Coccidioidal Pulmonary Cavitation: A New Age

Coccidioides species are thermally dimorphic fungi found in geographically defined areas of the Western Hemisphere. The primary portal of entry is respiratory, with symptomatic pneumonic diseases as the most common presentation. Subsequent pulmonary complications as well as extrapulmonary metastatic infection may occur, either of which may be the presenting disease manifestation. Cavitary lung disease may be found incidentally or when investigating symptoms such as cough or hemoptysis. This study aims to explore the spectrum of coccidioidal cavities and the evaluation and management in a cohort of patients seen at Kern Medical over the last 12 years.

Coccidioidal Peritonitis: A Review of 17 cases

Coccidioidomycosis is the second most common endemic fungal infection in the United States. Prior descriptions of coccidioidal peritonitis include only single cases. We describe 17 new cases previously unreported from healthcare institutions in California. The majority of cases presented with nonspecific abdominal complaints. PubMed and Google Scholar were searched for additional case series and only single case reports and reviews of single cases were found.

The diagnosis was confirmed by culture or histopathology and/or serology in each patient. All patients were treated with anti-fungal therapy. This case series demonstrates that coccidioidal peritonitis may be asymptomatic or present with only subtle abdominal symptoms. In a minority of our patients, the diagnosis was established incidentally during surgery. Based on this series, the overall outcome of coccidioidal peritonitis is favorable with long-term triazole treatment. The term cure is not usually used in disseminated coccidioidal disease because of the risk of late relapse.

Discovery of phosphotyrosine-binding oligopeptides with supramolecular target selectivity

Phage-display screening on self-assembled tyrosine-phosphate ligands enables the identification of oligopeptides selective to dynamic supramolecular targets, with the lead peptide showing a preferred hairpin-like conformation and catalytic activity.

Impact of video clinics in the management of fracture nasal bones in COVID times

Background: The COVID -19 pandemic created a panic situation where patient interaction with the other patients and health care staff had to be restricted to avoid spreading the disease. We planned an innovative strategy to restrict the inflow of patients to those who may need nasal bone manipulation by using Video Clinics (VC). Methods: All consecutive patients presenting to three units of Accident & Emergency (A & E) NHS sites of our trust with suspicion of fractured nasal bones were included in the study group for a period of three months. The impact of VC was studied by calculating the percentage of patients who could be discharged without a recall to the hospital from those attending it, the percentage who finally needed a fracture reduction, and the satisfaction scores of patients with VC. Results: Forty-two patients were offered appointments in VC. Thirty-one could attend VC, out of which thirteen (41.9%) were discharged without a recall. Twenty-three patients were recalled for F2F (Face2Face) clinic, out of which twelve (28.5% of 42) required fracture reduction, and 11 were discharged to home. Ten patients underwent fracture reduction under local anaesthesia, and two were booked for Septorhinoplasty later. Twenty-seven (87.1 %) patients expressed satisfaction with VC, two (6.4%) were lost to follow-up, and the remaining two (6.4%) were not satisfied. Conclusion: VC could effectively filter 41.9% of patients who did not need surgical intervention from the comfort of their homes or workplace by using the available multimedia facility without compromising outcomes and satisfaction scores. The satisfaction score was 87.1% with VC. The clinics helped prevent potential coronavirus exposure by staying safe, and they are recommended in emergencies like COVID -19.

Echocardiographic Findings in Heart Failure Patients With Methamphetamine Use: A Case-Control Study

Background

Methamphetamine use is associated with cardiovascular disease and significant morbidity and mortality. There is only one previous study performed on echocardiographic parameters in patients with methamphetamine cardiomyopathy.

Methods

We performed a retrospective review of medical records in a county hospital in Southern California with a high population of methamphetamine users. We reviewed medical records and echocardiogram findings in patients seen in our institution from November 2019 to November 2020 who had cardiomyopathy with and without methamphetamine use. We excluded patients who either left the hospital or expired before appropriate assessment. We divided our patient population into a case group (methamphetamine users) and a control group (non-methamphetamine users) to study and compare their echocardiographic parameters.

