Embryo mortality in a captive-bred, Critically Endangered amphibian

The Critically Endangered southern corroboree frog Pseudophryne corroboree is dependent upon captive assurance colonies for its continued survival. Although the captive breeding programme for this species has largely been successful, embryonic mortality remains high (40-90% per year). This study aimed to investigate the causes of mortality in P. corroboree embryos in the captive collection at Melbourne Zoo. During the 2021 breeding season, we investigated 108 abnormal embryos to determine the impact of infections and anatomical deformities on survival and used culture and molecular methods to identify microbes. Overall, 100% of abnormal embryos had fungal infections, and of these, 41.6% also had anatomical deformities. The mortality rate in abnormal embryos was 89.8%; however, we detected no difference in survival in any of the 3 observed fungal growth patterns or between deformed and non-deformed embryos. Sanger sequencing of the ITS region identified fungal isolates belonging to the genus Ilyonectria, the first record in a vertebrate host, and another as a Plectosphaerella sp., which is the first record of infection in an embryo. Dominant bacteria identified were of the genera Herbaspirillum and Flavobacterium; however, their role in the mortality is unknown. Fungal infection and deformities have a significant impact on embryo survival in captive-bred P. corroboree. In a species which relies on captive breeding, identifying and reducing the impacts of embryonic mortality can inform conservation efforts and improve reintroduction outcomes.

Change in levator ani muscle stiffness and active force during pregnancy and post-partum

INTRODUCTION AND HYPOTHESIS

It is assumed changes occur to the biomechanics and viscoelastic response of the levator ani muscle during pregnancy; however, there is limited evidence of this. This study used instrumentation and clinical measures to determine the stiffness and active force capacity of levator ani muscle during pregnancy and post-partum, investigated any associations with delivery outcomes, and explored the biomechanical properties associated with symptoms of pelvic floor dysfunction.

METHODS

This was a prospective observational study, with nulliparous women with a singleton low-risk pregnancy. Data were collected at two stages during pregnancy and post-partum. Measurements included the Australian Pelvic Floor Questionnaire, palpation of active force, and elastometry measurements. Post-partum, 3D/4D ultrasound measurements were included. Repeated measures ANOVAs, pairwise comparisons, Pearson correlation coefficients, and Student's t-tests were used as appropriate.

RESULTS

Fifty-nine women took part in the study. Active force was significantly different over the pregnancy and post-partum, measured with instrumentation (p = 0.002) and palpation (p = 0.006 right, p = 0.029 left). There was no significant change in muscle stiffness during pregnancy. Post-partum muscle stiffness was significantly different between women who gave birth vaginally vs. caesarean section (p = 0.002). Post-partum there were differences in levator hiatal area, symptoms of bladder dysfunction, prolapse symptoms, and sexual dysfunction symptoms.

CONCLUSIONS

Active force of the levator ani muscle was significantly reduced during pregnancy and in the post-partum period, while muscle stiffness reduced only in those who had vaginal deliveries.

Myotonometry Reliably Measures Muscle Stiffness in the Thenar and Perineal Muscles

Purpose: The authors investigated the reliability of myotonometry-measured muscle tone in the thenar and perineal muscles. Methods: Participants were women aged 18-50 years who were asymptomatic for thumb and pelvic floor dysfunction (interrater study n=20; intrarater study n=43) or who were symptomatic for vulvodynia (interrater study n=14; intrarater study n=32). Mechanical properties (stiffness, frequency, decrement, relaxation time, and creep) of the muscles were measured using a myotonometer (MyotonPRO) while the muscles were in a relaxed state. Measures were performed twice by two assessors. Intra- and interrater reliability were determined using intra-class correlation coefficients (ICCs) and absolute reliability using the standard error of measurement and a minimum detectable change. Results: The primary property of interest, muscle stiffness, showed very good interrater (ICC 0.85-0.86) and intrarater (ICC 0.82-0.88) reliability in the thenar eminence. In the perineal muscles, reliability results ranged from good to very good for interrater (ICC 0.70-0.86) and intrarater (ICC 0.80-0.91) reliability for muscle stiffness. Absolute reliability was confirmed, with all measures showing minimal variance. Conclusions: Muscle stiffness of the smaller muscles of the body can be reliably measured using the MyotonPRO. The device could be used as a reference standard in the development of a digital palpation scale that would facilitate accurate diagnosis of muscle tone.

