Determining predictive metabolomic biomarkers of meniscal injury in dogs with cranial cruciate ligament rupture

OBJECTIVES

This study used hydrogen nuclear magnetic resonance spectroscopy for the first time to examine differences in the metabolomic profile of stifle joint synovial fluid from dogs with cranial cruciate ligament rupture with and without meniscal injuries, in order to identify biomarkers of meniscal injury. Identifying a biomarker of meniscal injury could then ultimately be used to design a minimally invasive diagnostic test for meniscal injuries in dogs.

MATERIALS AND METHODS

Stifle joint synovial fluid was collected from dogs undergoing stifle joint surgery or arthrocentesis for lameness investigations. We used multi-variate statistical analysis using principal component analysis and univariate statistical analysis using one-way analysis of variance and analysis of co-variance to identify differences in the metabolomic profile between dogs with cranial cruciate ligament rupture and meniscal injury, cranial cruciate ligament rupture without meniscal injury, and neither cranial cruciate ligament rupture nor meniscal injury, taking into consideration clinical variables.

RESULTS

A total of 154 samples of canine synovial fluid were included in the study. Sixty-four metabolites were annotated to the hydrogen nuclear magnetic resonance spectroscopy spectra. Six spectral regions were found to be significantly altered (false discovery rate adjusted P-value <0.05) between groups with cranial cruciate ligament rupture with and without meniscal injury, including three attributed to nuclear magnetic resonance mobile lipids [mobile lipid -CH3 (P=0.016), mobile lipid -n(CH3 )3 (P=0.017), mobile unsaturated lipid (P=0.031)].

CLINICAL SIGNIFICANCE

We identified an increase in nuclear magnetic resonance mobile lipids in the synovial fluid of dogs with meniscal injury which are of interest as potential biomarkers of meniscal injury.

Metabolomic analysis of synovial fluid from Thoroughbred racehorses diagnosed with palmar osteochondral disease using magnetic resonance imaging

BACKGROUND

Palmar osteochondral disease (POD) is a common cause of lameness in competition horses. Magnetic resonance imaging (MRI) is the most sensitive diagnostic modality currently available, however it may not be financially or logistically practical for routine screening of POD. There is increasing interest in the use of metabolomics for diagnosis prior to progression to irreversible damage.

OBJECTIVES

To determine metabolite levels in synovial fluid (SF) of horses with a clinical diagnosis of POD based on diagnostic analgesia and MRI, with the hypothesis that metabolomic profiles differ between diseased and healthy joints.

STUDY DESIGN

Prospective clinical study.

METHODS

Synovial fluid was collected from metacarpo/tarsophalangeal joints (MC/TPJ) of 29 horses (n = 51 joints), including 14 controls (n = 26) and 15 cases (n = 25), the latter with lameness localised to the MC/TPJ and MR changes consistent with POD (n = 23). Spectra were produced using ¹ H-nuclear magnetic resonance (NMR) spectroscopy and analysed.

RESULTS

Twenty-five metabolites were recognised associated with various biosynthetic and degradation pathways. The metabolite abundances within the controls demonstrated increased variability compared with the clinical group. The low level of variance between the spectra of the two groups was explained by five principal components. Cross-validation of the cohort demonstrated modest separation of predictive power (R²  = 0.67; Q²  = 0.34). Although statistical significance was not achieved, the most influential metabolites were glucose and lactate.

MAIN LIMITATIONS

The modest sample size and variation in signalment, background and presenting condition of the controls may have impacted the discriminative power of the constructed models. The lack of matched controls, differences in time of fluid collection and freezing times may have also reduced accuracy when representing metabolite profiles.

CONCLUSIONS

This study identified and quantified metabolites present in MC/TPJ SF of clinical cases with POD.

Video-assisted thoracoscopic surgery for ectopic mediastinal parathyroid adenoma

Background

Primary hyperparathyroidism (PHPT), caused by an ectopic mediastinal parathyroid adenoma, is uncommon. In the past, when the adenoma was not accessible from the neck, median sternotomy was advocated for safe and successful parathyroidectomy. Video‐assisted thoracoscopic surgical (VATS) parathyroidectomy represents a modern alternative approach to this problem.

Methods

Information on patients undergoing VATS was obtained from a specific database, including clinical presentation, biochemistry, preoperative imaging, surgical approach and patient outcomes. A comprehensive literature review was undertaken to draw comparisons with other publications.

Results

Over a 2‐year period, nine patients underwent VATS parathyroidectomy for sporadic PHPT. Five patients had persistent PHPT following previous unsuccessful parathyroidectomy via cervicotomy, and four had had no previous parathyroid surgery. The median duration of surgery was 90 (range 60–160) min. Eight patients were cured biochemically, with no major complications. One patient required conversion to a median sternotomy for removal of a thymoma that had resulted in false‐positive preoperative imaging.

Conclusion

With appropriate preoperative imaging, multidisciplinary input and expertise, VATS parathyroidectomy is an effective, safe and well tolerated approach to ectopic mediastinal parathyroid adenoma.

