A Rare Case of Severe Burn Injury to the Oropharynx Caused by a Flare Gun

Flare gun injuries are rare, and patients often present with complex trauma that may require multiple operative interventions. Our objective is to explore a case of a 15-year-old male, who presented with second-degree flame burns to the face, left upper extremity and bilateral hands, as well as third-degree burns to the oropharynx and a tongue laceration after a flare gun was discharged into his mouth. The patient underwent multiple debridements of the oral cavity and oropharynx, and his hospital course was complicated by an intra-oral abscess. He eventually made a full recovery and was discharged. This case not only illustrates the need for early operative intervention, but it also underscores the need for awareness campaigns that highlight the dangers of flare guns and similar devices.

Attachment patterns and autobiographical episodic memory functioning: A systemic review of adult studies to advance clinical psychological science

Patterns of insecure attachment are associated with psychopathology but the mechanisms involved remain poorly understood. Cognitive science proposes that attachment patterns are influenced by the autobiographical memory system and in turn influence its ongoing functioning. Disturbances in autobiographical memory represent cognitive risks for later emotional difficulties. We systemically reviewed 33 studies (in 28 articles) examining the association between attachment patterns and autobiographical episodic memory (AEM) in individuals from the age of 16 (i.e., from young to older adulthood). Attachment patterns were associated with key areas of AEM phenomenology, including intensity and arousal; detail, specificity, and vividness; coherence and fragmentation; and accuracy and latency. These associations appeared to be moderated by contextual and individual factors; mediated by emotional regulation and schema-based processing; linked to mental health outcomes. Attachment patterns may also influence the impact of certain AEM-based manipulations. We conclude by providing a critical discussion and a research agenda for bringing together attachment, memory, and emotion, with a view to promote mechanism-driven treatment innovation in clinical psychology.

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.

Black oil sunflower seed ingestion associated with renal azotemia, gastroesophageal ulceration, and a high mortality rate in four alpacas and two llamas

CASE DESCRIPTION

4 alpacas and 2 llamas (11 months to 11 years old) from 2 properties were examined for lethargy (6/6), salivation and regurgitation (4/6), and recumbency (3/6). Signs developed approximately 48 to 72 hours after accidental access to black oil sunflower seeds.

CLINICAL FINDINGS

3 alpacas died suddenly prior to treatment and were necropsied. One llama survived, and 1 alpaca and 1 llama died after days of medical treatment. All 3 treated animals had systemic inflammatory signs including tachycardia, fever, and hematologic changes. Biochemical anomalies included azotemia, hyperglycemia, hyponatremia, hypochloremia, and hypoalbuminemia. Necropsy identified numerous sunflower seeds in the gastrointestinal tract of all 5 animals that died, with pulmonary congestion (5/5 animals), mild centrilobular vacuolar hepatic degeneration (4/5), and erosions of the esophagus (3/5) and first (3/5) and third (1/5) compartments of the forestomach. Renal tubular necrosis was found in the 2 animals that died on day 4 of treatment.

TREATMENT AND OUTCOME

One llama responded successfully to intensive medical management including supplemented IV fluid therapy, oral and partial parenteral nutrition, and administration of antimicrobials, furosemide, and insulin and was clinically normal with plasma biochemical analysis values within reference range 12 weeks later. Vitamin D, oxalates, heavy metals, and mycotoxins were excluded as the cause of clinical signs on the basis of screening of uneaten seeds and tissue samples and gastric content from the treated llama that died.

CLINICAL RELEVANCE

Inadvertent large volume black oil sunflower seed ingestion resulted in a high mortality rate in camelids. A specific toxic principle was not identified. Feeding this product to camelids is not recommended to avoid the risk of accidental overingestion and subsequent disease.

Prevalence and impact of cholecystitis on outcome in dogs with gallbladder mucocele

BACKGROUND

Gallbladder mucocele is a potentially life-threatening extrahepatic biliary disease in dogs. The primary aims of this study were to evaluate the prevalence of cholecystitis in dogs with gross and histopathologically confirmed gallbladder mucocele and to investigate if there is an association between cholecystitis, including its subtypes (eg, acute, acute on chronic, with necrosis, chronic), and survival. Our secondary objective was to evaluate if there is an association between cholecystitis and intraoperative bacteriological culture positivity.

