Summarizing US Wildlife Trade with an Eye Toward Assessing the Risk of Infectious Disease Introduction

The aim of this study was to characterize the role of the USA in the global exchange of wildlife and describe high volume trade with an eye toward prioritizing health risk assessment questions for further analysis. Here we summarize nearly 14 years (2000-2013) of the most comprehensive data available (USFWS LEMIS system), involving 11 billion individual specimens and an additional 977 million kilograms of wildlife. The majority of shipments contained mammals (27%), while the majority of specimens imported were shells (57%) and tropical fish (25%). Most imports were facilitated by the aquatic and pet industry, resulting in one-third of all shipments containing live animals. The importer reported origin of wildlife was 77.7% wild-caught and 17.7% captive-reared. Indonesia was the leading exporter of legal shipments, while Mexico was the leading source reported for illegal shipments. At the specimen level, China was the leading exporter of legal and illegal wildlife imports. The number of annual declared shipments doubled during the period examined, illustrating continually increasing demand, which reinforces the need to scale up capacity for border inspections, risk management protocols and disease surveillance. Most regulatory oversight of wildlife trade is aimed at conservation, rather than prevention of disease introduction.

Risk of cancer incidence before the age of 15 years after exposure to ionising radiation from computed tomography: results from a German cohort study

The aim of this cohort study was to assess the risk of developing cancer, specifically leukaemia, tumours of the central nervous system and lymphoma, before the age of 15 years in children previously exposed to computed tomography (CT) in Germany. Data for children with at least one CT between 1980 and 2010 were abstracted from 20 hospitals. Cancer cases occurring between 1980 and 2010 were identified by stochastic linkage with the German Childhood Cancer Registry (GCCR). For all cases and a sample of non-cases, radiology reports were reviewed to assess the underlying medical conditions at time of the CT. Cases were only included if diagnosis occurred at least 2 years after the first CT and no signs of cancer were recorded in the radiology reports. Standardised incidence ratios (SIR) using incidence rates from the general population were estimated. The cohort included information on 71,073 CT examinations in 44,584 children contributing 161,407 person-years at risk with 46 cases initially identified through linkage with the GCCR. Seven cases had to be excluded due to signs possibly suggestive of cancer at the time of first CT. Overall, more cancer cases were observed (O) than expected (E), but this was mainly driven by unexpected and possibly biased results for lymphomas. For leukaemia, the SIR (SIR = O/E) was 1.72 (95 % CI 0.89-3.01, O = 12), and for CNS tumours, the SIR was 1.35 (95 % CI 0.54-2.78, O = 7). Despite careful examination of the medical information, confounding by indication or reverse causation cannot be ruled out completely and may explain parts of the excess. Furthermore, the CT exposure may have been underestimated as only data from the participating clinics were available. This should be taken into account when interpreting risk estimates.

A novel bispecific EGFR/Met antibody blocks tumor-promoting phenotypic effects induced by resistance to EGFR inhibition and has potent antitumor activity

Simultaneous targeting of epidermal growth factor receptor (EGFR) and Met in cancer therapy is under pre-clinical and clinical evaluation. Here, we report the finding that treatment with EGFR inhibitors of various tumor cells, when stimulated with hepatocyte growth factor (HGF) and EGF, results in transient upregulation of phosphorylated AKT. Furthermore, EGFR inhibition in this setting stimulates a pro-invasive phenotype as assessed in Matrigel-based assays. Simultaneous treatment with AKT and EGFR inhibitors abrogates this invasive growth, hence functionally linking signaling and phenotype. This observation implies that during treatment of tumors a balanced ratio of EGFR and Met inhibition is required. To address this, we designed a bispecific antibody targeting EGFR and Met, which has the advantage of a fixed 2:1 stoichiometry. This bispecific antibody inhibits proliferation in tumor cell cultures and co-cultures with fibroblasts in an additive manner compared with treatment with both single agents. In addition, cell migration assays reveal a higher potency of the bispecific antibody in comparison with the antibodies' combination at low doses. We demonstrate that the bispecific antibody inhibits invasive growth, which is specifically observed with cetuximab. Finally, the bispecific antibody potently inhibits tumor growth in a non-small cell lung cancer xenograft model bearing a strong autocrine HGF-loop. Together, our findings strongly support a combination treatment of EGFR and Met inhibitors and further evaluation of resistance mechanisms to EGFR inhibition in the context of active Met signaling.

