BENCHMARKING OF THE SERPENT 2 MONTE CARLO CODE FOR FUSION NEUTRONICS APPLICATIONS

Analyses of radiation fields resulting from a deuterium-tritium (DT) plasma in fusion devices is a critical input to the design and validation of many aspects of the reactor design, including, shielding, material lifetime and remote maintenance requirements/scheduling. Neutronics studies, which perform in-depth analysis are typically performed using radiation transport codes such as MCNP, TRIPOLI, Serpent, FLUKA and OpenMC. The Serpent 2 Monte-Carlo code, developed by VTT in Finland, is the focus of this work which seeks to benchmark the code for fusion applications. The application of Serpent 2 in fusion specific analysis requires validation of the codes performance in an energy range, and a geometrical description, which significantly differs to conventional nuclear fission analysis, for which the code was originally developed.

A Serpent model of the Frascati Neutron Generator (FNG) Helium Cooled Pebble Bed (HCPB) mock up experiment has been prepared and the calculated results compared against experimental data, as well as the reference Monte Carlo code MCNP. The analysis is extended to a model of DEMO with HCPB blanket concept. For this model, the flux, nuclear heating, tritium production and DPA are calculated, all of which are integral nuclear responses in fusion reactor analysis. In general, a very good agreement is demonstrated for both of the benchmarks, with any discrepancies pinpointed to different physics models implemented.

Role of Curtobacterium herbarum strain CAH5 on aluminum bioaccumulation and enhancement of Lactuca sativa growth under aluminum and drought stresses

Aluminum (Al) bioaccumulation by a novel Al and drought tolerant Curtobacterium herbarum strain CAH5 isolated from rhizosphere soil of Beta vulgaris grown in acidic Andisols were examined. The rhizobacterial strain also presented important plant growth promoting traits even with Al and drought stresses under in-vitro conditions in broth. In experiments with a 2-6 mM as initial Al concentrations, the percentages of Al removal by bacteria were 89-93% and 78-91% within 72 h incubation under the normal and drought conditions, respectively. Cytogenotoxicity assay revealed that the toxicity of Al was reduced after bioaccumulation process. In the greenhouse study, formulated bio-inoculant CAH5 significantly improves the Lactuca sativa growth under Al and drought stress by reducing oxidative stress, lipid peroxidation and Al accumulation in plant parts. Our results highlighted that strain CAH5 could be used as a promising bioresource for restoration of agricultural soil with presence of phytotoxic Al improving crop production even under drought conditions.

Simultaneous mitigation of aluminum, salinity and drought stress in Lactuca sativa growth via formulated plant growth promoting Rhodotorula mucilaginosa CAM4

In the present study, a potent Aluminum (Al) resistant yeast strain CAM4 was isolated from rhizosphere soil of Rubus geoides, grown in acidic Andisols and identified as Rhodotorula mucilaginosa by 18S rRNA gene sequence analysis. The strain CAM4 was selected in terms of abiotic stress tolerance to Al, salinity and drought with multiple plant growth promoting (PGP) traits. Besides, strain CAM4 also exhibited Al removal efficiency (80-88%) from the culture medium even under combined stresses of salinity and drought. The sawdust-based formulation of strain CAM4 (sawdust-molasses 5%-PEG 1%-strain CAM4) showed higher cell viability of up to 24 weeks (8.54 log CFU g-1). Inoculation of formulated strain CAM4 significantly enhanced the various morphological and biochemical characters of Lactuca sativa grown under abiotic stress conditions. The formulated strain CAM4 also reduced the accumulation of Al in L. sativa as well that conferring Al tolerance to the plants. The study concludes that strain CAM4 could be used as a biofertilizer for healthy and safe crop production in soils, with Al toxicity as well as combined salt and drought stresses.