Application of the Droplet Digital Polymerase Chain Reaction (ddPCR) Platform for Detection and Quantification of Vertebrate Host DNA in Engorged Mosquitoes

Hematophagous arthropod bloodmeal identification has remained a challenge in the field of vector biology, but these studies are important to understand blood feeding patterns of arthropods, spatial, and temporal patterns in arbovirus transmission cycles, and risk of human and veterinary disease. We investigated the use of an existing vertebrate primer set for use on the droplet digital polymerase chain reaction (ddPCR) platform, to explore the use of this technology in the identification and quantification of vertebrate DNA in mosquito blood meals. Host DNA was detectable 48-h post-engorgement in some mosquitoes by ddPCR, compared with 24-h post-engorgement using traditional PCR. The capability of ddPCR for absolute quantification of template DNA offers unique potential applications of this new technology to field studies on the ecology of vector-borne diseases, but currently with limited scope.

Attenuated total reflection Fourier-transform infrared (ATR-FTIR) spectroscopy to diagnose osteoarthritis in equine serum

BACKGROUND

Reliable and validated biomarkers for osteoarthritis (OA) are currently lacking.

OBJECTIVES

To develop an accurate and minimally invasive method to assess OA-affected horses and provide potential spectral markers indicative of disease.

STUDY DESIGN

Observational, cross-sectional study.

METHODS

Our cohort consisted of 15 horses with OA and 48 without clinical signs of the disease, which were used as controls. Attenuated total reflection Fourier-transform infrared (ATR-FTIR) spectroscopy was used to investigate serum samples (50 μL) collected from these horses. Spectral processing and multivariate analysis revealed differences and similarities, allowing for detection of spectral biomarkers that discriminated between the two cohorts. A supervised classification algorithm, namely principal component analysis coupled with quadratic discriminant analysis (PCA-QDA), was applied to evaluate the diagnostic accuracy.

RESULTS

Segregation between the two different cohorts, OA-affected and controls, was achieved with 100% sensitivity and specificity. The six most discriminatory peaks were attributed to proteins and lipids. Four of the spectral peaks were elevated in OA horses, which could be potentially due to an increase in lipids, protein expression levels and collagen, all of which have been previously reported in OA. Two peaks were found decreased and were tentatively assigned to the reduction of proteoglycan content that is observed during OA.

MAIN LIMITATIONS

The control group had a wide range of ages and breeds. Presymptomatic OA cases were not included. Therefore, it remains unknown whether this test could also be used as an early diagnostic tool.

CONCLUSIONS

This spectrochemical approach could provide an accurate and cost-effective blood test, facilitating point-of-care diagnosis of equine OA.

Computational study of aortic hemodynamics for patients with an abnormal aortic valve: The importance of secondary flow at the ascending aorta inlet

Blood flow in the aorta is helical, but most computational studies ignore the presence of secondary flow components at the ascending aorta (AAo) inlet. The aim of this study is to ascertain the importance of inlet boundary conditions (BCs) in computational analysis of flow patterns in the thoracic aorta based on patient-specific images, with a particular focus on patients with an abnormal aortic valve. Two cases were studied: one presenting a severe aortic valve stenosis and the other with a mechanical valve. For both aorta models, three inlet BCs were compared; these included the flat profile and 1D through-plane velocity and 3D phase-contrast magnetic resonance imaging derived velocity profiles, with the latter being used for benchmarking. Our results showed that peak and mean velocities at the proximal end of the ascending aorta were underestimated by up to 41% when the secondary flow components were neglected. The results for helical flow descriptors highlighted the strong influence of secondary velocities on the helical flow structure in the AAo. Differences in all wall shear stress (WSS)-derived indices were much more pronounced in the AAo and aortic arch (AA) than in the descending aorta (DAo). Overall, this study demonstrates that using 3D velocity profiles as inlet BC is essential for patient-specific analysis of hemodynamics and WSS in the AAo and AA in the presence of an abnormal aortic valve. However, predicted flow in the DAo is less sensitive to the secondary velocities imposed at the inlet; hence, the 1D through-plane profile could be a sufficient inlet BC for studies focusing on distal regions of the thoracic aorta.

Investigating the heterogeneity of alkylating agents' efficacy and toxicity between sexes: A systematic review and meta-analysis of randomized trials comparing cyclophosphamide and ifosfamide (MAIAGE study)

BACKGROUND

A marginal interaction between sex and the type of alkylating agent was observed for event-free survival in the Euro-EWING99-R1 randomized controlled trial (RCT) comparing cyclophosphamide and ifosfamide in Ewing sarcoma. To further evaluate this interaction, we performed an individual patient data meta-analysis of RCTs assessing cyclophosphamide versus ifosfamide in any type of cancer.

METHODS

A literature search produced two more eligible RCTs (EICESS92 and IRS-IV). The endpoints were progression-free survival (PFS, main endpoint) and overall survival (OS). The hazard ratios (HRs) of the treatment-by-sex interaction and their 95% confidence interval (95% CI) were assessed using stratified multivariable Cox models. Heterogeneity of the interaction across age categories and trials was explored. We also assessed this interaction for severe acute toxicity using logistic models.

