Advanced Systemic Mastocytosis with associated haematological neoplasm: Treatment with avapritinib can facilitate successful bridge to allogeneic haematopoietic cell transplant

Advanced systemic mastocytosis (AdvSM) is a rare, life-limiting mast cell (MC) neoplasm, with approximately 70% patients having an associated haematological neoplasm (AHN). Avapritinib, a selective tyrosine kinase inhibitor targeting KIT D816V, has shown potent activity translating clinically into durable responses in the phase 1 EXPLORER (NCT02561988) and phase 2 PATHFINDER (NCT03580655) studies. We report three patients with AdvSM-AHN on avapritinib who achieved complete remission (CR) of SM and were successfully bridged to allogeneic haematopoietic cell transplant (allo-HCT). Two cases additionally highlight the risk of clonal evolution within the AHN component and requirement for close monitoring while on targeted therapy.

Sigmoid cancer mimicking ovarian echotexture on transvaginal ultrasound: Case report with literature review

Ultrasound is a first line imaging modality for the evaluation of female pelvic pain. Pelvic pain constitutes one of the most common reasons for presentation to the emergency department with increasing use of point of care ultrasound. Infrequently, point of care or formal ultrasound evaluation may lead to misdiagnosis of extraovarian disease. This can have serious consequences, especially if an extraovarian malignancy is mistaken for a normal ovary or an ovary with a benign process. We present a case of a 41-year-old female who presented to the emergency department for a chief complaint of pelvic pain and vaginal bleeding. Transvaginal ultrasound demonstrated a left adnexal mass, later characterized as a sigmoid colon cancer on MRI and pathology, simulating ovarian echotexture with peripheral hypoechoic components resembling follicles. This article will review the literature of various cases of extraovarian pathology misidentified as ovarian processes and highlight the importance of considering these extraovarian mimickers to prevent potential morbidity and mortality of a missed diagnosis.

Recovery of threatened plant species and their habitats in the biodiversity hotspot of the Southwest Australian Floristic Region

The Southwest Australian Floristic Region (SWAFR) is a global biodiversity hotspot with high plant diversity and endemism and a broad range of threatening processes. An outcome of this is a high proportion of rare and threatened plant species. Ongoing discovery and taxonomic description of new species, many of which are rare, increases the challenges for recovery of threatened species and prioritisation of conservation actions. Current conservation of this diverse flora is based on integrated and scientific evidence-based management. Here we present an overview of current approaches to the conservation of threatened flora in the SWAFR with a focus on active management through recovery and restoration that is integrated with targeted research. Key threats include disease, fragmentation, invasive weeds, altered fire regimes, grazing, altered hydro-ecology and climate change. We highlight the integrated approach to management of threats and recovery of species with four case studies of threatened flora recovery projects that illustrate the breadth of interventions ranging from In situ management to conservation reintroductions and restoration of threatened species habitats. Our review and case studies emphasise that despite the scale of the challenge, a scientific understanding of threats and their impacts enables effective conservation actions to arrest decline and enhance recovery of threatened species and habitats.

Effectiveness of a low support, remotely accessible, cognitive remediation training programme for chronic psychosis: cognitive, functional and cortical outcomes from a single blind randomised controlled trial

BACKGROUND

Cognitive remediation (CR) training has emerged as a promising approach to improving cognitive deficits in schizophrenia and related psychosis. The limited availability of psychological services for psychosis is a major barrier to accessing this intervention however. This study investigated the effectiveness of a low support, remotely accessible, computerised working memory (WM) training programme in patients with psychosis.

METHODS

Ninety patients were enrolled into a single blind randomised controlled trial of CR. Effectiveness of the intervention was assessed in terms of neuropsychological performance, social and occupational function, and functional MRI 2 weeks post-intervention, with neuropsychological and social function again assessed 3-6 months post-treatment.

RESULTS

Patients who completed the intervention showed significant gains in both neuropsychological function (measured using both untrained WM and episodic task performance, and a measure of performance IQ), and social function at both 2-week follow-up and 3-6-month follow-up timepoints. Furthermore, patients who completed MRI scanning showed improved resting state functional connectivity relative to patients in the placebo condition.

CONCLUSIONS

CR training has already been shown to improve cognitive and social function in patient with psychosis. This study demonstrates that, at least for some chronic but stable outpatients, a low support treatment was associated with gains that were comparable with those reported for CR delivered entirely on a 1:1 basis. We conclude that CR has potential to be delivered even in services in which psychological supports for patients with psychosis are limited.

