scores after controlling for the influence of cell loss in SN. Additionally, forward step-wise regression analyses indicated that neuropathological changes in the VTA-NAcc pathway predict apathetic behavior better than motor impairment or neuropathological changes in the nigrostriatal network. Our findings suggest that dopaminergic dysfunction within the VTA-NAcc pathway plays a role in the manifestation of apathetic behaviors in MPTP-lesioned primates. Similar changes in people with PD may contribute to apathy.

Mindfulness meditation-related pain relief: evidence for unique brain mechanisms in the regulation of pain

The cognitive modulation of pain is influenced by a number of factors ranging from attention, beliefs, conditioning, expectations, mood, and the regulation of emotional responses to noxious sensory events. Recently, mindfulness meditation has been found attenuate pain through some of these mechanisms including enhanced cognitive and emotional control, as well as altering the contextual evaluation of sensory events. This review discusses the brain mechanisms involved in mindfulness meditation-related pain relief across different meditative techniques, expertise and training levels, experimental procedures, and neuroimaging methodologies. Converging lines of neuroimaging evidence reveal that mindfulness meditation-related pain relief is associated with unique appraisal cognitive processes depending on expertise level and meditation tradition. Moreover, it is postulated that mindfulness meditation-related pain relief may share a common final pathway with other cognitive techniques in the modulation of pain.

Antagonists show GTP-sensitive high-affinity binding to the sigma-1 receptor

BACKGROUND AND PURPOSE

Sigma-1 receptors are atypical receptors with potentially two transmembrane domains. Antagonists require doses significantly higher than their published affinities to have biological effects. We have reassessed the binding characteristics of these ligands and found antagonists bind to high- and low-affinity states not distinguished by agonists.

EXPERIMENTAL APPROACH

The affinities of sigma-1 receptor ligands was assessed using radioligand saturation and competition binding of [³H]-(+)-pentazocine to permeabilized MDA-MB-468 cells. This was compared with the effect of ligands on metabolic activity using an MTS-based assay and calcium signalling using cells loaded with the calcium dye, Fura-2.

KEY RESULTS

Sigma-1 receptor antagonists, but not agonists, show GTP- and suramin-sensitive high-affinity binding. Functional responses (calcium signalling and metabolic activity), while associated with sigma-1 receptor binding, required binding to an unidentified, low-affinity target.

CONCLUSIONS AND IMPLICATIONS

Sigma-1 receptors are coupled to G proteins. This interaction is only observed when analysing antagonist binding. The identity of the G protein remains to be resolved. The concept of agonist and antagonist at the sigma-1 receptor needs to be revisited.

Heart rate variability response to standing in men and women receiving d,l-sotalol following coronary artery bypass graft surgery

Heart rate variability (HRV), a quantitative marker of autonomic control of heart rate (HR), declines in men and women following coronary artery bypass graft (CABG) surgery. Although d,l-sotalol is prescribed following CABG surgery primarily for its antiarrhythmic effect, its effects on HRV have not been reported; the β-adrenergic antagonist effect of d,l-sotalol may attenuate sympathetically mediated HR and blood pressure (BP) responses to standing, resulting in postural hypotension. In this study, the HRV response to standing 4 days following CABG surgery in men and women prescribed d,l-sotalol was measured to examine the influence of d,l-sotalol on previously reported HRV responses, taking age and gender into consideration. Participants included 28 men and 10 women who completed testing in supine and standing postures; all had received low-dose d,l-sotalol daily since the first postoperative day. Data included continuous electrocardiograph recording of R-R interval for 10 min in each posture. Participants showed significant effects of standing on the autonomic modulation of HR, as seen by a decrease in parasympathetic indices and R-R interval and an increase in BP. In men, standing decreased parasympathetic modulation and increased the sympathetic nervous system indicator, but previously reported age effects were not seen. In women, standing decreased low frequency power and R-R interval and increased BP, with older women having a smaller increase in BP, suggesting an attenuated response. The differential autonomic nervous system modulation of HR as a function of gender and age after CABG surgery may be attenuated by d,l-sotalol.

Bond lengths in free molecules of buckminsterfullerene, c60, from gas-phase electron diffraction

Electron diffraction patterns of the fullerene C(60) in the gaseous state have been obtained by volatilizing it from a newly designed oven-nozzle at 730 degrees C. The many peaks of the experimental radial distribution curve calculated from the scattered intensity are completely consistent with icosahedral symmetry for the free molecule. On the basis of this symmetry assumption, least-squares refinement of a model incorporating all possible interatomic distances led to the values r(g)(C(1)-C(2)) = 1.458(6) angstroms (A) for the thermal average bond length within the five-member ring (that is, for the bond fusing five- and six-member rings) and r(g)(C(1)-C(6)) = 1.401(10) A for that connecting five-member rings (the bond fusing six-member rings). The weighted average of the two bond lengths and the difference between them are the values 1.439(2) A and 0.057(6) A, respectively. The diameter of the icosahedral sphere is 7.113(10) A. The uncertainties in parentheses are estimated 2sigma values.