Expectations and realities of student nurses' experiences of negative behaviour and bullying in clinical placement and the influences of socialization processes

This paper explores nursing students' experiences and perceptions of negative behaviour and bullying in clinical placement measured against expectations at the start of their education. It explores their understanding and how they make sense of their circumstances and their experiences of negative behaviour, emphasizing socialization processes and factors which may prevent or reproduce negative behaviour and bullying. To this end, a focus group study was conducted, and this revealed that many students felt exploited, ignored or were made to feel unwelcome, although few reported personal experience of bullying. These frequent but less severe negative experiences appear to play a key role in institutionalizing an unwelcoming culture within which bullying could easily be triggered or take hold. Students' coping mechanisms may also contribute to reproducing such negative behaviour. The paper concludes that while the vulnerable position of student nurses might offer some protection against outright bullying, it is unable to shield them from unfriendly and negative behaviour, with implications for their learning and professional socialization. If student nurses respond to their experiences by suppressing their feelings and developing a hard front, such responses may themselves contribute to a reproduction of such behaviour with implications for personal wellbeing and retention rates.

Zero balance ultrafiltration for the correction of acute acidosis after a period of prolonged deep hypothermic circulatory arrest

A 36-year-old woman with normal renal function underwent a total arch replacement requiring 110 minutes of deep hypothermic circulatory arrest. Prior to rewarming, a pH of 7.063 with a base deficit of 10.8 was obtained. Zero-balance ultrafiltration (Z-BUF) was initiated during rewarming 7 minutes after resumption of cardiopulmonary bypass. After one hour (10L) of Z-BUF, all electrolyte and acid-base disturbances were fully corrected. Our case illustrates that Z-BUF offers a valuable option for the correction of severe electrolyte and acid-base disturbances in adults undergoing cardiac surgery. Its use should be considered in addition to the more standard pharmacologic approaches to such derangements as it offers rapid and predictable electrolyte and acid-base correction and potential anti-inflammatory benefits.

Strategies for endovascular mitral valve repair

Technological advances have recently enabled mitral valve repair to be performed using endovascular techniques and thus open the possibility of nonsurgical treatment of mitral valve disease. While balloon valvotomy has been applied to mitral stenosis for over 20 years, a number of devices aimed at correcting mitral regurgitation are currently in preclinical and clinical development. While some of these, such as edge-to-edge repair, are catheter adaptations of established surgical techniques, others represent true departures from the current surgical paradigms of correcting mitral regurgitation. This review will summarize the current status of percutaneous transcatheter techniques for mitral valve repair. Included are balloon mitral valvotomy, indirect annuloplasty, direct annuloplasty, ventricular shape change, and edge-to-edge repair. These techniques certainly represent a new interdisciplinary paradigm between cardiac surgery and interventional cardiology and may be the next frontier in minimally-invasive cardiac surgery.

Genetic manipulation of beta-adrenergic signalling in heart failure

Heart failure (HF) represents one of the leading causes for hospitalization in developed nations. Despite advances in the management of coronary artery disease, no significant improvements in prognosis have been achieved for HF over the last several decades. Heart failure itself represents a final common endpoint for several disease entities, including hypertension, coronary artery disease, and cardiomyopathy. However, certain biochemical features remain common to the failing myocardium. Foremost amongst these are alterations in the beta-adrenergic receptor signalling cascade. Recent advances in transgenic and gene therapy techniques have presented novel therapeutic strategies for the management of HF via enhancement of beta-adrenergic signalling. In this review, we will discuss the biochemical changes that accompany HF as well as corresponding therapeutic strategies. We will then review the evidence from transgenic mouse work supporting the use of adrenergic receptor augmentation in the failing heart and more recent in vivo applications of gene therapy directed at reversing or preventing HF.

Cardiac gene delivery with cardiopulmonary bypass

BACKGROUND

Cardiac gene therapy offers the possibility of enhancing myocardial performance in the compromised heart. However, current gene delivery techniques have limited myocardial transgene expression and pose the risk of extracardiac expression. Isolation of the coronary circulation during cardiac surgery may allow for more efficient and cardiac-selective gene delivery in a clinically relevant model. Methods and Results-- Neonatal piglets (3 kg) underwent a median sternotomy and cardiopulmonary bypass, followed by aortic cross-clamping with 30 minutes of cardioplegic arrest. Adenoviral vectors containing transgenes for either beta-galactosidase (adeno-beta-gal, n=11) or the human beta(2)-adrenergic receptor (adeno-beta(2)-AR, n=15) were administered through the cardioplegia cannula immediately after arrest and were allowed to dwell in the coronary circulation during the cross-clamp period. After 1 week, the animals were killed, and their heart, lungs, and liver were excised and examined for gene expression. Analysis of beta-galactosidase staining revealed transmural myocardial gene expression among animals receiving adeno-beta-gal. No marker gene expression was detected in liver or lung tissue. beta-AR density in the left ventricle after adeno-beta(2)-AR delivery was 396+/-85% of levels in control animals (P<0.01). Animals receiving adeno-beta(2)-AR and control animals demonstrated similar beta-AR density in both the liver (114+/-8% versus 100+/-9%, P=NS) and lung (114+/-7% versus 100+/-9%, P=NS). There was no evidence of cardiac inflammation.