Differential growth costs and nitrogen fixation in Cytisus multiflorus (L'Hér.) Sweet and Cytisus scoparius (L.) Link are mediated by sources of inorganic N

Shrubby legumes in Mediterranean-type ecosystems face strong nutrient limitations that worsen in summer, when water is absent. Nitrogen-fixing legumes are likely to be able to switch between soil N and atmospheric N (N₂ ) sources to adjust the C costs of N acquisition in different seasons. We investigated the utilisation of different inorganic N sources by two indigenous shrubby legumes (Cytisus multiflorus and Cytisus scoparius). Plant performance in terms of photosynthesis and biomass production was also analysed. Plants were cultivated in sterile river sand supplied with Hoagland nutrient solution, grown in N-free nutrient solution and inoculated with effective rhizobial strains from nodules of adult plants of the same species. A second treatment consisted of plants given 500 μm NH₄ NO₃ added into the nutrient solution. In a third treatment, plants were watered with another source of N (500 μm NH₄ NO₃ ) as well as being inoculated with effective rhizobial strains. The application of NH₄ NO₃ to the legumes resulted in a larger increase in plant dry matter. Carbon construction costs were higher in plants supplied with mineral and symbiotic N sources and always higher in the endemic C. multiflorus. Differences in photosynthesis rates were only observed between species, regardless of the N source. Non-fertilised inoculated plants had more effective root nodules and a clear dependence on N₂ fixation. We propose that the ability of C. scoparius to change N source makes it a plastic species, which would account for its broader distribution in nature.

Effectiveness and cost-effectiveness of a brief school-based group programme for parents of children at risk of ADHD: a cluster randomised controlled trial

BACKGROUND

National Institute for Health and Care Excellence guidelines recommend a stepped care approach for the identification and management of children with, or at risk of, attention-deficit/hyperactivity disorder (ADHD). We investigated the effectiveness, cost-effectiveness and acceptability of a group parenting intervention programme (+/- a teacher session) for children at risk of ADHD.

METHODS

In a three-arm cluster randomised controlled trial, 12 primary schools were randomly assigned to control, parent-only and combined (parent + teacher) intervention arms. Eligible children had high levels of parent-rated hyperactivity/inattention (n = 199). At 6 month follow-up, the primary outcome measure was the parent-completed Conners' Rating Scale - Revised (ADHD index). Secondary outcomes included the Conners' sub-scales (hyperactivity, cognitive problems/inattention and oppositional behaviour), the teacher-completed Conners' Rating Scale - Revised, child health-related quality of life, parental burden and parental mental health. The cost-effectiveness analyses reflected a health and personal social services perspective.

TRIAL REGISTRATION

ISRCTN87634685.

RESULTS

Follow-up data were obtained from 76 parents and 169 teachers. There was no effect of the parent-only (mean difference = -1.1, 95% CI -5.1,2.9; p = 0.57) or combined interventions (mean difference = -2.1, 95% CI -6.4,2.1; p = 0.31) on the ADHD index. The combined intervention was associated with reduced parent-reported hyperactivity symptoms (mean difference = -5.3; 95% CI -10.5,-0.01; p = 0.05) and the parent-only intervention with improved parental mental health (mean difference = -1.9; 95% CI -3.2,-0.5; p = 0.009). The incremental costs of the parent-only and the combined interventions were £73 and £123, respectively. Above a willingness-to-pay of £31 per one-point improvement in the ADHD index, the parent-only programme had the highest probability of cost-effectiveness. Participants found the interventions acceptable.

CONCLUSIONS

For children at risk of ADHD, this school-based parenting programme was not associated with improvement in core ADHD symptoms. Secondary analyses suggested a possible reduction in parent-reported hyperactivity and parental mental health problems. Future research should compare targeted interventions against watchful waiting and specialist referral.