RESULTS

The meta-analysis comprised 1,528 pediatric and young adult sarcoma patients from three RCTs: Euro-EWING99-R1 (n = 856), EICESS92 (n = 155), and IRS-IV (n = 517). There were 224 PFS events in Euro-EWING99-R1 and 200 in the validation set (EICESS92 + IRS-IV), and 171 and 154 deaths in each dataset, respectively. The estimated treatment-by-sex interaction for PFS in Euro-EWING99-R1 (HR = 1.73, 95% CI = 1.00-3.00) was not replicated in the validation set (HR = 0.97, 95% CI = 0.55-1.72), without heterogeneity across trials (P = 0.62). In the pooled analysis, the treatment-by-sex interaction was not significant (HR = 1.31, 95% CI = 0.89-1.95, P = 0.17), without heterogeneity across age categories (P = 0.88) and trials (P = 0.36). Similar results were observed for OS. No significant treatment-by-sex interaction was observed for leucopenia/neutropenia (P = 0.45), infection (P = 0.64), or renal toxicity (P = 0.20).

CONCLUSION

Our meta-analysis did not confirm the hypothesis of a treatment-by-sex interaction on efficacy or toxicity outcomes.

The Case of the Septic Fitness Instructor: Exercise Immunology in Action?

A 20 year old fitness instructor was admitted with abdominal pain and rapidly developed severe systemic inflammatory response syndrome and multi-organ dysfunction requiring ventilation and inotropic support. The cause was a histologically early appendicitis. Investigations excluded any underlying immunological or connective tissue disorder.

Intense exercise is known to cause changes in the physiology and function of the immune system. Innate and adaptive immune function, both in cellular numbers and function, has been shown to be impaired. An acute phase response similar to that seen with physical stressors such as sepsis and trauma has also been observed with elevation of pro-inflammatory and anti-inflammatory cytokines. This has led to the ‘open window’ theory of transient immunosuppresion following intense exercise. In this case presented, regular vigorous aerobic exercise was being performed whilst the patient was symptomatic up until 4 hours prior to admission. We propose that exercise induced immunosuppresion and priming of the inflammatory response led to a florid systemic inflammatory response developing and contributed to the rapid progression towards multi-organ dysfunction syndrome.

Evaluation of the PPAR-γ Agonist Pioglitazone in Mild Asthma: A Double-Blind Randomized Controlled Trial

Background

Peroxisome proliferator-activated receptor gamma (PPAR-γ) is a nuclear receptor that modulates inflammation in models of asthma. To determine whether pioglitazone improves measures of asthma control and airway inflammation, we performed a single-center randomized, double-blind, placebo-controlled, parallel-group trial.

Methods

Sixty-eight participants with mild asthma were randomized to 12 weeks pioglitazone (30 mg for 4 weeks, then 45 mg for 8 weeks) or placebo. The primary outcome was the adjusted mean forced expiratory volume in one second (FEV₁) at 12 weeks. The secondary outcomes were mean peak expiratory flow (PEF), scores on the Juniper Asthma Control Questionnaire (ACQ) and Asthma Quality of Life Questionnaire (AQLQ), fractional exhaled nitric oxide (FeNO), bronchial hyperresponsiveness (PD₂₀), induced sputum counts, and sputum supernatant interferon gamma-inducible protein-10 (IP-10), vascular endothelial growth factor (VEGF), monocyte chemotactic protein-1 (MCP-1), and eosinophil cationic protein (ECP) levels. Study recruitment was closed early after considering the European Medicines Agency’s reports of a potential increased risk of bladder cancer with pioglitazone treatment. Fifty-five cases were included in the full analysis (FA) and 52 in the per-protocol (PP) analysis.

Results

There was no difference in the adjusted FEV₁ at 12 weeks (-0.014 L, 95% confidence interval [CI] -0.15 to 0.12, p = 0.84) or in any of the secondary outcomes in the FA. The PP analysis replicated the FA, with the exception of a lower evening PEF in the pioglitazone group (-21 L/min, 95% CI -39 to -4, p = 0.02).

Conclusions

We found no evidence that treatment with 12 weeks of pioglitazone improved asthma control or airway inflammation in mild asthma.

Trial Registration

ClinicalTrials.gov NCT01134835

Lymphoepithelial cyst of the pancreas. A case report

We present the case of a 63 year-old male who presented with a cystic lesion of the distal pancreas. Excision and histology showed this to be a lymphoepithelial cyst. Cystic lesions of the pancreas represent a diagnostic challenge, especially when pseudocyst secondary to pancreatitis is excluded. These lesions can be broadly classified into benign, pre-malignant and malignant. Widely used imaging modalities such as CT and MRI are not able to categorically differentiate between these. More invasive procedures such as endoscopic US and FNA again do not give a cast-iron diagnosis. Our patient had a symptomatic cystic lesion in his pancreas which was excised after cross-specialty discussion. We advocate that this is the ideal way to treat patients with cystic lesions of the pancreas, with each case considered on its own merits as all current diagnostic investigations have their limitations.