CONCLUSIONS

By using cardiopulmonary bypass and cardioplegic arrest, intracoronary delivery of adenoviral vectors resulted in efficient myocardial uptake and expression. Undetectable transgene expression in liver or lung tissue suggests cardiac-selective expression.

Electroinjection of colloid particles and biopolymers into single unilamellar liposomes and cells for bioanalytical applications

A combined electroporation and pressure-driven microinjection method for efficient loading of biopolymers and colloidal particles into single-cell-sized unilamellar liposomes was developed. Single liposomes were positioned between a approximately 2-microm tip diameter solute-filled glass micropipet, equipped with a Pt electrode, and a 5-microm-diameter carbon fiber electrode. A transient, 1-10 ms, rectangular waveform dc voltage pulse (10-40 V/cm) was applied between the electrodes, thus focusing the electric field over the liposome. Dielectric membrane breakdown induced by the applied voltage pulse caused the micropipet tip to enter the liposome and a small volume (typically 50-500 x 10(-15) L) of fluorescein, YOYO-intercalated T7-phage DNA, 100-nm-diameter unilamellar liposomes, or fluorescent latex spheres could be injected into the intraliposomal compartment. We also demonstrate initiation of a chemical intercalation reaction between T2-phage DNA and YOYO-1 by dual injection into a single giant unilamellar liposome. The method was also successfully applied for loading of single cultured cells.

High-grade papillary cystadenocarcinoma of the tongue

AIMS

Salivary gland tumours of the tongue are rare. The most common type is low-grade mucoepidermoid carcinoma followed by adenoid cystic carcinoma. Papillary cystadenocarcinoma of salivary glands are uncommon lesions with low-grade mucoepidermoid carcinoma followed by adenoid cystic carcinoma. Papillary cystadenocarcinoma of salivary glands are uncommon lesions with low-grade histological and clinical features. We report a high-grade papillary cystadenocarcinoma in an 80-year-old man who presented with a tongue mass and metastatic disease in the neck.

METHODS AND RESULTS

He was treated with partial glossectomy and bilateral neck dissection but developed local and regional recurrences 6 months later. The tumour had a prominent cystic appearance and had areas of necrosis. The cyst lumen was occupied by numerous papillae lined by pseudostratified columnar cells with a high nuclear-cytoplasmic ratio. The cytoplasm was eosinophilic, the nuclei were pleomorphic and exhibited irregular nuclear membranes, vesicular chromatin and prominent eosinophilic nucleoli. The mitotic activity was high and there were occasional abnormal mitotic figures. Metastatic carcinoma was present in four lymph nodes. The differential diagnosis of this unusual lesion includes cystadenoma, salivary duct carcinoma and metastases.

CONCLUSIONS

This case and a review of the literature indicates that papillary cystadenocarcinomas of salivary gland origin exhibit a wider morphologic spectrum than described in the latest World Health Organization (WHO) classification which defines these lesions as low-grade neoplasms.

Predicting postlaryngectomy voice outcome in an era of primary tracheoesophageal fistulization: a retrospective evaluation

OBJECTIVES

Not all laryngectomees appear to have the same potential to develop functional spoken communication. Our goal was to evaluate voice outcome in different functional subgroups of laryngectomees and to identify physical and demographic factors associated with success and failure to achieve functional spoken communication.

DESIGN

Retrospective chart review.

SETTING

Surgery was performed at a tertiary care hospital. Multidisciplinary follow-up was conducted at weekly head and neck clinics held at the associated regional cancer centre. Voice rehabilitation procedures took place in both settings.

PATIENTS

Sixty-four consecutive patients who had undergone total laryngectomy during the era of primary tracheoesophageal fistulization (TEF) at this facility. Patients were subdivided into four groups according to whether they had undergone primary TEF, or whether this had been contraindicated by locoregional factors of TEF candidacy/performance status, or both.

INTERVENTIONS

Primary TEF was performed whenever technically feasible and traditional TEF candidacy criteria were met. Voice rehabilitation procedures were initiated prior to discharge.