Computerised working-memory focused cognitive remediation therapy for psychosis--A preliminary study

BACKGROUND

Cognitive deficits are a core feature of schizophrenia and related psychotic disorders and are associated with decreased levels of functioning. Behavioural interventions have shown success in remediating these deficits; determining how best to maximise this benefit while minimising the cost is an important next step in optimising this intervention for clinical use.

AIMS

To examine the effects of a novel working-memory focused cognitive remediation (CR) training on cognitive difficulties based on internet delivery of training and weekly telephone support.

METHOD

Participants with a diagnosis of psychosis (n=56) underwent either 8 weeks of CR (approximately 20 h) or 8 weeks of treatment as usual (TAU). General cognitive ability, working memory and episodic memory were measured both pre and post intervention for all participants.

RESULTS

In addition to improvements on trained working memory tasks, CR training was associated with significant improvements in two tests of verbal episodic memory. No association between CR and changes in general cognitive ability was observed. Effect sizes for statistically significant changes in memory were comparable to those reported in the literature based primarily on 1:1 training.

CONCLUSIONS

The cognitive benefits observed in this non-randomised preliminary study indicate that internet-based working memory training can be an effective cognitive remediation therapy. The successes and challenges of an internet-based treatment are discussed.

Fluorescence quantum yield measurements of fluorescent proteins: a laboratory experiment for a biochemistry or molecular biophysics laboratory course

Fluorescent proteins are commonly used in cell biology to assess where proteins are within a cell as a function of time and provide insight into intracellular protein function. However, the usefulness of a fluorescent protein depends directly on the quantum yield. The quantum yield relates the efficiency at which a fluorescent molecule converts absorbed photons into emitted photons and it is necessary to know for assessing what fluorescent protein is the most appropriate for a particular application. In this work, we have designed an upper-level, biochemistry laboratory experiment where students measure the fluorescence quantum yields of fluorescent proteins relative to a standard organic dye. Four fluorescent protein variants, enhanced cyan fluorescent protein (ECFP), enhanced green fluorescent protein (EGFP), mCitrine, and mCherry, were used, however the methods described are useful for the characterization of any fluorescent protein or could be expanded to fluorescent quantum yield measurements of organic dye molecules. The laboratory is designed as a guided inquiry project and takes two, 4 hr laboratory periods. During the first day students design the experiment by selecting the excitation wavelength, choosing the standard, and determining the concentration needed for the quantum yield experiment that takes place in the second laboratory period. Overall, this laboratory provides students with a guided inquiry learning experience and introduces concepts of fluorescence biophysics into a biochemistry laboratory curriculum.

A role for CCAAT/enhancer-binding protein in hepatic expression of thrombin-activable fibrinolysis inhibitor

Thrombin-activable fibrinolysis inhibitor (TAFI) is a procarboxypeptidase B-like zymogen that upon activation by thrombin, thrombin-thrombomodulin, or plasmin attenuates fibrin clot lysis by inhibiting positive feedback in the fibrinolytic cascade. The concentration of TAFI in plasma varies in the human population and thus may constitute a risk factor for thrombotic disorders. In addition, TAFI has been reported to be a positive acute phase reactant in mice. We have initiated molecular analysis of the human TAFI promoter to understand the mechanisms underlying regulation of TAFI gene expression. We identified a putative C/EBP-binding site between -53 and -40 of the promoter. Mutations in this site that abolish C/EBP binding decrease TAFI promoter activity in human hepatoma (HepG2) cells by approximately 80%. Gel mobility shift analyses indicated that C/EBP-beta present in HepG2 nuclear extracts and C/EBP-alpha and -beta present in adult rat liver nuclear extracts bind to the C/EBP site. C/EBP-alpha, -beta, and -delta isoforms are all capable of binding to the C/EBP site and activating the TAFI promoter. The identification of a functional C/EBP-binding site in the human TAFI promoter may have important implications for the regulation of expression of this gene during development and in response to inflammatory stimuli.

Marketing by hospitals: myths and realities

Is marketing by hospitals myth or reality? This article explores five myths of marketing as well as examines the perceptions of hospital administrators concerning the appropriateness of a number of marketing techniques. The opinions of these administrators indicate several opportunities for expanding the usefulness of marketing by hospitals.