Paroven and Graduated Compression Hosiery for Superficial Venous Insufficiency

The effects of Sigvaris graduated compression hosiery and Paroven on symptoms of superficial venous insufficiency were assessed in a prospective, randomized, crossover study. Seventy-two patients awaiting surgery for non-cosmetic symptoms associated with varicose veins received 4-week treatments in random order, namely; placebo, Paroven alone, Sigvaris graduated compression hosiery and placebo, Sigvaris graduated compression hosiery and Paroven. Symptoms were assessed before and after each treatment using linear analogue scales. No statistically significant effects were observed, but there was a consistent trend for both Paroven alone and hosiery alone to produce modest improvements in symptoms. The relief of symptoms associated with a combination of Paroven and Sigvaris graduated compression hosiery was greater than that produced by either treatment on its own.

Relationships and redundancies of selected hemodynamic and structural parameters for characterizing virtual treatment of cerebral aneurysms with flow diverter devices

BACKGROUND AND PURPOSE

To quantify the relationship and to demonstrate redundancies between hemodynamic and structural parameters before and after virtual treatment with a flow diverter device (FDD) in cerebral aneurysms.

METHODS

Steady computational fluid dynamics (CFD) simulations were performed for 10 cerebral aneurysms where FDD treatment with the SILK device was simulated by virtually reducing the porosity at the aneurysm ostium. Velocity and pressure values proximal and distal to and at the aneurysm ostium as well as inside the aneurysm were quantified. In addition, dome-to-neck ratios and size ratios were determined. Multiple correlation analysis (MCA) and hierarchical cluster analysis (HCA) were conducted to demonstrate dependencies between both structural and hemodynamic parameters.

RESULTS

Velocities in the aneurysm were reduced by 0.14m/s on average and correlated significantly (p<0.05) with velocity values in the parent artery (average correlation coefficient: 0.70). Pressure changes in the aneurysm correlated significantly with pressure values in the parent artery and aneurysm (average correlation coefficient: 0.87). MCA found statistically significant correlations between velocity values and between pressure values, respectively. HCA sorted velocity parameters, pressure parameters and structural parameters into different hierarchical clusters. HCA of aneurysms based on the parameter values yielded similar results by either including all (n=22) or only non-redundant parameters (n=2, 3 and 4).

CONCLUSION

Hemodynamic and structural parameters before and after virtual FDD treatment show strong inter-correlations. Redundancy of parameters was demonstrated with hierarchical cluster analysis.

Parameningeal rhabdomyosarcoma in pediatric age: results of a pooled analysis from North American and European cooperative groups

BACKGROUND

Parameningeal (PM) site is a well-known adverse prognostic factor in children with localized rhabdomyosarcoma (RMS). To identify risk factors associated with outcome at this site, we pooled data from 1105 patients treated in 10 studies conducted by European and North American cooperative groups between 1984 and 2004.

PATIENTS AND METHODS

Clinical factors including age, histology, size, invasiveness, nodal involvement, Intergroup Rhabdomyosarcoma Study (IRS) clinical group, site, risk factors for meningeal involvement (MI), study group, and application of radiotherapy (RT) were studied for their impact on event-free and overall survival (EFS and OS).

RESULTS

Ten-year EFS and OS were 62.6 and 66.1% for the whole group. Patients without initial RT showed worse survival (10-year OS 40.8% versus 68.5% for RT treated patients). Multivariate analysis focusing on 862 patients who received RT as part of their initial treatment revealed four unfavorable prognostic factors: age <3 or >10 years, signs of MI, unfavorable site, and tumor size. Utilizing these prognostic factors, patients could be classified into different risk groups with 10-year OS ranging between 51.1 and 80.9%.

CONCLUSIONS

While, in general, PM localization is regarded as an adverse prognostic factor, the current analysis differentiates those with good prognosis (36% patients with 0-1 risk factor: 10-year OS 80.9%) from high-risk PM patients (28% with 3-4 factors: 10-year OS 51.1%). Furthermore, this analysis reinforces the necessity for RT in PM RMS.

Responses to a novel food acquisition task in three species of lemurs

In order to study learning and social processes in lemurs, a food acquisition task was presented to three groups: Lemur macaco, L. fulvus and L. catta. The lid of a box had to be pivoted horizontally in order to expose figs contained therein. Individuals in all three groups learned the task, but they showed only limited comprehension. In L. macaco, two adult females learned, with one female showing increasing aggressive monopolization of the new food-source. In L. fulvus, two adult males learned, and one of them increasingly prevented the other from approaching. In L. catta, the adult female frequently threatened away the most efficient opener - a young adult male. The simultaneous presentation of two boxes led to a more equal distribution of the figs. Social processes revealed in the test situation included female dominance in L. macaco and L. catta, and an intermale dominance relationship in L. fulvus. The experimental situation also highlighted the privileged position of the offspring of the dominant female in L. macaco, reduced competitiveness of females with very young infants in L. fulvus, and a general tolerance towards others in L. fulvus.