KEY FINDINGS

Two hundred nineteen dogs with gallbladder mucocele were included in this multi-institutional retrospective study, of which 63 (28.8%) dogs had histopathological evidence of cholecystitis. The most common forms of cholecystitis were acute on chronic (n = 22/63, 34.9%) and with necrosis (n = 20, 31.7%). Thirty-one (14.1%) dogs had growth of at least 1 bacterial isolate; however, 88.7% had antimicrobials administered within the 48 hours before surgery or intraoperatively. There was not an association between cholecystitis or its subtypes and survival. Furthermore, there was not an association between cholecystitis and intraoperative bacteriological culture positivity. A total of 38 (17.4%) dogs either died or were euthanized during hospitalization.

SIGNIFICANCE

Cholecystitis is a common comorbidity in dogs with gallbladder mucocele but was not associated with decreased survival.

Public health delivery in the information age: the role of informatics and technology

AIM

Public health systems have embraced health informatics and information technology as a potential transformational tool to improve real-time surveillance systems, communication, and sharing of information among various agencies. Global pandemic outbreaks like Zika and Ebola were quickly controlled due to electronic surveillance systems enabling efficient information access and exchange. However, there is the need for a more robust technology to enhance adequate epidemic forecasting, data sharing, and effective communication. The purpose of this review was to examine the use of informatics and information technology tools and its impact on public health delivery.

METHOD

Investigators searched six electronic databases. These were MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Cochrane Database of Systematic Reviews, COMPENDEX, Scopus, and Academic Search Premier from January 2000 to 31 March 2016.

RESULTS

A total of 60 articles met the eligibility criteria for inclusion. These studies were organized into three areas as (1) definition of the term public health informatics; (2) type of public health surveillance systems and implications for public health; and (3) electronic surveillance systems functionality, capability, training, and challenges. Our analysis revealed that due to the growing expectations to provide real-time response and population-centered evidence-based public health in this information-driven age there has been a surge in informatics and information technology adoption. Education and training programs are now available to equip public health students and professionals with skills in public health informatics. However, obstacles including interoperability, data standardization, privacy, and technology transfer persist.

CONCLUSION

Re-engineering the delivery of public health is necessary to meet the demands of the 21st century and beyond. To meet this expectation, public health must invest in workforce development and capacity through education and training in informatics.

An outbreak of Mycoplasma mycoides subspecies capri arthritis in young goats: a case study

Mycoplasmosis is a well-known cause of morbidity and mortality in small ruminants. Previously recognized outbreaks have involved arthritis, and pneumonia or pleuropneumonia. Modern bacteriology procedures rely less on isolation techniques that require special media for mollicutes given that these species are notoriously difficult to isolate, and rely more on PCR tests. We report an outbreak of arthritis, pleuropneumonia, and mild meningitis affecting dairy goat kids, spanning a period of 3 y, which had unusual epidemiologic characteristics related to husbandry practices. Lesions were characterized by polyarthritis of the appendicular joints, with copious joint fluid and extension of arthritic exudate beyond the joint itself. The cause remained unknown until serendipitous isolation of a mycoplasma on blood agar. Mycoplasmosis was not detected from synovial samples by a general mycoplasma PCR, despite multiple attempts. Isolated colonies were also negative by this general PCR assay. The isolate was identified as Mycoplasma mycoides subspecies capri, using universal 16S primers and amplicon sequencing. Testing of additional isolates from other diseased goats in the herd confirmed that this was the cause of illness. A failure to recognize the distinct nature of organisms of the M. mycoides group of mycoplasmas meant that a PCR test that cannot detect this group of organisms was utilized at first, and the etiology of the illness was overlooked for a period of time. Veterinary pathologists and microbiologists must be aware of the limitations of some PCR assays when confronted with joint disease and pleuropneumonia in small ruminants.

Biosurveillance: a systematic review of global infectious disease surveillance systems from 1900 to 2016

Biosurveillance is crucial to detect, identify and minimise the negative consequences of infectious disease. Its value to society and importance to global public health and global health security are growing. Despite the long history and global importance of biosurveillance, a systematic review of all existing biosurveillance systems across the 'One Health' spectrum has not yet been published. This study conducted a systematic review to identify all extant and defunct biosurveillance systems from 1900 to 2016. Of the 815 systems examined, the majority surveyed human, animal or plant data discretely. Some 105 collected human and animal data, whereas only 31 collected data on all three categories. The authors found a large increase in the number of global biosurveillance systems between 1900 and 2008, but a reduction in the number of biosurveillance systems from 2008 to the present. The number of syndromic systems created, versus laboratory-based biosurveillance systems, increased rapidly after 1980 across the globe.