A microscale model of bacterial and biofilm dynamics in porous media

A microscale model for the transport and coupled reaction of microbes and chemicals in an idealized two-dimensional porous media has been developed. This model includes the flow, transport, and bioreaction of nutrients, electron acceptors, and microbial cells in a saturated granular porous media. The fluid and chemicals are represented as a continuum, but the bacterial cells and solid granular particles are represented discretely. Bacterial cells can attach to the particle surfaces or be advected in the bulk fluid. The bacterial cells can also be motile and move preferentially via a run and tumble mechanism toward a chemoattractant. The bacteria consume oxygen and nutrients and alter the profiles of these chemicals. Attachment of bacterial cells to the soil matrix and growth of bacteria can change the local permeability. The coupling of mass transport and bioreaction can produce spatial gradients of nutrients and electron acceptor concentrations. We describe a numerical method for the microscale model, show results of a convergence study, and present example simulations of the model system.

An analysis of the implications of a magnetic field threshold limit value on utility work practices

This article examines the implications of a 10 gauss (G) occupational threshold limit value (TLV) on the work practices of a utility that must maintain and repair 500 and 230 kV transmission lines. Three work practices are compared: bare-handed work with live lines (the current practice at the example utility), use of hot sticks, and de-energizing lines prior to work. Bare-handed work with live lines leads to occasional exceedances of the 10 G TLV. Use of hot sticks and de-energizing lines eliminate these exceedances, but they do so at a price. Both practices increase the job duration and, as a result, may increase occupational injury risks. The annual costs for the current live-line, bare-handed practice is approximately $175,000. Use of hot sticks increases this annual cost of maintenance and repair by 30 to 55%. De-energizing lines can increase annual costs by $4 million to $14 million, due to the need for adding additional electricity generation during the planned outages. De-energizing lines also increases the risk to service reliability slightly.

A mathematical model for outgrowth and spatial patterning of the vertebrate limb bud

A new model for limb development which incorporates both outgrowth due to cell growth and division, and interactions between morphogens produced in the zone of polarizing activity (ZPA) and the apical epidermal ridge (AER) is developed and analysed. The numerically-computed spatio-temporal distributions of these morphogens demonstrate the importance of interaction between the organizing regions in establishing the morphogenetic terrain on which cells reside, and because growth is explicitly incorporated, it is found that the history of a cell's exposure to the morphogens depends heavily on where the cell originates in the early limb bud. Because the biochemical steps between morphogen(s) and gene activation have not been elucidated, there is no biologically-based mechanism for translating the spatio-temporal distributions of morphogens into patterns of gene expression, but several theoretically plausible functions that bridge the gap are suggested. For example it is shown that interpretation functions based on the history of a cell's exposure to the morphogens can qualitatively account for observed patterns of gene expression. The mathematical model and the associated computational algorithms are sufficiently flexible that other schemes for the interactions between morphogens, and their effect on the spatio-temporal pattern of growth and gene expression, can easily be tested. Thus an additional result of this work is a computational tool that can be used to explore the effects of various mutations and experimental interventions on the growth of the limb and the pattern of gene expression. In future work we will extend the model to a three-dimensional representation of the limb and will incorporate a more realistic description of the rheological properties of the tissue mass, which here is treated as a Newtonian fluid.

Clinical significance of feline heartworm disease

The clinical signs and diagnostic approach are different in the cat as compared with the dog, which has impaired the veterinarian's ability to detect this parasite in the cat. New techniques and methodologies have enabled the cat owner and veterinarian to recognize this potentially severe disease. Although much is now known about the pathophysiology and biology of this parasite in the cat, the practical application and rapid development of this information to daily practice has led to confusion.

Volume-overload cardiac hypertrophy is unaffected by ACE inhibitor treatment in dogs

We tested the hypothesis that angiotensin-converting enzyme (ACE) inhibitor therapy prevents volume-overload hypertrophy in dogs with chronic mitral regurgitation (MR). Seven adult mongrel dogs receiving ramipril (R; 10 mg orally, twice/day) for 4 mo were compared with 11 dogs receiving no R (N) for 4 mo after induction of MR. Cine-magnetic resonance imaging demonstrated that left ventricular (LV) mass increased in the R-MR dogs [80 +/- 4 (SE) to 108 +/- 7 g, P < 0.01] and in the N-MR dogs (92 +/- 7 to 112 +/- 8 g, P < 0.001). LV myocyte cell length was greater in the R-MR and N-MR dogs (203 +/- 6 and 177 +/- 10 microns, respectively) than in normal (144 +/- 4 microns, P < 0.05) dogs. There was significant loss of the collagen weave pattern by scanning electron microscopy in both R-MR and N-MR dogs. LV ACE and chymase activities were significantly elevated in R-MR and N-MR compared with normal dogs. LV angiotensin II (ANG II) levels in the R-MR dogs (28 +/- 12 pg/g) were reduced to levels seen in normal dogs (28 +/- 4 pg/g) compared with N-MR dogs (72 +/- 11 pg/g, P < 0.05). Steady-state AT1-receptor mRNA levels decreased 66% in N-MR compared with normal dogs (P < 0.001) and increased 1.5-fold in R-MR compared with normal dogs (P < 0.01). Thus upregulation of the AT1 receptor in the R-MR hearts may provide a mechanism by which normal intracardiac ANG II levels could continue to mediate LV hypertrophy. However, the mechanism of dissolution collagen weave in both N-MR and R-MR hearts may be related to the stretch of volume overload.