Results

Case group included a total of 254 patients and control group included 268 patients. Majority of the patient population were males - 178 (70%) and 180 (67%) in the case and control group respectively. Age was found to be statistically significant with the younger population in the case group (p = 0.0000). Our analysis revealed statistically significant difference in methamphetamine users compared to non-users in regards to left ventricle ejection fraction (33.65% ± 18.02 vs. 41.55% ± 15.61, p=0.0000), left ventricle mass index (122.49 grams/m² ± 40.66 vs. 108.62 grams/m² ± 32.82, p=0.0000), left ventricle end diastolic volume index (85.91 mL/m² ± 37.40 vs. 72.44 mL/m² ± 25.44; p=0.0000) and marginally significant right ventricle systolic pressure (42.29mmHg ± 17.53 vs. 39.59mmHg ± 15.61; p=0.0540)

Conclusion

Our results indicated that methamphetamine users had echocardiogram findings with decreased ejection fraction and increased left ventricular mass index, end-diastolic volume index, and right ventricular systolic pressure consistent with worse dilated cardiomyopathy comparison to non-users.

Self-Assembly Propensity Dictates Lifetimes in Transient Naphthalimide-Dipeptide Nanofibers

Transient self-assembly of dipeptide nanofibers with lifetimes that are predictably variable through dipeptide sequence design are presented. This was achieved using 1,8-naphthalimide (NI) amino acid methyl-esters (Phe, Tyr, Leu) that are biocatalytically coupled to amino acid-amides (Phe, Tyr, Leu, Val, Ala, Ser) to form self-assembling NI-dipeptides. However, competing hydrolysis of the dipeptides results in disassembly. It was demonstrated that the kinetic parameters like lifetimes of these nanofibers can be predictably regulated by the thermodynamic parameter, namely the self-assembly propensity of the constituent dipeptide sequence. These lifetimes could vary from minutes, to hours, to permanent gels that do not degrade. Moreover, the in-built NI fluorophore was utilized to image the transient nanostructures in solution with stimulated emission depletion (STED) based super-resolution fluorescence microscopy.

Amino-acid-encoded biocatalytic self-assembly enables the formation of transient conducting nanostructures

Aqueous compatible supramolecular materials hold promise for applications in environmental remediation, energy harvesting and biomedicine. One remaining challenge is to actively select a target structure from a multitude of possible options, in response to chemical signals, while maintaining constant, physiological conditions. Here, we demonstrate the use of amino acids to actively decorate a self-assembling core molecule in situ, thereby controlling its amphiphilicity and consequent mode of assembly. The core molecule is the organic semiconductor naphthalene diimide, functionalized with D- and L- tyrosine methyl esters as competing reactive sites. In the presence of α-chymotrypsin and a selected encoding amino acid, kinetic competition between ester hydrolysis and amidation results in covalent or non-covalent amino acid incorporation, and variable supramolecular self-assembly pathways. Taking advantage of the semiconducting nature of the naphthalene diimide core, electronic wires could be formed and subsequently degraded, giving rise to temporally regulated electro-conductivity.

Switchable Hydrolase Based on Reversible Formation of Supramolecular Catalytic Site Using a Self-Assembling Peptide

The reversible regulation of catalytic activity is a feature found in natural enzymes which is not commonly observed in artificial catalytic systems. Here, we fabricate an artificial hydrolase with pH-switchable activity, achieved by introducing a catalytic histidine residue at the terminus of a pH-responsive peptide. The peptide exhibits a conformational transition from random coil to β-sheet by changing the pH from acidic to alkaline. The β-sheet self-assembles to form long fibrils with the hydrophobic edge and histidine residues extending in an ordered array as the catalytic microenvironment, which shows significant esterase activity. Catalytic activity can be reversible switched by pH-induced assembly/disassembly of the fibrils into random coils. At higher concentrations, the peptide forms a hydrogel which is also catalytically active and maintains its reversible (de-)activation.

Correlation between X-ray diffraction and Raman spectra of 16 commercial graphene-based materials and their resulting classification

Structural properties of sixteen (16) commercial samples of graphene-based materials (GBM) labelled as graphene, graphene oxide or reduced graphene oxide are investigated at room temperature using X-ray diffraction (XRD) and Raman spectroscopy. Based on the observed correlation between the results obtained with these two techniques, these samples are classified into three groups: Group A of seven samples consisting of graphitic nanosheets with evaluated thickness ≃20 nm and exhibiting both the 2H and 3R phases in XRD; Group B of six samples exhibiting XRD spectra characteristic of either graphene oxides (GO) or carbons with some order; and Group C of three samples with XRD spectra characteristic of disordered carbons. The relative intensities and widths of D, G, D', 2D and (D + D') bands in the Raman spectra are equally distinguishable between the samples in groups A, B and C. The width of the D-band is the smallest for Group A samples, intermediate for group B and the largest for group C samples. The intensity ratio I(D)/I(G) of the D and G bands in the Raman spectra of the samples is used to quantify the Raman-active defects whose concentration increases in going from samples in Group A to those in Group C.