OUTCOME MEASURES

A judgement of voice outcome was assigned based on documentation on at least one of three patient treatment records by a physician or speech-language pathologist that a patient had demonstrated functional spoken communication within the clinical setting.

RESULTS

Forty-five of 64 patients (70%) achieved functional spoken communication. Six laryngectomized subgroups were ultimately identified and characterized. Voice outcome varied considerably between these subgroups. Prelaryngectomy communication status and age emerged as predictors of voice outcome.

CONCLUSIONS

Voice outcome is related to several factors present prior to or at laryngectomy. Different combinations of such factors create various postlaryngectomy recovery streams for which voice outcome may be predicted more specifically.

ABC of work related disorders. Legal aspects

Images

Phenotypic characterization of individuals with 30-40 CAG repeats in the Huntington disease (HD) gene reveals HD cases with 36 repeats and apparently normal elderly individuals with 36-39 repeats

Abnormal CAG expansions in the IT-15 gene are associated with Huntington disease (HD). In the diagnostic setting it is necessary to define the limits of the CAG size ranges on normal and HD-associated chromosomes. Most large analyses that defined the limits of the normal and pathological size ranges employed PCR assays, which included the CAG repeats and a CCG repeat tract that was thought to be invariant. Many of these experiments found an overlap between the normal and disease size ranges. Subsequent findings that the CCG repeats vary by 8 trinucleotide lengths suggested that the limits of the normal and disease size ranges should be reevaluated with assays that exclude the CCG polymorphism. Since patients with between 30 and 40 repeats are rare, a consortium was assembled to collect such individuals. All 178 samples were reanalyzed in Cambridge by using assays specific for the CAG repeats. We have optimized methods for reliable sizing of CAG repeats and show cases that demonstrate the dangers of using PCR assays that include both the CAG and CCG polymorphisms. Seven HD patients had 36 repeats, which confirms that this allele is associated with disease. Individuals without apparent symptoms or signs of HD were found at 36 repeats (aged 74, 78, 79, and 87 years), 37 repeats (aged 69 years), 38 repeats (aged 69 and 90 years), and 39 repeats (aged 67, 90, and 95 years). The detailed case histories of an exceptional case from this series will be presented: a 95-year-old man with 39 repeats who did not have classical features of HD. The apparently healthy survival into old age of some individuals with 36-39 repeats suggests that the HD mutation may not always be fully penetrant.

Huntington's disease in Grampian region: correlation of the CAG repeat number and the age of onset of the disease

The identification of an unstable trinucleotide repeat as the mutation responsible for Huntington's disease (HD) has given the hope that additional information can be provided about age of onset and mode of action of the mutated gene. We present in this paper results of a clinical and molecular study of 82 patients affected with HD from 46 pedigrees within the Grampian region, Scotland. Our results show a correlation between age of onset and size of the CAG expansion. This study has produced no overlap in mutation size between affected and unaffected alleles. The sex of the parent transmitting the mutated allele and the size of the normal allele have no significant effect on the clinical features of the disease. In the three juvenile cases the affected parent was the father but the number of cases is too small to produce statistical significance. An increase in the CAG repeat size is shown in the transmission of the gene in five cases, accompanied by an earlier age of onset in four; in three of these cases, the affected parent was the father. Eleven sib pairs were studied and there is a negative correlation between the difference in age at onset and the difference in repeat size. Thus there is some evidence of a relationship, but this is not statistically significant because of the small numbers involved. The presence of the same or different normal allele had no effect on age of onset in this small group. We suggest that additional factors, as yet unrecognised, influence the age of onset and clinical presentation of HD.

Visual display units and pregnancy outcome: a prospective study

This paper presents the results of a prospective study of the impact of work with visual display units (VDUs) and associated ergonomic and stress variables on pregnancy outcome and infertility. An apparent relationship between VDU use and pregnancy outcome in retrospective data probably reflected the operation of recall bias. Prospective data did not reveal any evidence for an adverse effect of VDUs on pregnancy in this sample, or any mechanism by which such an effect could occur. There was no evidence for any effect of VDU use on infertility. Implications for working women and future research are also presented.

Prosthetic plate mandibular reconstruction

The head and neck surgeon may choose one of several available methods to reconstruct the mandible following tumor ablation. This article discusses the use of metallic mandibular prostheses, the indications for alloplastic mandibular reconstruction, techniques of plate application (AO and THRP), and associated complications.

Ewing's sarcoma of the temporal bone. A case report

An 11-year-old girl with a primary Ewing's sarcoma in the squamous temporal bone is described, and differential diagnosis and management are discussed. The membranous bones of the skull are rare sites for a primary Ewing's sarcoma; the squamous temporal bone has not been previously described as a primary site.