Effects of serotonin(1/2) receptor agonists on dark-phase food and water intake in rats

The effects of serotonin (5-hydroxytryptamine, 5-HT)(1/2) receptor agonists for 5-HT(1) and 5-HT(2) receptors on dark-phase ingestive behavior were evaluated in 12-h food-deprived, female Wistar rats. The amount of food and water consumed after 1, 2, 6 and 12 h was measured. The following agonists were tested: ipsapirone [preferred 5-HT receptor(s) and dose range in mg/kg, IP: 5-HT(1A) and 3-30, respectively], CP-94,253 (5-HT(1B); 0.3-3), TFMPP (5-HT(1B/2C); 0. 3-10), m-CPP (5-HT(2C/1B); 0.3-10), ORG 37684 (5-HT(2C); 0.3-10), BW 723C86 (5-HT(2B); 3-30) and DOI (5-HT(2A/2C); 0.3-3). Ipsapirone induced hyperphagia during the first hour of food access and hypophagia during the last interval. All other compounds induced dose- and time-dependent hypophagia. m-CPP and TFMPP induced the most marked reduction of food intake and were the only drugs inducing rebound hyperphagia. Except for m-CPP and TFMPP, effects on food intake could generally be dissociated from effects on water intake. The receptor profile of the compounds tested suggests that stimulation of 5-HT(1B), 5-HT(2C), 5-HT(2A) or 5-HT(2B) receptors results in hypophagia. As the less selective agonists were the more potent anorexics, it is suggested that simultaneous activation of these receptors results in synergistic effects on ingestive behavior. Additional antagonism studies are required to ascertain the proposed role of particular 5-HT receptor subtypes in the hypophagic effects of the tested compounds.

Primary adenocarcinoma localized to the fallopian tubes: report on 33 cases

Thirty-three cases of primary adenocarcinoma localized to the fallopian tubes were analyzed according to prognostic factors such as depth of infiltration, tumor differentiation, and lymph vessel invasion. Fifteen patients (45, 5%) died of recurrence within 5 years. Only for positive vessel invasion was the survival significance worse. Combination chemotherapy seems promising compared to radiotherapy in these early stages.

Reimplantation of a benign ovarian tumor

An unusual case of a benign ovarian tumor, which had been torn off its primary usual anatomical site and transplanted to a new intra-abdominal location with new blood supply from the omentum, is described.

Endoluminal ultrasonic scanning in the staging of cervical carcinomas

A new method in the staging of cervical carcinomas using endoluminal rectal ultrasound scanning is demonstrated in the different staging.

Ovarian radiation dose during dynamic cystourethrography using videorecording and photofluorography

The ovarian radiation dose in dynamic cystourethrography was estimated by thermoluminescence dosimetry in a phantom and in 26 patients. The urodynamic examination technique was standardized and included fluoroscopy with videorecording and rapid sequence 100 mm fluorography. The examination was performed in the lateral position with dosimeters in the vagina, uterine cavity and rectum. The total dose in the midline was 13 mGy per examination, which compares with 12 mGy in urography.

Anatomical and functional changes in the lower urinary tract after radical hysterectomy with lymph node dissection as studied by dynamic urethrocystography and simultaneous urethrocystometry

Seventeen urologically healthy women undergoing standardized radical hysterectomy with lymph node dissection for stage I carcinoma of the cervix were evaluated urodynamically before, immediately after, and 1 year after surgery, by dynamic videourethrocystography and simultaneous urethrocystometry. The surgical technique had been developed in order to preserve as much of the nerve and blood supply to the bladder and urethra as possible. Major dysfunction was found in the early postoperative state, but the lower urinary tract almost always regained its preoperative functional status in the course of approximately 1 year. There were no long-lasting functional changes which interfered with daily life, although small static and dynamic changes were observed. The changes occurred chiefly above the urogenital diaphragm. The results of the two urodynamic examinations, each giving different information, corresponded well. Used together they gave a more complete picture than used separately. Dynamic videourethrocystography offered information about the function of the bladder and urethra which could not be obtained by urethrocystometry alone.

Acute urinary retention in first trimester of pregnancy

A 34-year old pregnant women with retroverted uterus and suffering from acute attacks of urinary retention in the first trimester of pregnancy is described. The attacks of retention were caused by the enlarged retroverted uterus associated with a 1x1 cm, well differentiated papilliferous carcinoma in the right side of the trigone. The urinary symptom disappeared after resection of the tumor.

Dynamic urethrocystography in women

A technique for video urethrocystography in women is described and evaluated from the results of examinations on 76 subjects. The patients were examined seated in the lateral position and investigations were carried out at rest, and during straining and coughing, micturition and holding-back maneuvers. Special attention was paid to the overall morphology and the position of the bladder base, the bladder neck and the urethra. Apart from the contour of the symphysis, which in some patients was difficult to identify, the various structures were easily displayed. Also the dynamics of the function of the bladder base, the bladder neck and the urethra were visualized. Almost all patients were able to carry out all parts of the examination including micturition without difficulty. TLD dosimeters in the vagina and uterus showed a low radiation dose to the ovaries.

Location of maximum intraurethral pressure related to urogenital diaphragm in the female subject as studied by simultaneous urethrocystometry and voiding urethrocystography

The urethral pressure profiles were recorded by microtransducers in 25 continent female subjects. From the recordings, the urethral length and the site of maximum intraurethral pressure were determined with a high degree of precision. The urethral length and the distance from the external urethral meatus to the urogenital diaphragm were also assessed on 100 mm roentgenograms taken in the lateral projection. When the results from both recording techniques were compared, the urogenital diaphragm was found to be located, on average, 5.2 mm more distal in the urethra than the site of the maximum urethral pressure. Thus, the conclusion to be drawn is that the high-pressure zone of the urethra in continent women is located proximal to the urogenital diaphragm.