Dynamic responses of photosynthesis and the antioxidant system during a drought and rehydration cycle in peanut plants

Drought stress is one of the most important environmental factors that adversely affect the productivity and quality of crops. Most studies focus on elucidating plant responses to this stress but the reversibility of these effects is less known. The aim of this work was to evaluate whether drought-stressed peanut (Arachis hypogaea L.) plants were capable of recovering their metabolism upon rehydration, with a focus on their antioxidant system. Peanut plants in the flowering phase (30 days after sowing) were exposed to drought stress by withholding irrigation during 14 days and subsequent rehydration during 3 days. Under these conditions, physiological status indicators, reactive oxygen species production and antioxidant system activity were evaluated. Under drought stress, the stomatal conductance, photosynthetic quantum yield and 13C:12C ratio of the peanut plants were negatively affected, and also they accumulated reactive oxygen species. The antioxidant system of peanut plants showed increases in superoxide dismutase-, ascorbate peroxidase- and glutathione reductase-specific activities, as well as the total ascorbate content. All of these responses were reversed upon rehydration at 3 days. The efficient and dynamic regulation of variables related to photosynthesis and the antioxidant system during a drought and rehydration cycle in peanut plants was demonstrated. It is suggested that the activation of the antioxidant system could mediate the signalling of drought stress responses that enable the plant to survive and recover completely within 3 days of rehydration.

The reallocation of carbon in P deficient lupins affects biological nitrogen fixation

It is not known how phosphate (P) deficiency affects the allocation of carbon (C) to biological nitrogen fixation (BNF) in legumes. The alteration of the respiratory and photosynthetic C costs of BNF was investigated under P deficiency. Although BNF can impose considerable sink stimulation on host respiratory and photosynthetic C, it is not known how the change in the C and energy allocation during P deficiency may affect BNF. Nodulated Lupinus luteus plants were grown in sand culture, using a modified Long Ashton nutrient solution containing no nitrogen (N) for ca. four weeks, after which one set was exposed to a P-deficient nutrient medium, while the other set continued growing on a P-sufficient nutrient medium. Phosphorus stress was measured at 20 days after onset of P-starvation. During P stress the decline in nodular P levels was associated with lower BNF and nodule growth. There was also a shift in the balance of photosynthetic and respiratory C toward a loss of C during P stress. Below-ground respiration declined under limiting P conditions. However, during this decline there was also a shift in the proportion of respiratory energy from maintenance toward growth respiration. Under P stress, there was an increased allocation of C toward root growth, thereby decreasing the amount of C available for maintenance respiration. It is therefore possible that the decline in BNF under P deficiency may be due to this change in resource allocation away from respiration associated with direct nutrient uptake, but rather toward a long term nutrient acquisition strategy of increased root growth.

Identification of RBCK1 as a novel regulator of FKBPL: implications for tumor growth and response to tamoxifen

FKBPL has been implicated in processes associated with cancer, including regulation of tumor growth and angiogenesis with high levels of FKBPL prognosticating for improved patient survival. Understanding how FKBPL levels are controlled within the cell is therefore critical. We have identified a novel role for RBCK1 as an FKBPL-interacting protein, which regulates FKBPL stability at the post-translational level via ubiquitination. Both RBCK1 and FKBPL are upregulated by 17-β-estradiol and interact within heat shock protein 90 chaperone complexes, together with estrogen receptor-α (ERα). Furthermore, FKBPL and RBCK1 associate with ERα at the promoter of the estrogen responsive gene, pS2, and regulate pS2 levels. MCF-7 clones stably overexpressing RBCK1 were shown to have reduced proliferation and increased levels of FKBPL and p21. Furthermore, these clones were resistant to tamoxifen therapy, suggesting that RBCK1 could be a predictive marker of response to endocrine therapy. RBCK1 knockdown using targeted small interfering RNA resulted in increased proliferation and increased sensitivity to tamoxifen treatment. Moreover, in support of our in vitro data, analysis of mRNA microarray data sets demonstrated that high levels of FKBPL and RBCK1 correlated with increased patient survival, whereas high RBCK1 predicted for a poor response to tamoxifen. Our findings support a role for RBCK1 in the regulation of FKBPL with important implications for estrogen receptor signaling, cell proliferation and response to endocrine therapy.