Mirror-image reactions in a tool-using, adult male Macaca tonkeana

This study examined reactions to mirror-image stimulation in a wild- reared adult male monkey (Macaca tonkeana) which had spontaneously developed a form of tool-use, namely the use of plant stems to reach mucus inside the nose. Initial intense social responsiveness to the mirror was followed by habituation, although some social responding persisted. Mirror- induced social facilitation of drinking was demonstrated, the first record of such an effect in a nonhuman primate. Rather than enhancing the subject's tool-using activity, the presence of the mirror disrupted tool-use. Finally, an objective test for the presence of self-recognition failed to obtain any evidence of self-recognition in the subject, lending support to the view that the capacity for self-recognition may be lacking in monkeys.

Social rank and responses to feeding competition in rhesus monkeys

A group of rhesus monkeys (Macaca mulatta) living in a large enclosure received food which varied in desirability and spatial distribution. Feeding and agonistic behaviour of four hierarchical subgroups were analyzed. In general, there was less aggression and improved feeding rates with dispersed food than with piled food. The behaviour of high-ranking subjects was the most stable: they usually ate first, ate most, and showed little agonistic behaviour. The most subordinate subjects were also involved in few agonistic episodes, since they tended to remain on the periphery and eat little. However, subordinates obtained access earlier to a pile of the most highly prized food (banana pieces) than to piles of less attractive foods. Subordinates also obtained their highest feeding score when banana pieces were dispersed. This latter condition was associated with increased aggression. The feeding behaviour of intermediate-ranking subjects lay between that of dominants and subordinates, and the former were involved in more aggression. Behaviour in situations involving restricted food reflects cognitive processes in which several factors including attractiveness of the food, social status, and risks involved are evaluated.

Social stimuli and social rewards in primate learning and cognition

Many studies have suggested that non-human primates have good individual recognition abilities, that social stimuli can serve as discriminative stimuli in learning tests and that visual access to social objects or events can be a reinforcer for operant behaviour. Intensified research efforts comparing the effectiveness of social and non-social stimuli and rewards across a range of learning and other cognitive tasks would help clarify the extent to which monkeys and apes might be specially predisposed to process information in the social domain. In addition to identity, social interactions and relationships constitute raw material to be mentally represented and processed. Some studies have addressed the individual and evolutionary origins of mechanisms underlying the ability to attribute mental states and intentions to others, for example by looking at the understanding of another's gaze, imitation and the development of tactical deception. The results of some of this research suggest that only some species might be capable of higher-order attribution. Further progress in the study of primate social cognition will require continuing refinement of methods and the development of new techniques to compare primates as behaviourists and mentalists.

A 30 mK, 13.5 T scanning tunneling microscope with two independent tips

We describe the design, construction, and performance of an ultra-low temperature, high-field scanning tunneling microscope (STM) with two independent tips. The STM is mounted on a dilution refrigerator and operates at a base temperature of 30 mK with magnetic fields of up to 13.5 T. We focus on the design of the two-tip STM head, as well as the sample transfer mechanism, which allows in situ transfer from an ultra high vacuum preparation chamber while the STM is at 1.5 K. Other design details such as the vibration isolation and rf-filtered wiring are also described. Their effectiveness is demonstrated via spectral current noise characteristics and the root mean square roughness of atomic resolution images. The high-field capability is shown by the magnetic field dependence of the superconducting gap of CuxBi2Se3. Finally, we present images and spectroscopy taken with superconducting Nb tips with the refrigerator at 35 mK that indicate that the effective temperature of our tips/sample is approximately 184 mK, corresponding to an energy resolution of 16 μeV.

Anatomical modifications, viviparous reproduction and hydraulic expulsion of larvae by Cephenemyia nasopharyngeal bot flies of deer

Several specialized adaptations of the reproductive and respiratory systems associated with the retention and expulsion of larvae in ovoviviparous Cephenemyia species (Diptera: Oestridae) are described and illustrated. In these flies the anterior section of the common oviduct is modified into a large sac-like uterus that contains larvae, and the posterior section is modified into a larvipositor with a central tubular vagina. During larviposition, contraction of abdominal muscles forces haemolymph into a perivaginal sinus, causing a hydraulically driven exsertion of the larvipositor. A group of larvae and uterine fluid sealed off within the lumen of the vagina are then expelled from the vulva via hydraulic pressure as the stretched vagina is compressed. A one-way, non-return valve between the uterus and vagina prevents a reflux of larvae upward into the uterus during larviposition. All mutually dependent actions associated with larviposition occur almost simultaneously. All species have evolved a similar mechanism of expelling their larvae, but the shape of the non-return valve is different in each species studied.

Risk-spreading larviposition behaviour of female nose bot flies (Cephenemyia) attacking black-tailed deer

While baited deer models were under observation nine Cephenemyia jellisoni Townsend (Diptera: Oestridae) females and seven C. apicata Bennett & Sabrosky engaged in a risk-spreading larviposition behaviour by larvipositing on models only once and then flying away. Additionally, analysis of 225 unobserved larvipostions in which larvae were trapped in adhesive on the muzzles of deer models showed that 94% of C. apicata and 95% of C. jellisoni larviposited on a model only once. The number of single larvipositions was highly significant for both species. The principal adaptive significance of such risk-spreading larviposition behaviour is that it spreads the reproductive output of a female among many hosts, and in years when adult eclosion and survival rates are low, it ensures that the larvae of the few surviving females will be distributed among a maximum number of hosts. Several other benefits of such behaviour also are discussed.