A GWAS meta-analysis from 5 population-based cohorts implicates ion channel genes in the pathogenesis of irritable bowel syndrome

BACKGROUND

Irritable bowel syndrome (IBS) shows genetic predisposition, however, large-scale, powered gene mapping studies are lacking. We sought to exploit existing genetic (genotype) and epidemiological (questionnaire) data from a series of population-based cohorts for IBS genome-wide association studies (GWAS) and their meta-analysis.

METHODS

Based on questionnaire data compatible with Rome III Criteria, we identified a total of 1335 IBS cases and 9768 asymptomatic individuals from 5 independent European genotyped cohorts. Individual GWAS were carried out with sex-adjusted logistic regression under an additive model, followed by meta-analysis using the inverse variance method. Functional annotation of significant results was obtained via a computational pipeline exploiting ontology and interaction networks, and tissue-specific and gene set enrichment analyses.

KEY RESULTS

Suggestive GWAS signals (P ≤ 5.0 × 10^-6 ) were detected for 7 genomic regions, harboring 64 gene candidates to affect IBS risk via functional or expression changes. Functional annotation of this gene set convincingly (best FDR-corrected P = 3.1 × 10^-10 ) highlighted regulation of ion channel activity as the most plausible pathway affecting IBS risk.

CONCLUSION & INFERENCES

Our results confirm the feasibility of population-based studies for gene-discovery efforts in IBS, identify risk genes and loci to be prioritized in independent follow-ups, and pinpoint ion channels as important players and potential therapeutic targets warranting further investigation.

Technical note: Evaluation of fine needle aspiration cytology for the diagnosis of fatty liver in dairy cattle

Fatty liver is a common condition affecting dairy cattle during the periparturient period, characterized by a pathological accumulation of triglycerides (TG) in the hepatocytes. The objective of this study was to evaluate the diagnostic potential of fine needle aspiration cytology in fresh liver specimens using liver TG concentrations as a gold standard. Fifty-seven liver samples from Holstein cows were collected during processing at a slaughterhouse. Tissue and fine needle aspirate samples were obtained from the parietal upper portion of the caudate lobe. Two samples of liver tissue were collected with a 16 gauge × 15 cm biopsy needle for histological and TG concentration assessment. A third sample was collected for cytology using an 18 gauge × 5.08 cm needle. The contents of the needle were transferred to a glass slide, spread, and air-dried. Liver samples were assayed by colorimetry/fluorimetry to determine TG concentrations. Concentrations of TG <2% were considered normal. Histological and cytological evaluations were conducted by 2 different pathologists blind to the visual classification. Sensitivity (Se) and specificity (Sp) were calculated. Cytology had a Se and Sp of 73 and 85%, respectively. Histopathology had a Se and Sp of 45.9 and 100%, respectively. The likelihood of having higher scores for histopathology and cytology increased as a function of liver TG content (mg/g).

Female sexual pain: Epidemiology and genetic overlap with chronic widespread pain

BACKGROUND

Increased tender spots and lowered general pain thresholds have been observed in patients with dyspareunia. Based on this, the aim of the study was to compare the co-occurrence of female sexual pain across various pain populations and to further explore the aetiological structure underlying sexual pain by dissecting the genetic and environmental covariation among sexual pain, chronic widespread pain (CWP) and the previously reported psychological correlates of anxiety sensitivity and depression.

METHODS

A multivariate twin study including 1489 female twin individuals (246 full MZ pairs, 187 full DZ pairs and 623 whose co-twin did not participate). Main outcomes measures included self-reported diagnosis of osteoarthritis and rheumatoid arthritis, and validated questionnaires for the assessment of sexual pain, CWP, depression and anxiety sensitivity.

RESULTS

Sexual pain showed a small but statistically significant correlation with CWP (r = 0.08; p < 0.05), anxiety sensitivity (r = 0.15, p < 0.001) and depression (r = 0.09, p < 0.01). The heritability of sexual pain was found to be 31%. Multivariate variance component analysis revealed a genetic factor common among CWP, depression, anxiety sensitivity and sexual pain, and a second genetic factor shared between anxiety sensitivity and sexual pain only. We further detected genetic and environmental factors unique to sexual pain, explaining 24.01% and 67.24%, respectively, of the phenotypic variance.