The use of computed tomography in the management of facial trauma by British oral and maxillofacial surgeons

A survey of 184 British oral and maxillofacial surgeons on their use of computed tomography (CT) in the management of craniofacial trauma showed that the majority of the 116 surgeons who replied used this form of imaging for frontal, nasoethmoidal, and orbital fractures. Only 6% of respondents reported no advantage in CT imaging over plain radiography. The access to CT scanners and the value of the reports in the management of patients was rated as satisfactory by 75% of respondents, and a similar percentage reported that CT service was becoming increasingly available to their units.

Computed tomography in the diagnosis of maxillofacial trauma

A study of 34 patients who were investigated for maxillofacial trauma using high resolution computed tomography (CT) scanning is presented. The areas where this increasingly available technique offers more accurate information than conventional plain radiographs are discussed.

Thin section computed tomography in the evaluation of naso-ethmoidal trauma

We reviewed the computed tomography (CT) appearances, plain film radiographs and clinical findings of 17 patients who suffered fractures of the naso-ethmoidal complex. Six patients (35%) with diplopia were noted on CT to have lateral displacement of medial orbital wall fragments into the orbit (medial wall 'blow-in' fractures) leading to displacement of the globe or extra-ocular muscles. Medial displacement of ethmoid bone fragments (medial wall 'blow-out' fractures) with medial rectus entrapment was noted in a further two cases (11%) also. Multiple associated facial fractures were seen in all but one case with CT evidence of frontal bone fracture and intracranial injury in 12 (70%) patients. CT was judged to add valuable information to clinical findings and plain film radiography and was especially helpful where marked soft tissue swelling precluded detailed physical examination of the naso-orbital region. The CT features of naso-ethmoidal trauma are illustrated and discussed and the advantages of CT in the pre-operative evaluation of such injuries are emphasised.

Stress in the police service

In this study, the sources of stress among supervisory police officers were explored. It was found that one of the major sources of stress across all managerial levels among the police was the perception that the police service was inhibited by unnecessary bureaucratic and outside obstacles, e.g., increased paperwork, interdepartmental politics, lack of adequate planning and resources and the inability of the courts to prosecute offenders. It was also found that junior and middle supervisory police officers were adversely affected by lack of available manpower and long working hours, whereas senior officers were affected more by the conflict in maintaining positive policing as well as good community relations.

Metoprolol overdose

We report the first two documented cases of the deliberate metoprolol overdose occurring in the United States, one of which eventually proved fatal. The potentially lethal cardiotoxic effects of this drug are illustrated and correlated with the blood and tissue levels of metoprolol. We emphasize the often sudden and rapid clinical deterioration which excessive ingestion of this drug may produce, and the need for close, careful supervision and monitoring of these patients.

Type A coronary-prone behavior and stress in senior female managers and administrators

This article describes a study of relationships between Type A coronary-prone behavior patterns, as measured by the Bortner and Rosenman scale, and stress levels, coping ability and psychological stress-related symptoms of a group of 148 senior female managers and administrators. The results indicate that the majority of the sample were categorized as Type A individuals, and that Type A behavior was related to age. A relationship was found between Type A behavior and subjects perceiving themselves as having higher stress levels compared to the female and male peers with whom they worked. Type A individuals perceived that their "ability to cope with stress" was worse compared to that of their female peers and female superiors, but saw themselves as better "copers" compared to their female subordinates. Type A individuals did not see themselves as a source of stress to their subordinates. A relationship was also found between Type A behavior and symptoms of anxiety, frustration and irritation. Results are compared to those of previous relevant research, and the implications of the findings are discussed.

Type A coronary-prone behavior in the work environment

The model presented in this paper accounts for the relationship between Type A behavior and the work environment and identifies: (1) susceptible Type A individuals; (2) potential occupational stressors in the work environment; (3) subsequent resulting control conflict and maladaptive coping behavior; (4) feedback error and time lag resulting in detrimental symptoms; and (5) methods of changing Type A behavior (Fig 1). From this literature review, it becomes clear that there is a need for further prospective research especially in the area aimed at isolating and determining the specific work environment variables which enhance Type A behavior. As yet, no prospective research project is known which has followed a sample of employees from their job application and interview situation through their careers, in order to investigate changes in, and influences on, Type A behavior patterns. Finally, there is an obvious need for the introduction of more Type A behavior modification programs for workers, and perhaps more emphasis should also be directed toward changing the Type A behavior pattern socialization process, which appears to be so prevalent in urban, middle-class home environments.