Corrected misidentification of first instars of the bot flies Cephenemyia apicata and C. jellisoni, with a review of the biology and life history of both species

First instars obtained from the uteri of host-seeking females, and compared with previously published descriptions of larvae collected from Columbian black-tailed deer (Odocoileus hemionus columbianus), revealed that larvae described as Cephenemyia apicata Bennett & Sabrosky (Diptera: Oestridae) actually are C. jellisoni Townsend. Several new characters are added to supplement the original descriptions of the first instars of these species. Collections of all larvae from deer autopsied during different months established that the first instars of C. apicata undergo a long obligate period of development and growth in the bronchi before molting and migrating to the retropharyngeal pouches of deer. This is the first study to document an obligatory lung phase in the life history of a species of Cephenemyia. The lung phase of C. apicata is compared with that described for Pharyngomyia picta (Meigen) (Diptera: Oestridae) in European red deer. A literature review found that for all Cephenemyia species studied, as well as for P. picta, a 6-8 month period of development as first instars during the fall/winter months ensures that pupal development and eclosion of adults will occur during periods of favourable external environmental conditions.

Semipermeable Hollow Fiber Phantoms for Development and Validation of Perfusion-Sensitive MR Methods and Signal Models

Two semipermeable, hollow fiber phantoms for the validation of perfusion-sensitive magnetic resonance methods and signal models are described. Semipermeable hollow fibers harvested from a standard commercial hemodialysis cartridge serve to mimic tissue capillary function. Flow of aqueous media through the fiber lumen is achieved with a laboratory-grade peristaltic pump. Diffusion of water and solute species (e.g., Gd-based contrast agent) occurs across the fiber wall, allowing exchange between the lumen and the extralumenal space. Phantom design attributes include: i) small physical size, ii) easy and low-cost construction, iii) definable compartment volumes, and iv) experimental control over media content and flow rate.

The Intergroup Rhabdomyosarcoma Study Group (IRSG): Major Lessons From the IRS-I Through IRS-IV Studies as Background for the Current IRS-V Treatment Protocols

Purpose. To enumerate lessons from studying 4292 patients with rhabdomyosarcoma (RMS) in the Intergroup Rhabdomyosarcoma Study Group (IRSG, 1972-1997).Patients. Untreated patients < 21 years of age at diagnosis received systemic chemotherapy, with or without irradiation (XRT) and/or surgical removal of the tumor.Methods. Pathologic materials and treatment were reviewed to ascertain compliance and to confirm response and relapse status.Results. Survival at 5 years increased from 55 to 71% over the period. Important lessons include the fact that extent of disease at diagnosis affects prognosis. Re-excising an incompletely removed tumor is worthwhile if acceptable form and function can be preserved. The eye, vagina, and bladder can usually be saved. XRT is not necessary for children with localized, completely excised embryonal RMS. Hyperfractionated XRT has thus far not produced superior local control rates compared with conventional, once-daily XRT. Patients with non-metastatic cranial parameningeal sarcoma can usually be cured with localized XRT and systemic chemotherapy, without whole-brain XRT and intrathecal drugs. Adding doxorubicin, cisplatin, etoposide, and ifosfamide has not significantly improved survival of patients with gross residual or metastatic disease beyond that achieved with VAC (vincristine, actinomycin D, cyclophosphamide) and XRT. Most patients with alveolar RMS have a tumor-specific translocation. Mature rhabdomyoblasts after treatment of patients with bladder rhabdomyosarcoma are not necessarily malignant, provided that the tumor has shrunk and malignant cells have disappeared.Discussion. Current IRSG-V protocols, summarized herein, incorporate recommendations for risk-based management. Two new agents, topotecan and irinotecan, are under investigation for patients who have an intermediate or high risk of recurrence.

Hyperbolic-cosine waveguide tapers and oversize rectangular waveguide for reduced broadband insertion loss in W-band electron paramagnetic resonance spectroscopy

The two-way insertion loss of a 1 m length of waveguide was reduced by nearly 5 dB over a 4% bandwidth at W-band (94 GHz) for an electron paramagnetic resonance (EPR) spectrometer relative to WR10 waveguide. The waveguide has an oversize section of commercially available rectangular WR28 and a novel pair of tapers that vary in cross section with axial position according to a hyperbolic-cosine (HC) function. The tapers connect conventional rectangular WR10 waveguide to the WR28. For minimum loss, the main mode electric field is parallel to the long side of the WR28. Using mode coupling theory, the position of maximum flare (inflection point) in the taper was optimized with respect to the coupling to higher order modes and the reflection of the main mode. The optimum inflection point position is about one-tenth of the taper length from the small end of the taper. Reflection and coupling were reduced by about 20 dB relative to a pyramidal (linear) taper of the same length. Comb-like dips in the transmission coefficient produced by resonances of the higher order modes in the oversize section were about 0.03 dB. Specially designed high-precision, adjustable WR28 flanges with alignment to about 5 μm were required to keep higher order mode amplitudes arising from the flanges comparable to those from the HC tapers. Minimum return loss was about 30 dB. This paper provides a foundation for further optimization, if needed. Methods are not specific to EPR or the microwave frequency band.