CONCLUSIONS

Our findings suggest some overlap between sexual pain and CWP and point towards a shared but complex psychophysiological aetiology underlying sexual pain. Results further highlight the influence of specific environmental and contextual stressors in the development and maintenance of sexual pain.

SIGNIFICANCE

Sexual pain shares a common genetic aetiology with chronic widespread pain and the frequently reported psychological comorbidities of depression and anxiety. Overall this suggests a complex psychophysiological aetiology underlying chronic pain conditions. The high proportion of variance in sexual pain explained by environmental factors further highlights the importance of specific environmental and contextual stressors in the development and maintenance of the condition.

A meta-analysis of reflux genome-wide association studies in 6750 Northern Europeans from the general population

BACKGROUND

Gastroesophageal reflux disease (GERD), the regurgitation of gastric acids often accompanied by heartburn, affects up to 20% of the general population. Genetic predisposition is suspected from twin and family studies but gene-hunting efforts have so far been scarce and no conclusive genome-wide study has been reported. We exploited data available from general population samples, and studied self-reported reflux symptoms in relation to genome-wide single nucleotide polymorphism (SNP) genotypes.

METHODS

We performed a GWAS meta-analysis of three independent population-based cohorts from Sweden, Finland, and UK. GERD cases (n=2247) and asymptomatic controls (n=4503) were identified using questionnaire-derived symptom data. Upon stringent quality controls, genotype data for more than 2.5M markers were used for association testing. Bioinformatic characterization of genomic regions associated with GERD included gene-set enrichment analysis (GSEA), in silico prediction of genetic risk effects on gene expression, and computational analysis of drug-induced gene expression signatures using Connectivity Map (cMap).

KEY RESULTS

We identified 30 GERD suggestive risk loci (P≤5×10^-5 ), with concordant risk effects in all cohorts, and predicted functional effects on gene expression in relevant tissues. GSEA revealed involvement of GERD risk genes in biological processes associated with the regulation of ion channel and cell adhesion. From cMap analysis, omeprazole had significant effects on GERD risk gene expression, while antituberculosis and anti-inflammatory drugs scored highest among the repurposed compounds.

CONCLUSIONS

We report a large-scale genetic study of GERD, and highlight genes and pathways that contribute to further our understanding of its pathogenesis and therapeutic opportunities.

Assignment of Opsonic Values to Pneumococcal Reference Serum 007sp for Use in Opsonophagocytic Assays for 13 Serotypes

Opsonophagocytic assays (OPAs) are routinely used for assessing the immunogenicity of pneumococcal vaccines, with OPA data often being utilized for licensure of new vaccine formulations. However, no reference serum for pneumococcal OPAs is available, making evaluation of data among different laboratories difficult. This international collaboration was initiated to (i) assign consensus opsonic indexes (OIs) to FDA pneumococcal reference serum lot 007sp (here referred to as 007sp) and a panel of serum samples used for calibration of the OPA and (ii) determine if the normalization of the OPA results obtained with test samples to those obtained with 007sp decreases the variability in OPA results among laboratories. To meet these goals, six participating laboratories tested a panel of serum samples in five runs for 13 serotypes. For each serum sample, consensus OIs were obtained using a mixed-effects analysis of variance model. For the calibration serum samples, normalized consensus values were also determined on the basis of the results obtained with 007sp. For each serotype, the overall reduction in interlaboratory variability was calculated by comparing the coefficients of variation of the unadjusted and the normalized values. Normalization of the results substantially reduced the interlaboratory variability, ranging from a 15% reduction in variability for serotype 9V to a 64% reduction for serotype 7F. Normalization also increased the proportion of data within 2-fold of the consensus value from approximately 70% (average for all serotypes) to >90%. On the basis of the data obtained in this study, pneumococcal reference standard lot 007sp will likely be a useful reagent for the normalization of pneumococcal OPA results from different laboratories. The data also support the use of the 16 FDA serum samples used for calibration of the OPA as part of the initial evaluation of new assays or periodic assessment of established assays.

Appraisal and evaluation of software products

Software product evaluation can be problematical as products from different backgrounds are likely to exhibit different strengths and weaknesses. A weakness in one area will not necessarily eliminate a product from consideration as project requirements are seldom absolute What therefore is needed is a systematic approach which helps to identity the product or products which best meet the needs of the project or organisation.