Lymphography following complete dissection of iliac lymph nodes

Twenty-five patients with carcinoma of the uterine cervix stage I were treated by radical hysterectomy and complete iliac lymph node dissection. None of the patients had postoperative lymphedema. Postoperative lymphography was performed in 6 of the patients. The flow time of contrast medium from the foot to the inguinal region was compared with that of a control group. Five different postoperative flow patterns were observed. No delay of the flow was found.

Factors maintaining the intraurethral pressure in women

To determine the components of the intraurethral pressure at rest, five continent women were studied with simultaneous urethrocystometry, including urethral pressure profile measurements, before, during and after curarization, as well as after clamping of the arterial blood supply to the urethra. The results showed that the striated muscle component in the urethra and pelvic floor is responsible for one-third of the total intraurethral pressure. Another one-third is exerted by the urethral vascular bed. The remaining one-third is most probably attributable to the smooth musculature and connective tissues in the urethra and the periurethral tissues.

A new technique for simultaneous urethrocystometry including measurements of the urethral pressure profile

A new standardized technique for continuous recording of the urethral pressure profile simultaneously with intravesical pressure has been developed. The pressure are recorded using two microtransducers enclosed in a thin Dacron catheter. The catheter is moved at a constant speed through the urethra with the aid of a specially designed withdrawal instrument. Using electronic subtraction the closure pressure can easily be measured simultaneously with the intravesical and intraurethral pressure. About 900 investigations have been performed with this technique. It has been testified that very detailed information about normal micturition as well as stress and urgency incontinence can be obtained. The functional as well as the absolute length of the urethra can be estimated within half a millimeter.

A new technique for measurements of the urethra pressure profile

A new standardized technique for continuous recording of the urethral pressure profile simultaneously with intravesical pressure has been developed. The pressures were recorded using two micr-transducers enclosed in a thin Dacron catheter. The catheter moved with a constant speed through the urethra with the aid of a specially designed instrument. This instrument is described. Twenty-five healthy women were examined. The patients were divided into two groups: (A) 10 postmenopausal women, and (B) 15 fertile women. The results of the recordings showed that the functional length and the absolute length of the urethra could be reproduced with an error of less than 1 mm. The maximal pressure amplitude was significantly less in group A.

Intraurethral pressure recording. A comparison betwen tip-transducer catheters and open-end catheters with constant flow

This paper presents the results of a comparative study of intraurethral pressure recording with two different catheter systems: (1) Open-end water-filled catheters with constant flow connected to conventional pressure transducers, and (2) Micro-transducers mounted in the tip of a dacron catheter. When open-end catheters were used, the best reproducibility of the urethra pressure profile was obtained, if the catheter dimensions 6-8 F were used and if the flow in the catheters was kept to approximately 1-2 ml/min. In addition, the withdrawal rate of the open-end catheters should not exceed 3-4 mm/sec. The best reproducibility of the intraurethral pressure was obtained with the micro-transducer. It was free from measuring artefacts and seemed from this investigation superior to the open-end catheter systems, both for clinical practice and for research.

Simultaneous urethro-cystometry with a new technique

A new technique for studying simultaneous intravesical-intraurethral pressure is described. The basic principle of our technique is pressure recordings with the aid of micro-transducers. These micro-transducers have excellent frequency response, are easy to calibrate and to sterilize and are free from artefacts induced by motion. They permit a more accurate study of the pressures within the bladder and the urethra than catheter-transducer systems described earlier. Using electronical subtraction the closure pressure can easily be measured under static and dynamic conditions. Typical pressure diagrammes obtained with this catheter system are presented.

A catheter-manometer calibrator--a new clinical instrument

Although catheter-manometer systems are widely used in clinical medicine, little effert has been make to evaluate the accuracy of these systems. There is consequently a need for an acceptable method of evaluating the complete pressure recording system under clinical conditions, i.e. a catheter-transducer system that be put together and kept sterilised during the preparation of the patient and applied promptly after static and dynamic calibration of pressure under sterile conditions is described. All kinds of catheters, connectors, transducers, as well as the effect of different fluids or air bubbles on the measuring system, can be investigated. The value of the instrument, especially in clinical practice, is demonstrated and discussed.

Simultaneous urethrocystometry and urethra pressure profile measurement with a new technique

A new technique for simultaneous recording of the pressures within the urethra and urinary bladder is described. The pressures are recorded by microtransducers enclosed in a semiflexible dacron catheter. The recording system has a high frequency response (2000 HZ) and is free of motion-induced artefacts, which makes it possible to measure the urethra pressure profile with a high degree of precision.