On discovering relevant scales in surface roughness measurement--an evaluation of a band-pass method

When characterizing surfaces and searching for correlations to functional properties, such as friction, finding the right scale of roughness for evaluation can improve correlations. However, in traditional roughness parameter analysis, a wide range of scales, or all scales of topography in the surface roughness measurements are evaluated together. In this study a multi-scale method using a series of band-pass filters is employed for finding scales of topography with strong correlations to friction.

Investigation of surface topography differences in native and exotic invertebrates in the St. Lawrence River

The texture, or topography, interior of shells from native and exotic mollusks are measured and compared to determine if they can be discriminated. Area-scale fractal analysis is used to calculate relative areas as a function of scale, and the relative areas are used to evaluate the measurements. Measurements from a scanning laser profiler and from confocal and interferometric microscopes are compared, as are measurements of an original and a replica. The relative areas indicate clear differences between the measurement instruments. The largest relative areas are calculated from the confocal measurements. The trueness of the measurements has not been determined. However, the relative areas calculated from the confocal measurements are capable of discriminating the native clam from the exotic mussels with a confidence of greater than 99% at scales below 10 µm².

The impact of the Cartwright Report upon the regulation, discipline and accountability of medical practitioners in New Zealand

The Cartwright Report instigated a profound change in thinking about patient-doctor relationships and the need for public involvement in the processes by which doctors are censored. It was also the key catalyst to legislative reforms designed to ensure the accountability of practitioners to their patients. This article considers the effect of the Cartwright Report on the incidence of disciplinary hearings against medical practitioners in New Zealand. Perhaps contrary to expectations, the statistics show a pronounced decline in disciplinary hearings. The authors argue that this should not necessarily be considered an adverse development, and that these statistics in fact reflect the working of multi-layered, more constructive and open processes for regulating doctors and holding them accountable.

Aleutian disease in two domestic striped skunks (Mephitis mephitis)

This report describes the use of polymerase chain reaction and DNA in situ hybridization to diagnose Aleutian mink disease parvovirus DNA in various tissue specimens from 2 companion striped skunks. Clinical, laboratory, and microscopic findings also support a clinical diagnosis of Aleutian disease in these mink.

Endoscopic retrograde cholangiopancreatography after a liquid fatty meal: effect on deep common bile duct cannulation time

BACKGROUND AND STUDY AIM

Endoscopic retrograde cholangiopancreatography (ERCP) is an important gastrointestinal endoscopic procedure in the study and treatment of pancreaticobiliary diseases. The critical step of the procedure is cannulation of the common bile duct (CBD) and/or the pancreatic duct. Cannulation can be a technical challenge at times. Fat is a natural stimulator for bile secretion and relaxation of the sphincter of Oddi. The objective of this study was to determine the effect of a liquid fatty meal on deep CBD cannulation during ERCP.

PATIENTS AND METHODS

We performed a randomized double-blind study in 84 patients to examine the effect of a liquid fatty meal on deep CBD cannulation during ERCP, in a teaching medical center. In the study group, each patient had a liquid fatty meal orally about 1 hour before the procedure. In the control group, each patient had the same volume of a non-fat meal. The appearance of the major papilla, the cannulation rate, the cannulation time, and the fluoroscopy time during cannulation were compared for the two groups.

RESULTS

The orifice of the CBD/pancreatic duct was much more easily identified in the group who ingested the fatty meal. Compared with the non-fat meal group, in the fatty meal group the mean and the median deep CBD cannulation times were shorter, at 8.0 minutes vs. 14.7 minutes ( P = 0.005) and 8.0 minutes vs. 11.5 minutes ( P = 0.008), respectively. Additionally, in the fatty meal group, the mean and the median fluoroscopy times during deep CBD cannulation were lower, at 3.3 minutes vs. 6.1 minutes ( P = 0.040) and 2.5 minutes vs. 3.9 minutes ( P = 0.013), respectively. There were no complications, such as aspiration, associated with the liquid meals given shortly before the ERCP procedure.

CONCLUSIONS

To avoid prolonged cannulation and unnecessary radiation exposure, patients should have a liquid fatty meal before ERCP procedures.

Migraine and other headaches: associations with Rose angina and coronary heart disease

OBJECTIVE

To examine the association between a lifetime history of migraines and other headaches with and without aura and Rose angina and coronary heart disease (CHD).

METHODS

Participants were 12,409 African American and white men and women from the Atherosclerosis Risk in Communities Study, categorized by their lifetime history of headaches lasting > or =4 hours (migraine with aura, migraine without aura, other headaches with aura, other headaches without aura, no headaches). Gender-specific associations of headaches with Rose angina and CHD, adjusted for sociodemographic and cardiovascular disease risk factors, were evaluated using Poisson regression.