A method will be described which has been designed to assess the suitability of software products against the total requirements of a project. The method consists of a weighted scoring technique based on a customisable criteria hierarchy Different scenarios in which the method can be used will be covered, together with a description of a hierarchy for the evaluation of text-based information management systems

Atypical Coccidiosis in South American Camelids

Reported clinical signs of coccidiosis in South American camelids include anorexia of a few days duration, sudden death, and diarrhea. Antemortem diagnosis of clinical coccidiosis is usually based on clinical signs and supported by detection of coccidial oocysts in feces. This report describes 2 atypical cases of coccidiosis in South American camelids that had no coccidial oocysts detected on antemortem fecal flotation, prolonged weight loss, and normal fecal consistency.

Exophthalmia Associated with Paranasal Sinus Osteoma in a Quarterhorse Mare

An 11-year-old Quarterhorse mare developed a paranasal sinus osteoma that extended into the right orbit and led to ipsilateral exophthalmia. Although the tumor was radiographically evident in the paranasal sinuses, ultrasonography was used to demonstrate extension of the tumor into the retrobulbar space, and endoscopy was used to identify its extension into the nasopharynx. Biopsies were obtained using both fine-needle aspiration and paranasal sinus trephination. Despite numerous antemortem diagnostic tests, only postmortem histologic analysis of the mass afforded the diagnosis of osteoma.

Isolation of Aureimonas altamirensis, a Brucella canis–like bacterium, from an edematous canine testicle

Microbiological and histological analysis of a sample from a swollen testicle of a 2-year-old Border Collie dog revealed a mixed infection of the fungus Blastomyces dermatitidis and the Gram-negative bacterium Aureimonas altamirensis. When subjected to an automated microbial identification system, the latter isolate was provisionally identified as Psychrobacter phenylpyruvicus, but the organism shared several biochemical features with Brucella canis and exhibited agglutination, albeit weakly, with anti– B. canis antiserum. Unequivocal identification of the organism was only achieved by 16S ribosomal RNA gene sequencing, ultimately establishing the identity as A. altamirensis. Since its first description in 2006, this organism has been isolated infrequently from human clinical samples, but, to the authors’ knowledge, has not been reported from a veterinary clinical sample. While of unknown clinical significance with respect to the pathology observed for the polymicrobial infection described herein, it highlights the critical importance to unambiguously identify the microbe for diagnostic, epidemiological, infection control, and public health purposes.

Sea-level and deep-sea-temperature variability over the past 5.3 million years

Ice volume (and hence sea level) and deep-sea temperature are key measures of global climate change. Sea level has been documented using several independent methods over the past 0.5 million years (Myr). Older periods, however, lack such independent validation; all existing records are related to deep-sea oxygen isotope (δ(18)O) data that are influenced by processes unrelated to sea level. For deep-sea temperature, only one continuous high-resolution (Mg/Ca-based) record exists, with related sea-level estimates, spanning the past 1.5 Myr. Here we present a novel sea-level reconstruction, with associated estimates of deep-sea temperature, which independently validates the previous 0-1.5 Myr reconstruction and extends it back to 5.3 Myr ago. We find that deep-sea temperature and sea level generally decreased through time, but distinctly out of synchrony, which is remarkable given the importance of ice-albedo feedbacks on the radiative forcing of climate. In particular, we observe a large temporal offset during the onset of Plio-Pleistocene ice ages, between a marked cooling step at 2.73 Myr ago and the first major glaciation at 2.15 Myr ago. Last, we tentatively infer that ice sheets may have grown largest during glacials with more modest reductions in deep-sea temperature.

Clinical experience in the screening and management of a large kindred with familial isolated pituitary adenoma due to an aryl hydrocarbon receptor interacting protein (AIP) mutation

CONTEXT

Germline AIP mutations usually cause young-onset acromegaly with low penetrance in a subset of familial isolated pituitary adenoma families. We describe our experience with a large family with R304* AIP mutation and discuss some of the diagnostic dilemmas and management issues.

OBJECTIVE

The aim of the study was to identify and screen mutation carriers in the family.

PATIENTS

Forty-three family members participated in the study.

SETTING

The study was performed in university hospitals.

OUTCOME

We conducted genetic and endocrine screening of family members.