Dynamic peptide libraries for the discovery of supramolecular nanomaterials

Sequence-specific polymers, such as oligonucleotides and peptides, can be used as building blocks for functional supramolecular nanomaterials. The design and selection of suitable self-assembling sequences is, however, challenging because of the vast combinatorial space available. Here we report a methodology that allows the peptide sequence space to be searched for self-assembling structures. In this approach, unprotected homo- and heterodipeptides (including aromatic, aliphatic, polar and charged amino acids) are subjected to continuous enzymatic condensation, hydrolysis and sequence exchange to create a dynamic combinatorial peptide library. The free-energy change associated with the assembly process itself gives rise to selective amplification of self-assembling candidates. By changing the environmental conditions during the selection process, different sequences and consequent nanoscale morphologies are selected.

On the nature of magnetic state in the spinel Co₂SnO₄

In the spinel Co2SnO4, coexistence of ferrimagnetic ordering below T(N) ≃ 41 K followed by a spin glass state below T(SG) ≃ 39 K was proposed recently based on the temperature dependence of magnetization M(T) data. Here new measurements of the temperature dependence of the specific heat C(P)(T), ac-susceptibilities χ'(T) and χ″(T) measured at frequencies between 0.51 and 1.2 kHz, and the hysteresis loop parameters (coercivity H(C)(T) and remanence M(R)(T)) in two differently prepared samples of Co2SnO4 are reported. The presence of the Co(2+) and Sn(4+) states is confirmed by x-ray photoelectron spectroscopy (XPS) yielding the structure: Co2SnO4 = [Co(2+)][Co(2+)Sn(4+)]O4. The data of C(P) versus T shows only an inflection near 39 K characteristic of spin-glass ordering. The analysis of the frequency dependence of ac-magnetic susceptibility data near 39 K using the Vogel-Fulcher law and the power-law of the critical slowing-down suggests the presence of spin clusters in the system which is close to a spin-glass state. With a decrease in temperature below 39 K, the temperature dependence of the coercivity H(C) and remanence M(R) for the zero-field cooled samples show both H(C) and M(R) reaching their peak magnitudes near 25 K, then decreasing with decreasing T and becoming negligible below 15 K. The plot of C(P)/T versus T also yields a weak inflection near 15 K. This temperature dependence of H(C) and remanence M(R) is likely associated with the different magnitudes of the magnetic moments of Co(2+) ions on the 'A' and 'B' sites and their different temperature dependence.

Effects of Erbium alloying on the structural and piezoelectric properties of Aluminum Nitride thin films annealed under extreme thermal conditions

Effects of adding Erbium(Er) to Aluminum Nitride thin films on their structural and piezoelectric are reported along with stability of the films after annealing them at temperatures up to 600° C. The thin films samples were deposited on the (001) p-type silicon substrates by reactive magnetron sputtering, using the Er alloyed Aluminum targets with Er atomic concentrations of 0, 1, 3 and 4% and the magnetron sputtering power of 200 W. The samples were characterized by X-ray diffraction (XRD) and X-ray photoelectron spectroscopy (XPS). XPS analysis was used to confirm the stoichiometry of AlN phase, Er atomic content and its possible chemical state in the films. Results show that alloying with Er results in higher piezoelectric coefficient d33 as compared to that in Er-free AlN thin films. Structural analysis of the films by XRD shows the shift of (0002) AlN peak to lower 2θ values upon Er doping, indicating the presence of uniform internal compressive stress.

Genome-wide mapping of Myc binding and gene regulation in serum-stimulated fibroblasts

The transition from quiescence to proliferation is a key regulatory step that can be induced by serum stimulation in cultured fibroblasts. The transcription factor Myc is directly induced by serum mitogens and drives a secondary gene expression program that remains largely unknown. Using mRNA profiling, we identify close to 300 Myc-dependent serum response (MDSR) genes, which are induced by serum in a Myc-dependent manner in mouse fibroblasts. Mapping of genomic Myc-binding sites by ChIP-seq technology revealed that most MDSR genes were directly targeted by Myc, but represented a minor fraction (5.5%) of all Myc-bound promoters (which were 22.4% of all promoters). Other target loci were either induced by serum in a Myc-independent manner, were not significantly regulated or were negatively regulated. MDSR gene products were involved in a variety of processes, including nucleotide biosynthesis, ribosome biogenesis, DNA replication and RNA control. Of the 29 MDSR genes targeted by RNA interference, three showed a requirement for cell-cycle entry upon serum stimulation and 11 for long-term proliferation and/or survival. Hence, proper coordination of key regulatory and biosynthetic pathways following mitogenic stimulation relies upon the concerted regulation of multiple Myc-dependent genes.