Cytokine-mediated induction of anti-apoptotic genes that are linked to nuclear factor kappa-B (NF-kappaB) signalling in human islets and in a mouse beta cell line

AIMS/HYPOTHESIS

The destruction of pancreatic beta cells leading to type 1 diabetes in humans is thought to occur mainly through apoptosis and necrosis induced by activated macrophages and T cells, and in which secreted cytokines play a significant role. The transcription factor nuclear factor kappa-B (NF-kappaB) plays an important role in mediating the apoptotic action of cytokines in beta cells. We therefore sought to determine the changes in expression of genes modulated by NF-kappaB in human islets exposed to a combination of IL1beta, TNF-alpha and IFN-gamma.

METHODS

Microarray and gene set enrichment analysis were performed to investigate the global response of gene expression and pathways modulated in cultured human islets exposed to cytokines. Validation of a panel of NF-kappaB-regulated genes was performed by quantitative RT-PCR. The mechanism of induction of BIRC3 by cytokines was examined by transient transfection of BIRC3 promoter constructs linked to a luciferase gene in MIN6 cells, a mouse beta cell line.

RESULTS

Enrichment of several metabolic and signalling pathways was observed in cytokine-treated human islets. In addition to the upregulation of known pro-apoptotic genes, a number of anti-apoptotic genes including BIRC3, BCL2A1, TNFAIP3, CFLAR and TRAF1 were induced by cytokines through NF-kappaB. Significant synergy between the cytokines was observed in NF-kappaB-mediated induction of the promoter of BIRC3 in MIN6 cells.

CONCLUSIONS/INTERPRETATION

These findings suggest that, via NF-kappaB activation, cytokines induce a concurrent anti-apoptotic pathway that may be critical for preserving islet integrity and viability during the progression of insulitis in type 1 diabetes.

Initial results of screening of nondiabetic organ donors for expression of islet autoantibodies

CONTEXT

Type 1A diabetes is characterized by a long prodromal phase during which autoantibodies to islet antigens are present. Nevertheless, we lack data on the pancreatic pathology of subjects who are positive for islet autoantibodies (to islet autoantigens GAD65, insulin, and ICA512).

OBJECTIVE

In this manuscript, we describe a novel strategy in obtaining pancreata and pancreatic lymph nodes from islet autoantibody-positive organ donors that involves careful coordination among the laboratory and the organ donor provider organization.

DESIGN

We developed a rapid screening protocol for islet autoantibodies measurement of organ donors to allow identification of positive subjects before organ harvesting. In this way we were able to obtain pancreata and pancreatic lymph nodes from subjects with and without islet autoimmunity.

SETTING

The organ donors used in this study were obtained from the general community.

SUBJECTS

The population studied consisted of 112 organ donors (age range 1 month to 86 yr, mean age 39 yr).

MAIN OUTCOME MEASURE

The main outcome measure of this study consisted of evaluating the pancreatic histology and identify T cells autoreactive for islet antigens in the pancreatic lymph nodes.

RESULTS

To date we have identified three positive subjects and obtained the pancreas for histological evaluation from one of the autoantibody-positive donors who expressed ICA512 autoantibodies. Although this subject did not exhibit insulitis, lymphocytes derived from pancreatic lymph nodes reacted to the islet antigen phogrin.

CONCLUSION

In summary, these results indicate that it is possible to screen organ donors in real time for antiislet antibodies, characterize pancreatic histology, and obtain viable T cells for immunological studies.

Intrinsic spinal cord lesions complicating epidural anaesthesia and analgesia: report of three cases

Serious neurological complications related to epidural anaesthesia and analgesia are only rarely reported. We describe the clinical and radiological features of three patients who sustained intrinsic spinal cord lesions after attempted epidural catheterisation. In each case there was an early onset of motor and sensory impairment after the procedure and MRI demonstrated similar, extensive, paracentral, high signal intensity lesions within the cord on T2 weighted images. Possible mechanisms to explain these MRI appearances are discussed. It is proposed that the most likely cause of these lesions was direct trauma to the spinal cord during the procedure and subsequent injection of fluid into the spinal cord producing localised hydromyelia. The prognosis in each case was for a gradual recovery of motor function but spinothalamic sensory impairment and severe spontaneous pain over the affected area persisted.