Diffusion effects on longitudinal relaxation in poorly mixed compartments

Diffusion of spins between physical or virtual, communicating compartments having different states of longitudinal magnetization leads to diffusion-driven longitudinal relaxation. Herein, in two model systems, the effects of diffusion-driven longitudinal relaxation are explored experimentally and analyzed quantitatively. In the first case, longitudinal relaxation in a single slice of a water phantom is monitored spectroscopically as a function of slice thickness. In the second case, mimicking vascular flow/diffusion effects, longitudinal relaxation is monitored in a two-compartment, semi-permeable fiber phantom. In both cases, apparent longitudinal relaxation, though clearly multi-exponential, is well-modeled as bi-exponential.

The Viking viewer for connectomics: scalable multi-user annotation and summarization of large volume data sets

Modern microscope automation permits the collection of vast amounts of continuous anatomical imagery in both two and three dimensions. These large data sets present significant challenges for data storage, access, viewing, annotation and analysis. The cost and overhead of collecting and storing the data can be extremely high. Large data sets quickly exceed an individual's capability for timely analysis and present challenges in efficiently applying transforms, if needed. Finally annotated anatomical data sets can represent a significant investment of resources and should be easily accessible to the scientific community. The Viking application was our solution created to view and annotate a 16.5 TB ultrastructural retinal connectome volume and we demonstrate its utility in reconstructing neural networks for a distinctive retinal amacrine cell class. Viking has several key features. (1) It works over the internet using HTTP and supports many concurrent users limited only by hardware. (2) It supports a multi-user, collaborative annotation strategy. (3) It cleanly demarcates viewing and analysis from data collection and hosting. (4) It is capable of applying transformations in real-time. (5) It has an easily extensible user interface, allowing addition of specialized modules without rewriting the viewer.

The magnetic contribution to the specific heat of Pb(1-x)Gd(x)Te

The temperature dependence of the magnetic specific heat of the semimagnetic semiconductor Pb(1-x)Gd(x)Te for x = 0.033 and 0.054, over the temperature range from 0.5 to 10 K, in magnetic fields up to 2 T, has been measured and analyzed theoretically. The maxima of the magnetic specific heat in nonzero magnetic fields are shifted to lower temperatures in comparison with theoretical predictions based on the simple cluster model. We propose a mechanism which explains these shifts. According to our model, they are caused by strong hybridization of the 5d shell of gadolinium with band states of the crystal.

Baboon palm nut harvesters in ancient Egypt: new (ancient) evidence, new questions

It is well documented that hamadryas baboons were used by the ancient Egyptians to pick fruits, but it is not well known that these baboons were also used to collect palm nuts. We describe this practice as it is depicted on a painting on a rarely exhibited ancient Egyptian artefact. Striking similarities with the modern use of pig-tailed macaques as coconut harvesters are described, raising new questions about the demise of the practice in Africa and its continuation in South-East Asia.

Chemotherapy induced carcinoma-adenoma regression in the caecum

The case of a male patient with synchronous oesophago-gastric junction (OGJ) and caecal adenocarcinomas is reported. His management is described, particularly the administration of neoadjuvant chemotherapy targeting his upper gastrointestinal cancer. Synchronous gastrectomy and hemicolectomy were performed. Histopathological examination of the surgical specimen confirmed the OGJ cancer but only identified a caecal adenoma. This is believed to be the first description of chemotherapy induced reversal of the adenoma-carcinoma sequence.

Aortic valve replacement with patent bilateral internal thoracic artery grafts using cross-clamp fibrillation

Aortic valve replacement in patients with patent coronary grafts poses many challenges. Intraoperative myocardial protection remains one of the key technical issues in these redo cases. We present a case of aortic valve replacement with patent bilateral internal thoracic artery grafts, using cross-clamp fibrillation.

The relationship between quality of life (EORTC QLQ-C30) and survival in patients with gastro-oesophageal cancer

It remains unclear whether any aspect of quality of life has a role in predicting survival in an unselected cohort of patients with gastro-oesophageal cancer. Therefore the aim of the present study was to examine the relationship between quality of life (EORTC QLQ-C30), clinico-pathological characteristics and survival in patients with gastro-oesophageal cancer. Patients presenting with gastric or oesophageal cancer, staged using the UICC tumour node metastasis (TNM) classification and who received either potentially curative surgery or palliative treatment between November 1997 and December 2002 (n=152) participated in a quality of life study, using the EORTC QLQ-C30 core questionnaire. On univariate analysis, age (P<0.01), tumour length (P<0.0001), TNM stage (P<0.0001), weight loss (P<0.0001), dysphagia score (P<0.001), performance status (P<0.1) and treatment (P<0.0001) were significantly associated with cancer-specific survival. EORTC QLQ-C30, physical functioning (P<0.0001), role functioning (P<0.001), cognitive functioning (P<0.01), social functioning (P<0.0001), global quality of life (P<0.0001), fatigue (P<0.0001), nausea/vomiting (P<0.01), pain (P<0.001), dyspnoea (P<0.0001), appetite loss (P<0.0001) and constipation (P<0.05) were also significantly associated with cancer-specific survival. On multivariate survival analysis, tumour stage (P<0.0001), treatment (P<0.001) and appetite loss (P<0.0001) were significant independent predictors of cancer-specific survival. The present study highlights the importance of quality of life (EORTC QLQ-C30) measures, in particular appetite loss, as a prognostic factor in these patients.