Voided Urinary Cytology in Bladder Cancer: Is It Time to Review the Indications?

OBJECTIVES

The sensitivity of voided urinary cytology has been reported as very low. In this study, we investigated the sensitivity and clinical utility of voided urinary cytology in the detection of various grades and stages of transitional cell carcinoma (TCC) of the bladder compared with the urinary nuclear matrix protein-22 (NMP-22) qualitative assay.

METHODS

From March 2004 to April 2006, all patients with TCC of the bladder receiving follow-up care and those presenting with gross hematuria were enrolled in this prospective study. These patients underwent urinary cytologic examination and NMP-22 qualitative assay. The diagnosis, determined from the cystoscopy findings and biopsy findings of the suspicious lesion, was accepted as the reference standard.

RESULTS

A total of 196 patients were enrolled in this study, of whom 127 patients had previously been diagnosed with bladder TCC and 69 were presenting for investigation of gross hematuria. A total of 52 cases of bladder TCC were diagnosed. The overall sensitivity of voided urine cytology and NMP-22 assay was 21.1% and 67.3%, respectively (P <0.001). The sensitivity of urinary cytology and urinary NMP-22 for well-differentiated tumors was 9.5% and 52.4%, respectively, and was 18.1% and 77.3%, respectively (P <0.001), in moderately differentiated tumors. The overall specificity of urinary cytology for TCC of the bladder was 98.6% and was greater than the specificity of NMP-22 (80.5%).

CONCLUSIONS

The results of our study suggest that urinary cytology has a very low sensitivity and can be omitted in favor of NMP-22 in the follow-up of low-grade superficial bladder TCC.

Intravesical Explosion during Transurethral Resection of Prostate - a reminder

Intravesical explosion during transurethral resection of the prostate (TURP) is an extremely rare but dreaded complication and results in rupture of the bladder. It is believed that intravesical explosion occurs due to formation of explosive gases in the bladder during TURP and its admixture with air. A case of intravesical explosion during TURP resulting in bladder rupture at our institution is described. Though the management of this catastrophe is relatively straightforward, it has the potential for dire consequences. We emphasize that, despite its rare occurrence, it is preventable and suggest measures to avoid it.

A Comparative Study of Laparoscopic with Conventional Open Donor Nephrectomy in Renal Transplantation

BACKGROUND

Laparoscopic donor nephrectomy (LDN) has been gaining popularity among kidney donors. There have been concerns about the safety and efficacy of the procedure as compared to open donor nephrectomy (ODN). We compare our results on LDN with ODN.

METHODS

We retrospectively analysed our data of LDN and ODN. Duration of surgery, blood loss, period of hospitalisation, per oral intake and analgesic requirements.

RESULT

22 LDNs were done, the operation time ranged from 220-300 minutes, and blood loss from 100-150ml. In the first 10 laparoscopic operations four cases required conversion to open surgical dissection. Only one case was converted to open surgery in the subsequent 12 laparoscopic cases. Oral intake was started on the first postoperative day. Analgesic requirement in laparoscopy cases was less. Patients were mobilised on the first day after surgery. Patients were discharged by seventh day. There was no significant difference in the functioning of the graft after revascularisation in the recipient.

CONCLUSION

Laparoscopic donor nephrectomy is a safe and effective technique of donor nephrectomy.

Dispelling inhibition for laparoscopic surgery in younger children with Cushing's syndrome. Case report and literature review

Laparoscopic adrenalectomy (LA) is now the gold standard for the treatment of small, benign adrenal tumors in adults. In Cushing's syndrome (CS), LA is difficult and seldom done, especially in younger children. A 6-year-old girl was diagnosed with CS due to a juxtaadrenal tumor. She underwent LA and made an uneventful recovery. The histopathology was reported as paraganglioma which is a very rare cause of CS. LA is seldom done in younger children with CS owing to extreme obesity, abundant perinephric fat and a high incidence of pre- and postoperative complications.