RESULTS

Participants with a history of migraines and other headaches were more likely to have a history of Rose angina than those without headaches. The associations were stronger for migraine and other headaches with aura (prevalence ratio [PR] = 3.0, 95% CI = 2.4, 3.7 and PR = 2.0, 95% CI = 1.5, 2.7 for women; PR = 2.2, 95% CI = 1.2, 3.9 and PR = 2.4, 95% CI = 1.4, 3.9 for men) than for migraine and other headaches without aura (PR = 1.5, 95% CI = 1.2, 1.9 and PR = 1.3, 95% CI = 1.1, 1.6 for women; PR = 1.9, 95% CI = 1.2, 2.9 and OR = 1.4, 95% CI = 1.0, 1.8 for men). In contrast, migraine and other headaches were not associated with CHD, regardless of the presence of aura.

CONCLUSIONS

The lack of association of migraines with coronary heart disease suggests that the association of migraine with Rose angina is not related to coronary artery disease. Future research assessing other common underlying pathologic mechanisms is warranted.

Maternal cardiac autonomic function and fetal heart rate in preeclamptic compared to normotensive pregnancies

BACKGROUND

Preeclampsia during pregnancy increases a woman's risk of cardiovascular disease in two ways. Women who develop preeclampsia are at increased risk for the development of hypertension and cardiovascular disease later in life. As well, fetal adaptations (e.g., growth restriction) may lead to the development of cardiovascular risk factors (e.g., obesity, increased cholesterol) in the offspring. Although atypical maternal cardiac autonomic function has been reported in preeclampsia, to date, its effects on fetal cardiac function have not been determined.

PURPOSE

To characterize the pattern of short-term maternal cardiac autonomic modulation and spontaneous fetal heart rate changes in preeclamptic compared to normotensive women and to determine the relationship between them.

METHOD

Twenty-seven mother-fetal pairs (n = 9 preeclamptic, n = 18 normotensive) at 32 to 40 weeks gestation were tested on one occasion. Maternal autonomic modulation of heart rate was measured for 20 minutes using electrocardiographic and beat-by-beat arterial systolic blood pressure recordings. Simultaneously, spontaneous fetal heart rate was obtained using a cardiotachograph. Women's cardiac autonomic responses to orthostatic stress were obtained for five minutes in a standing position.

RESULTS

Comparisons of maternal cardiac measures in the preeclamptic versus the normotensive group showed that the preeclamptic group had a decreased parasympathetic nervous system indicator and an increased sympathetic nervous system indicator with increasing gestation. In response to orthostatic stress, women in both groups showed a similar increase in arterial systolic blood pressure and a decrease in parasympathetic nervous system indicator and R-R interval when standing compared to lying. Fetuses in the normotensive compared to the preeclamptic group had more spontaneous fetal heart rate accelerations; the greater the decrease in the parasympathetic nervous system indicator from lying to standing, the greater the number of fetal heart rate accelerations.

CONCLUSIONS

These findings serve to further our understanding of the cardiovascular pathophysiology of preeclampsia in both the mother and the fetus. Women who develop preeclampsia during pregnancy show atypical autonomic nervous system modulation of heart rate that is associated with a decrease in spontaneous fetal heart rate accelerations in late gestation. Implications for cardiovascular nursing practice include the monitoring of maternal cardiac autonomic function during pregnancy, especially during standing, as well as a need for continued surveillance of maternal cardiovascular function following pregnancy. The negative effect on fetal heart rate accelerations has implications for the interpretation of standardized obstetrical tests of fetal well-being.

Infant schistosomiasis in Ghana: a survey in an irrigation community

We used a rapid, visually read, field applicable monoclonal antibody (MoAb)-dipstick assay for specific diagnosis of urinary schistosomiasis together with microscopy to determine the prevalence of infant schistosomiasis in a community in the Awutu-Efutu Senya District in the Central Region of Ghana. The study group consisted of 97 infants (51 males and 46 females) aged 2 months to 5 years. A total of 75 of 97 (77.3%) subjects submitted stool samples; none had Schistosoma mansoni. Three individuals (3.1%) had hookworms but there were no other intestinal helminths. The urinary schistosomiasis prevalence by MoAb-dipstick (30%) was higher (P < 0.05) than that estimated by microscopy (11.2%). However, three of nine (33.3%) microscopically confirmed cases tested MoAb-dipstick positive after pre-treatment of the urine specimen with heat. The youngest infant to be found infected with S. haematobium microscopically was 4 months old. Fifteen of 71 S. haematobium egg negative individuals tested dipstick positive, giving a dipstick specificity of 78.9% as compared with microscopy as gold standard test. The relative sensitivity of the dipstick was 100%.