A microscale model of bacterial swimming, chemotaxis and substrate transport

In this paper, we introduce a mathematical and computational model at the microscale level of bacterial motility and chemotaxis coupled with the advection and diffusion of a biologically reacting substrate. The hydrodynamic interaction of a small bacterial population is explicitly modelled through the use of discrete representations of individual microbes. We use the immersed boundary method to couple microbial motion and the advection-diffusion of substrate with the full incompressible Navier-Stokes equations. Simulations using a preliminary two-dimensional model are presented, demonstrating the mutual dependence through the fluid media of several swimming bacteria. A run and tumble mechanism is introduced for simulating the chemotaxis of swimming bacteria.

Increased ACE and chymase-like activity in cardiac tissue of dogs with chronic mitral regurgitation

The current study was designed to test the hypothesis that intracardiac angiotensin-converting enzyme (ACE) activity, chymase-like activity, and angiotensin (ANG) peptide levels are increased and are positively related to wall stress estimates in response to the chronic low pressure volume overload of mitral regurgitation produced by percutaneous chordal rupture in the dog. Chronic mitral regurgitation (MR) resulted in an increase in left ventricular (LV) end-diastolic volume [59 +/- 11 (SD) to 103 +/- 32 ml, P < 0.001], LV mass (96 +/- 17 to 114 +/- 23 g, P < 0.001), and a decrease in the LV mass-to-end-diastolic volume ratio (1.64 +/- 0.22 to 1.16 +/- 0.23 g/ml, P < 0.001) measured by magnetic resonance imaging. In vitro studies of heart tissue extracts demonstrated that the majority of ANG II-forming activity was from chymase-like activity rather than from ACE activity in five normal (83.5 +/- 7.5 vs. 6.04 +/- 5.2%) and seven MR hearts (86 +/- 3.9 vs. 2.6 +/- 1.7%). ACE activity (1.22 +/- 0.22 vs. 3.55 +/- 0.62 mU/g, P < 0.05) and chymase-like activity (9.42 +/- 4.64 vs. 20.60 +/- 8.41 nmol.g-1.min-1, P < 0.05) were increased in MR compared with normal hearts. ACE activity correlated with the LV mass-to-volume ratio (r = -0.93, P < 0.001) and LV diastolic wall stress ( r = 0.71, P < 0.05); however, chymase-like activity did not correlate with any hemodynamic parameter. ANG II levels were significantly higher in the midwall of the left ventricle in MR hearts than in normal controls (85 +/- 39 vs. 27 +/- 16 pg/g, P < 0.01). Our results demonstrate a positive correlation between LV diastolic wall stress and increased ACE activity with increased ANG II stores, suggesting that mechanical wall stress activated intracardiac ACE. Although chymase accounted for most ANG II formation in vitro in extracts of both normal and MR dog hearts, the significance of this enzyme in vivo remains unclear.

Occurrence of Listeria in hot and cold smoked seafood products

Over a one-year period, 258 samples of smoked fish products were obtained from retail outlets in Newfoundland and processed for Listeria. Of these, 142 were hot smoked and 116 cold smoked, and the samples comprised of nine species of fish. The Canadian FDA listeria isolation protocol consisted of a two-stage enrichment followed by plating on selective isolation media, Oxford, and LPM. An additional selective medium, PALCAM, was also used. Listeria spp. were isolated from 43 of 258 (16.7%) samples processed in all, with hot smoked products yielding 25.4% (36/142) of the isolates, and cold smoked products yielding 6% of the isolates (7/116). Among the nine species tested, cod had the highest rate of Listeria contamination at 46.7%. Of the 43 Listeria spp. isolated, 18 (41.9%) were L. innocua, 13 (30.2%) were L. welshimeri and 12 (27.9%) were L. monocytogenes.