Phase II breast cancer chemoprevention trial of the third generation selective estrogen receptor modulator arzoxifene

1001

Background: Arzoxifene (ARZ) is a third generation SERM with efficacy in metastatic breast cancer but lacking uterine agonist activity. Methods: We conducted a randomized, double-blind, placebo-controlled Phase II prevention trial in 199 high risk women assessing the effects of ARZ 20 mg/day on several risk biomarkers. Biomarkers, including cytomorphology of breast epithelial cells obtained by random periareolar FNA (RPFNA) were assessed at baseline and following 6 months of placebo or ARZ. Subjects were stratified by presence or absence of atypia, ER expression, BRCA1/2 mutation, as well as menopause status. Results: At entry, mean age was 47, 52% were premenopausal and 47% of postmenopausal women were taking HRT. Mean 10 year Gail was 6.8% and mean Masood cytology index score was 14.3. The ARZ and placebo groups were well matched. The protocol defined primary endpoint was a decrease in RPFNA cytology Masood index score by ≥3 points at 6 months and required 160 evaluable subjects for 81% power to detect a change from 30% to 52% of subjects showing improvement. For the 181 evaluable subjects, there was no significant difference in the proportion of women achieving ≥3 point improvement (19% placebo vs. 24% ARZ, p=0.46); or in change in mean index score (0.6 placebo vs. 0.9 ARZ, p=0.53). There was also no difference in grade 3 or 4 side effects or dropout prior to 6 months. However, comparing ARZ to placebo, there was favorable modulation of the two risk biomarkers, mammographic breast density (p=0.001) and IGF-1:IGFBP-3 ratio (p=0.001), and reduction in bone turnover biomarker osteocalcin (p= 0.002), but without an increase in endometrial thickness. Conclusions: Although improvement in cytomorphology after 6 months of ARZ was not shown, the acceptable side effect profile and favorable modulation of other biomarkers (breast density, IGF-1:IGFBP-3, osteocalcin) provides support for continued evaluation of ARZ as a breast cancer prevention agent.

No significant financial relationships to disclose.

Outcome of clear cell sarcoma of the kidney (CCSK) treated on the National Wilms Tumor Study-5 (NWTS)

9000

Background: CCSK was initially described by its bone metastasizing tendencies and propensity for late recurrences. Outcome for patients with CCSK has improved from NWTS 1–4. On NWTS 4 patients were randomized to treatment for 15 months vs 6 months. Their overall 8 year relapse free survival was 88% vs 61%, respectively. NWTS-5 was designed to improve the event free survival (EFS) and overall survival (S) for patients with CCSK by incorporating cyclophosphamide and etoposide. Methods: Prospective single-arm study conducted between August, 1995 and June, 2002. Patients less than 16 years of age with a centrally confirmed pathological diagnosis of CCSK were eligible. Staging consisted of CT scans of chest, abdomen, pelvis, bone scan, skeletal survey, and CT or MRI of head. Patients were treated with vincristine/doxorubicin/cyclophosphamide alternating with cyclophosphamide/etoposide for 24 weeks and XRT (10.8 cGy). Results: 110 eligible patients were enrolled on study. Median age was 22 months, 69% were males, and 63% white. Stage distribution was: stage I, 14; II, 41; III, 46; IV, 9 [metastatic sites: lung (3), bone (1), brain (1), liver (1), bone and bilateral lung (1) and other (2)] Median follow-up is 4.6 years. 5-year EFS and S were 79% (95% CI, 69% to 86%) and 89% (95% CI, 80% to 94%). All but one of 21 recurrences occurred within 3 years of initial treatment. The most common site of recurrence was brain (11/21). 5-year EFS for Stage I-IV was 100%, 87%, 74% and 36% respectively. Adverse prognostic factors for patients with Stage II/III disease were white race, and lymph node involvement. Conclusions: Outcome for patients with CCSK treated on NWTS-5 is similar to that seen on NWTS-4 and recent SIOP and UKCCSG trials. Stage is highly predictive of outcome. Brain recurrence was higher than that seen on NWTS-4; lung recurrences were lower. The next Childrens Oncology Group (COG) protocol will use the same treatment for patients with Stages I-III; therapy for patients with Stage IV disease will incorporate carboplatin. The role of XRT in CCSK needs to be evaluated.

No significant financial relationships to disclose.