Assessing the efficiency of extracorporeal shockwave lithotripsy for stones in renal units with impaired function: a prospective controlled study

The objective was to determine the efficiency of extracorporeal shockwave lithotripsy (ESWL) in clearing stones from renal units with impaired function. Thirty-five patients with poorly functioning kidneys determined by intravenous urogram and 99mtechnetium diethylene triamine pentacetic acid renal dynamic scan underwent ESWL. Stone clearance was assessed at 3 months and compared with that in normally functioning kidneys. The study group was divided into two subgroups. Those with split glomerular filtration rate (GFR) of the concerned kidney between 10 and 20 ml/min were in group 1. Group 2 consisted of patients with split GFR between 20 and 30 ml/min. A control group (group 3) was formed from patients with urolithiasis and normally functioning kidneys. The overall retreatment rate was 84.4%. The overall stone clearance rate in the study group was 34.2% while it was 57.7% in the control group. The stone clearance rate in group 2 was 40%. The difference in stone clearance rate between the study and control groups was statistically significant (P=0.023) but that between group 2 and the control group was not (P=0.159). The incidence of steinstrasse between the study group 2 and control group was not statistically significant (P=0.408). The clearance rate for ureteral stones was comparable in all the three groups. The stone-free rate and rate of steinstrasse for renal stones in kidneys with moderately impaired function were comparable to normally functioning kidneys. However, kidneys with severely impaired function had poor results. The clearance rate for ureteral stones was not influenced by the impairment of renal function.

Experience with marginal living related kidney donors: Are they becoming routine or are there still any doubts?

OBJECTIVES

To analyze donor and recipient outcome of grafts from marginal kidney donors (ie, elderly or suffering from some anomaly).

METHODS

We had 81 marginal donors from July 1996 to July 2004; 46 were older than 60 years, and 39 had renal or nonrenal anomaly. The donors and recipients were evaluated for morbidity, graft and recipient survival, and the number of rejection episodes.

RESULTS

The mean (+/- standard deviation) age of elderly donors was 62.2 +/- 3.1 years. Follow-up ranged from 6 months to 50 months (mean 21.15 +/- 0.9 months). Actuarial 1-year and 3-year graft survival rates were 95% and 81%, respectively. Twenty-six percent of recipients maintained serum creatinine levels less than 1.4 mg/dL. The mean age of hypertensive donors was 46.2 years, and blood pressure was controlled with one drug. Serum creatinine levels in the recipients were less than 1.4 mg/dL in 10 and less than 2.5 mg/dL in the rest. Eleven percent of hypertensive donors required an increase in their antihypertensive medication. All donors showed a 15% to 20% increase in their glomerular filtration rate. Donors underwent simultaneous surgery when indicated.

CONCLUSIONS

Criteria to reject donors need to be reviewed periodically. The elderly and donors with other anomalies are consistently showing acceptable results. Hypertensive donors require assessment with awake ambulatory blood pressure monitoring.

Early development of emergency medicine in Chennai (Madras), India

India is the second most populous country in the world, with a population approaching 1 billion people. The development of emergency medicine is still in its earliest stages because the Medical Council of India (MCI) does not yet recogonize the specialty. Recent developments may cause the MCI to reconsider specialty status for emergency medicine as an academic discipline.

Immunologic response to tetanus toxoid in geriatric patients

STUDY OBJECTIVE

Tetanus antibody levels have been shown to be inadequate in 50% of patients older than 65 years. Although immunization recommendations have been made for this age group, the efficacy of this intervention has not been well documented. We sought to determine the difference in tetanus antibody levels after the administration of one tetanus toxoid immunization to geriatric patients without adequate titers.

METHODS

Thirty-five patients older than 65 years at a large urban comprehensive care geriatric center who were documented to have inadequate tetanus antibody titers were each given one tetanus toxoid immunization. Repeat titers were obtained at least 2 months after the immunization with the use of enzyme-linked immunosorbent assay (Bindazyme kit; the Binding Site Corporation, Birmingham, England). We considered tetanus antibody levels greater than .17 IU/mL protective.

RESULTS

The mean age was 79.4 years; 30 of 35 (86%) were female. Repeat tetanus antibody titers were obtained an average of 123 days (range, 63 to 204 days) after immunization with tetanus toxoid. The mean preimmunization antibody titer was .1 IU/mL (range, .04 to .16 IU/mL). After immunization, antibody titers increased a mean of .61 IU/mL (range, -.01 to 2.23 IU/mL; 95% confidence interval, .35 to .87 IU/mL). Thirty of the 35 patients who received a single injection of tetanus toxoid (86%) developed protective titers. We found no relationship between seroconversion and age, sex, or medical history; nor did we find a relationship between antibody level and time elapsed since immunization when repeat titers were obtained.