RESULTS

We identified 18 carriers of the R304* mutation, three family members with an AIP-variant A299V, and two family members who harbored both changes. One of the two index cases presented with gigantism and pituitary apoplexy, the other presented with young-onset acromegaly, and both had surgery and radiotherapy. After genetic and clinical screening of the family, two R304* carriers were diagnosed with acromegaly. They underwent transsphenoidal surgery after a short period of somatostatin analog treatment. One of these two patients is in remission; the other achieved successful pregnancy despite suboptimal control of acromegaly. One of the A299V carrier family members was previously diagnosed with a microprolactinoma; we consider this case to be a phenocopy. Height of the unaffected R304* carrier family members is not different compared to noncarrier relatives.

CONCLUSIONS

Families with AIP mutations present particular problems such as the occurrence of large invasive tumors, poor response to medical treatment, difficulties with fertility and management of pregnancy, and the finding of AIP sequence variants of unknown significance. Because disease mostly develops at a younger age and penetrance is low, the timing and duration of the follow-up of carriers without overt disease requires further study. The psychological and financial impact of prolonged clinical screening must be considered. Excellent relationships between the family, endocrinologists, and geneticists are essential, and ideally these families should be managed in centers with specialist expertise.

MRI of the foetal brain using a rapid 3D steady-state sequence

OBJECTIVE

To evaluate the capacity of a rapid T2 weighted three-dimensional (3D) sequence to diagnose foetal brain abnormalities by comparing the results with current two-dimensional (2D) methods. We have also made assessments of the estimates of energy deposition using those methods.

METHODS

50 pregnant females were included in this study under the guidance of the institutional review board. All their foetuses had suspected brain abnormalities on antenatal ultrasonography or were at increased risk of a brain malformation based on the results of an earlier pregnancy. All the foetuses had a routine MR protocol that includes three orthogonal plane single-shot fast-spin echoes and 2D steady-state sequences. In addition, a 3D rapid steady-state sequence of the foetal brain was performed (acquisition time approximately 40 s), and the standard and 3D sequences were reported independently and the results were compared. The specific absorption rate (SAR) predicted by the scanner was recorded in 12 cases in order to estimate the energy deposited by the three sequences.

RESULTS

The 3D rapid steady-state sequences produced diagnostic-quality images in 41/50 (82%) cases. All the failures were in second trimester foetuses (9/26-35% failure rate). There was a discrepancy between the standard report and findings using the 3D sequence in 2/41 of the foetuses with good-quality 3D imaging. The predicted SAR deposition of the 3D steady-state sequences was comparable with the single-shot fast-spin echo sequence.

CONCLUSION

Our initial assessments of a 3D rapid steady-state sequence to image the foetus are encouraging in terms of diagnostic information and acceptable energy deposition values. The high failure rate in second trimester foetuses probably relates to the greater mobility of the smaller foetuses, and improvements in the 3D sequence are required in terms of reduced acquisition time and higher resolution.

ADVANCES IN KNOWLEDGE

We have shown that 3D T2 weighted images of the foetal brain can be acquired in a clinical setting and produce diagnostic-quality imaging in a high proportion of cases. The success rate in acquiring diagnostic-quality images is related to gestational age. Good-quality images were obtained in all third trimester foetuses but only in approximately two-thirds of second trimester foetuses. This probably reflects the problem of the greater mobility of second trimester foetuses. 3D T2 weighted acquisitions have great potential for improving the antenatal diagnosis of foetal brain abnormalities and may reduce the time that a pregnant female needs to spend on the MR scanner.

Junior doctors' knowledge and perceptions of antibiotic resistance and prescribing: a survey in France and Scotland

Our objective was to assess junior doctors' perceptions of their antibiotic prescribing practice and of bacterial resistance. We surveyed 190 postgraduate doctors still in training at two university teaching hospitals, in Nice (France) and Dundee (Scotland, UK), and 139 of them (73%) responded to the survey. The main results presented in this abstract are combined for Nice and Dundee, because there was no statistical difference for these points between the two hospitals. Antibiotic resistance was perceived as a national problem by 95% of the junior doctors, but only 63% rated the problem as important in their own daily practice. Their perceptions of the causes of antibiotic resistance were sometimes at variance with available medical evidence, with excessive duration of antibiotic treatment and poor hand hygiene practices rarely being perceived as important drivers for resistance. Only 31% and 26% of the doctors knew the correct prevalences of antibiotic misuse and of methicillin-resistant Staphylococcus aureus in hospitals, respectively. They preferred educational interventions, such as specific teaching sessions, availability of guidelines or readily accessible advice from an infectious diseases specialist, to improve antibiotic prescribing, rather than restricted prescription of antibiotics. These data provide helpful information for the design of strategies to optimize adherence to good antimicrobial stewardship.