Visceral leishmaniasis in Teresina, n. e. Brazil: towards a DNA probe kit and its adaptation to processing blood-contaminated samples

The Lmet2 chemiluminescent DNA probe is a valuable tool for identifying parasites of the Leishmania donovani -complex in sand flies, dogs and human samples. Recent blood meals in sand flies or blood contamination of tissue samples inhibited probe sensitivity, whether radiolabelled or chemiluminescent detection systems were used. Treatment of membranes with protease before hybridisation restored positive signal. Alternatively samples could be lysed with protease and applied to membranes with a vacuum blotting apparatus. The Lmet2 protocol provides the basis for a DNA probe kit that is adaptable for use with a wide range of other probes.

Charge-transfer-plate spatial light modulators

Charge-transfer-plate spatial light modulators (CTPSLM's) are a class of devices that employ chargetransfer plates as the interface between the charge-generation element and the light-modulation element. Both optically addressed and electrically addressed devices have been built. Chargegenerating elements for the optically addressed devices include photoconductors, photodiode and phototransistor arrays, optoelectronic integrated circuit chips, and photocathode-microchannel-plate assemblies. For electrically addressed devices, electron guns, very large-scale integrated circuits, thin-film transistors, and matrix electrodes are among the possible charge-generation elements. Lightmodulation elements used in CTPSLM's include liquid crystals, electro-optic organic and inorganic crystals, polymers, deformable membrane mirrors, oil films, multilayer dielectric films, and electroluminescent films. In principle, all combinations of charge-generation elements and light-modulating elements are possible. This paper explores the fundamental performance limitations of CTP technology, and describes the design, operation, and applications of five different CTPSLM's (three based on membrane-mirror technology and two on liquid-crystal technology).

A multimedia medical communication link between a radiology department and an emergency department

The most critical aspect of a radiologist's work is communicating his findings to the attending physician responsible for the patient's care. This is also the part of the process that is least well organized and the most subject to failure. At the University of Ottawa Medical Communications Research Centre we are investigating technical means to improving communications between radiologists and attending physicians. We first introduce the radiology communication service problem and show why it is essentially a multimedia communication problem. We then briefly describe a multimedia communication system designed and implemented by our research team. The multimedia system consists of several work stations linked by the Hospital's local area network (LAN). Each physician work station comprises a Compaq 386/20-Mhz microcomputer with 16 Mbytes of RAM, a 500-Mbyte image disk, and an image memory that drives a 1,000-line monochrome monitor. The images are digitized using a Konica laser-based film digitizer (2430 by 2000 10-bit pixels for a standard chest radiograph). The multimedia file server manager station is built around a PC-AT compatible with a Northern Telecom Meridian SL-1ST digital PBX and a Meridian Mail digital voice messaging system. This last device is used to store voice data and is linked via the PBX to the workstations' digital telephones. A Sytek 6,000 LAN links all work stations to the file server. All data, image, and graphic information is transmitted via this network, while the twisted pair connections linking the digital PBX to the telephone sets are used for transmitting voice data.(ABSTRACT TRUNCATED AT 250 WORDS)

Context-dependent enhancements for radiological images

Many techniques have been proposed to enhance radiographic images and each of them may be optimal depending upon the circumstances. However, the problem confronting the radiologist or the physician is which enhancement to use and how to select the parameters when a specific feature is to be emphasized. At the University of Ottawa, our research work is oriented towards automatic context-dependent enhancements. Our approach attempts to match the three phases involved in viewing a radiograph: getting a global impression, analyzing the objects and the local features, and focusing on the image perturbations. In this article, we report on enhancements to support the first two phases in the case of chest radiographs and on the applicability of gray level reversal transformations.

The liver in systemic disease. An innocent bystander

The role of the liver in maintaining the health and function of other organs is frequently described in pathophysiologic terms. A large volume of information has been gleaned on the biochemistry and physiology of the "primary" hepatic diseases. In the dog, there is a paucity of information about the chemical events essential to the viability of normal liver cells and, more specifically, the mechanisms by which diseases of other organs secondarily affect the liver.

Cost-based fee-setting for therapeutic consulting services

A method for developing cost-based dietetic consulting fees is presented which can be applied in hospital in-patient and out-patient departments and in private practice. Limitations and advantages of the method are noted. The advantages outweigh the drawbacks.