Clinical audit and long-term evaluation of renal transplant recipients

Renal transplant recipients now have an increased life expectancy, and this has highlighted the need for increased concern about the long-term complications associated with transplantation. To better manage renal transplant recipients over the long term, it is essential to schedule periodic clinic visits to detect problems and intervene in a timely fashion. Besides enabling early detection and possible treatment, periodic visits permit continuing patient education. Unfortunately, there is no scientifically based consensus that indicates what the optimal frequency and timing of such visits should be, although the AST has recently issued some guidelines. At the MINT, an Annual Review Clinic has been implemented to provide better service to renal transplant recipients over the long term. The clinic offers a comprehensive medical assessment, identifies and quantifies risk factors for CVD, and initiates referrals to appropriate specialists. The Annual Review Clinic increases patient awareness in a number of areas specific to transplantation, promotes a positive approach to healthcare, enables collection of structured data for analysis, and, with hope, engenders a significant degree of patient well-being and satisfaction. The medical community needs to continue long-term patient evaluation and clinical audit as means to improve long-term patient and graft survival, as well as patient quality of life.

A familial case of X chromosome deletion ascertained by cytogenetic screening of women with premature ovarian failure

The association between X chromosome deletions and premature ovarian failure is well established. Previous anecdotal reports however, have not documented the prevalence of X deletions in women with premature ovarian failure. We therefore performed cytogenetic analyses on 79 women with primary or secondary amenorrhoea to assess the utility of screening for a genetic marker for familial premature ovarian failure. A normal karyotype was found in 77 women. One woman with primary amenorrhoea had an XY karyotype and a woman with secondary amenorrhoea had a deletion at Xq 26.1. This second case had a family history of premature ovarian failure, and her mother who underwent premature ovarian failure at 28 years shared this deletion. The early diagnosis of familial X deletions causing premature ovarian failure allowed for the prediction of impending menopause and the implementation of manoeuvres to advance conception. Although cytogenetic aberrations are rare in secondary amenorrhoea, the ability to predict premature ovarian failure can be vital.

Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children

BACKGROUND

We investigated a consecutive series of children with chronic enterocolitis and regressive developmental disorder.

METHODS

12 children (mean age 6 years [range 3-10], 11 boys) were referred to a paediatric gastroenterology unit with a history of normal development followed by loss of acquired skills, including language, together with diarrhoea and abdominal pain. Children underwent gastroenterological, neurological, and developmental assessment and review of developmental records. Ileocolonoscopy and biopsy sampling, magnetic-resonance imaging (MRI), electroencephalography (EEG), and lumbar puncture were done under sedation. Barium follow-through radiography was done where possible. Biochemical, haematological, and immunological profiles were examined.

FINDINGS

Onset of behavioural symptoms was associated, by the parents, with measles, mumps, and rubella vaccination in eight of the 12 children, with measles infection in one child, and otitis media in another. All 12 children had intestinal abnormalities, ranging from lymphoid nodular hyperplasia to aphthoid ulceration. Histology showed patchy chronic inflammation in the colon in 11 children and reactive ileal lymphoid hyperplasia in seven, but no granulomas. Behavioural disorders included autism (nine), disintegrative psychosis (one), and possible postviral or vaccinal encephalitis (two). There were no focal neurological abnormalities and MRI and EEG tests were normal. Abnormal laboratory results were significantly raised urinary methylmalonic acid compared with age-matched controls (p=0.003), low haemoglobin in four children, and a low serum IgA in four children.

INTERPRETATION

We identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers.