Analysis of KIR gene frequencies in HLA class I characterised bladder, colorectal and laryngeal tumours

Three cohorts of patients with laryngeal, bladder or colorectal tumours were investigated for frequency of killer immunoglobulin-like receptor (KIR) genes compared with a normal control population. The frequency of KIR3DL1 and KIR2DS4 was significantly increased (but not after correction for number of comparisons made) in patients with bladder tumour compared with controls. No other significant differences were found in gene frequencies or in the frequencies of those KIR genes with and without their human leucocyte antigen (HLA) ligands. Furthermore, no significant differences were found in KIR gene frequencies, taking into consideration the type of loss of HLA expression in the individual tumours. Finally, in the group of colorectal carcinomas, there was an overall significant difference in the frequencies of C group heterozygosity and homozygosity with HLA alterations on the tumour.

Increased frequencies of activating natural killer receptors are associated with liver injury in individuals who do not eliminate hepatitis C virus

This study was designed to investigate the role of killer immunoglobulin-like receptor (KIR) genes in the outcome of hepatitis C virus (HCV) infection. In patients who cleared the virus (HCV RNA-) we found a decrease of 2DL2 (P= 0.04), and 2DS2 (P= 0.014) accompanied by an increase of 2DS5 (P= 0.04). Those RNA+ patients with elevated levels of hepatic transaminases (HCV RNA+ elevated alanine aminotransferase) showed an increased frequency of 2DS3 (P= 0.018). Additionally, in cirrhotic patients we found an increased frequency of individuals having two copies of 3DS1 and HLA-Bw4 (P= 0.016). We conclude that higher natural killer cytotoxicity might be associated with a worse progression of the HCV infection.

KIR genes polymorphism in Argentinean Caucasoid and Amerindian populations

In natural killer cells, killer immunoglobulin-like receptors (KIRs) loci code for either inhibitory or activating receptors, and according to the number of genes present in each individual, it is possible to identify a high rate of polymorphism in the populations. We performed KIR typing by polymerase chain reaction-sequence-specific oligonucleotide probing in 402 Argentinean Caucasoid and in two Amerindian populations (101 Wichis and 54 Chiriguanos) from the North of Argentina. KIR2DL4, KIR3DL2, KIR3DL3 and KIR3DP1 were always present, whereas the frequencies of KIR2DL1, KIR2DL3, KIR2DS4, KIR3DL1 and KIR2DP1 ranged between 84% and 96%. The frequencies of KIR2DS2, KIR2DL2, KIR2DL5, KIR2DS5, KIR2DS1 and KIR3DS1 ranged between 41% and 62%. The KIR2DS3 with a frequency of 29% in Argentinean Caucasoid population was present at a very low frequency in Amerindian populations. Haplotype segregation studies performed in 10 Wichi families showed the presence of only three haplotypes: A, B5 and B1. The Amerindian populations showed several similarities to Asian but not to Caucasoid populations with regard to the frequency of KIR2DS3, full-length KIR2DS4 gene and KIR2DL4 alleles.

KIR receptors and HLA-C in the maintenance of pregnancy

The present study demonstrated that patients who have recurrent spontaneous abortions (RSA) presented a decreased number of killer immunoglobulin-like inhibitory receptors (KIR), in particular KIR2DL2. The KIR AA genotype was found increased in comparison with controls. Individuals AA will also be homozygous for 2DL3, which in contrast to 2DL2, show a weaker interaction with C1 ligands and therefore a weaker inhibition. The present study might support that in RSA patients, the balance between inhibitory and activating receptors present in natural killer cells is inclined toward an activating state that may contribute to pregnancy loss.

Multiple trichoepitheliomas in an alpaca (Lama pacos)

A 13-yr-old male Alpaca (Lama pacos) presented with multiple ovoid, well-circumscribed, nonulcerated intradermal masses. Individual masses measured 1-4 cm in diameter, and the overlying skin was alopecic. Several of the masses were surgically removed and evaluated microscopically. Histopathologic evaluation demonstrated multiple dermal cysts lined by neoplastic follicular epithelium. The cysts were filled with multiple layers of lamellar keratin and lined by abortive inner and outer root sheaths exhibiting cellular atypia, supporting the diagnosis of trichoepitheliomas. No additional treatment was initiated, and the alpaca continues to do well.