CONCLUSION

Administration of one tetanus toxoid injection affords protective immunity in many geriatric patients.

Antibody protection to diphtheria in geriatric patients: need for ED compliance with immunization guidelines

STUDY OBJECTIVE

Because 50% to 70% of geriatric patients have been shown to have nonproductive levels of tetanus antibodies, we postulated that this population might also have inadequate levels of diphtheria antibodies. Emergency physicians have the opportunity to immunize patients against tetanus and diphtheria. We sought to determine the seroprevalence of diphtheria antibodies in patients older than 65 years and to assess compliance with immunization guidelines in EDs.

METHODS

Enzyme-linked immunosorbent assay for diphtheria antibodies was conducted in 58 outpatients of geriatric medical facility aged 65 years or older. We considered titers greater than .1 IU/mL protective. Eighteen ED personnel, ages 25 to 40 years, served as comparison subjects. The preparation used for immunization of injured patients--tetanus toxoid or tetanus and diphtheria toxoids adsorbed for adult use--was determined by means of a telephone survey of 64 New York City EDs.

RESULTS

The mean age of our patients was 80 years (range, 65 to 95 years). Their mean diphtheria antibody titer was .17 IU/mL (range, .04 to .54 IU/mL). Thirty-three percent (19 of 58; 95% confidence interval [Cl], 21% to 54%) of patients had inadequate levels of diphtheria antibodies. We found no significant differences between protected and nonprotected patients with respect to age, sex, medical history, or military service. Patients with nonprotective levels of diphtheria antibodies were more likely to have inadequate tetanus antibody titers. Sixty-eight percent of patients without protection from diphtheria (13 of 19; 95% Cl, 48% to 88%) were also unprotected from tetanus, and 33% (13 of 39; 95% Cl, 19% to 47%) o those with adequate diphtheria antibodies had nonprotective levels of tetanus antibodies (P = .012). All 18 ED personnel had adequate diphtheria and tetanus antibodies. The telephone survey revealed that 30% (19 of 64) of EDs use only tetanus toxoid for immunization of injured patients.

CONCLUSION

A significant percentage of geriatric patients have inadequate diphtheria antibodies. Emergency physicians must comply with immunization guidelines for injured patients to assure adequate protection from both tetanus and diphtheria.

Segmental enteritis: "enteritis necroticans". A clinicopathologic study

Acute segmental enteritis, also called "enteritis necroticans" is characterized by nonocclusive intestinal ischemia in the absence of any precipitating cause. We studied 30 such patients over a 5.5-year period. All patients had acute abdominal symptoms requiring emergency laparotomy, and in only 30% was a preoperative diagnosis of segmental enteritis proposed. The jejunum alone (63.3%), or with the ileum (26.7%), was the most common site of necrotic patches (86.7%), frank gangrene (50.0%), free perforation (36.7%), and circumferential dusky lesions (30.0%). Twenty-eight patients required resection of the affected bowel. Specimen angiography in two cases showed normal mesenteric vasculature. In 12 patients, a detailed microbiological profile from peritoneal fluid, intestinal contents, and intestinal wall was performed, but Clostridium welchii was isolated from none. The resected intestinal specimens showed mucosal ulceration, submucosal edema, mixed inflammatory infiltrate, and patchy necrosis of the muscularis propria. The intramural vessels were patent in all cases. Wound-related complications occurred in 14, pulmonary complications in 14, renal failure in eight, and fecal fistulas in five; 23.3% died.

Psychomotor testing of on-call anaesthetists

The critical flicker fusion frequency and choice reaction times of 16 on-call anaesthetists were measured between 1400 and 1600, at 2300 and at 0200 hours. Critical flicker fusion decreased between the afternoon and 2300; there was no further change between 2300 and 0200. No significant differences in choice reaction times were found on any of these different occasions.

Somatic embryogenesis and regeneration of plants in the bamboo Dendrocalamus strictus

Somatic embryogenesis leading to plant regeneration has been achieved in the bamboo, Dendrocalamus strictus, by culturing seeds (caryopses) on B5 basal medium supplemented with 2,4-dichlorophenoxyacetic acid. Callus cultures obtained from the embryonal end of the seeds differentiated chlorophyllous embryoids. On transfer to a germination medium (B5 liquid, sucrose, indolebutyric acid, and ∝ -naphthaleneacetic acid) 40% of the embryoids developed into plantlets. Further development of the plantlets occured on B5 liquid medium (half strength) + sucrose (1%) + IBA (5 × 10(-7)M) + NAA (10(-7)M).