Iopentol (Imagopaque 350) compared with diatrizoate (Urografin 370) in cerebral CT. A clinical trial assessing immediate and late (7 days) adverse events and diagnostic information (visualization quality and Hounsfield unit measurements)

The non-ionic contrast medium iopentol (Imagopaque, Nycomed Imaging AS, Oslo, Norway) 350 mg I/ml was compared for safety and efficacy with the ionic contrast medium diatrizoate (Urografin, Schering AG, Berlin, Germany) 370 mg I/ml in a randomized, double-blind, parallel-group clinical trial in cerebral computed tomography (CT). The numbers of participating patients was 79; forty in the iopentol group and 39 in the diatrizoate group. Safety was evaluated by assessing the numbers of patients reporting immediate adverse events (up to 30 min after injection) and delayed adverse events (within 7 days after the examination). Efficacy was expressed as the quality of visualization of the cerebral lesions after injection of the contrast medium. In addition, Hounsfield units were measured pre- and post-contrast. No patient in either group experienced any serious adverse event. The frequency of patients with immediate adverse events was statistically significantly lower in the iopentol group (23%) than in the diatrizoate group (64%), p = 0.0003. Delayed adverse events were also significantly less frequent in the iopentol group (43%) than in the diatrizoate group (69%), p = 0.047. Patients in the iopentol group reported significantly less discomfort (53%), especially sensation of warmth, than patients in the diatrizoate group (92%), p = 0.0001. The intensity of adverse events and injection-associated discomfort seemed, in general, to be lower for patients in the iopentol group. No difference was found between the two contrast media regarding efficacy.

Chronic inflammatory demyelinating polyneuropathy with multifocal CNS demyelination in an Afrid

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The neuroradiology of Kallmann's syndrome: a genotypic and phenotypic analysis

A detailed neurological investigation of patients with Kallmann's syndrome (KS) has been performed in an attempt to relate phenotypic characterization with genotype. Twenty-seven subjects with KS were studied (including 12 males with X-linked disease and 3 females). Six male and 2 female normosmics with isolated GnRH deficiency, 1 male with KS variant, and 1 obligate female carrier were also imaged. Evidence for X-linked disease was derived both from analysis of pedigree and by mutation analysis at the KAL locus. The female carrier and all 8 normosmics had normal olfactory bulbs and sulci, as did 3 male KS. The study, therefore, confirms the value of magnetic resonance imaging in the diagnosis of KS, but suggests that the technique is not sufficiently sensitive to differentiate KS from the normosmic form of GnRH deficiency in all cases. Phenotypic characterization of KS was more effectively achieved by accurate estimation of olfactory status. Three new mutations at the KAL locus were identified, 2 single exon deletions and 1 point mutation. In 2 pedigrees with clear X-linked inheritance, no coding sequence mutations were detected; it may be that these harbor mutations of pKAL, the recently characterized 5'-promoter region. No clear relationship could be established between specific phenotypic anomalies and particular KAL mutations. Involuntary, mirror movements of the upper limbs were present in 10 of 12 cases of X-linked KS, but in none of the other subjects. Although this phenomenon has been ascribed to an abnormality of the corpus callosum, in the present study magnetic resonance imaging demonstrated no quantitative or qualitative morphological anomalies of this structure.

Brain glucose metabolism in chronic marijuana users at baseline and during marijuana intoxication

Despite the widespread abuse of marijuana, knowledge about its effects in the human brain is limited. Brain glucose metabolism with and without delta 9 tetrahydrocannabinol (THC) (main psychoactive component of marijuana) was evaluated in eight normal subjects and eight chronic marijuana abusers with positron emission tomography. At baseline, marijuana abusers showed lower relative cerebellar metabolism than normal subjects. THC increased relative cerebellar metabolism in all subjects, but only abusers showed increases in orbitofrontal cortex, prefrontal cortex, and basal ganglia. Cerebellar metabolism during THC intoxication was significantly correlated with the subjective sense of intoxication. The decreased cerebellar metabolism in marijuana abusers at baseline could account for the motor deficits previously reported in these subjects. The activation of orbitofrontal cortex and basal ganglia by THC in the abusers but not in the normal subjects could underlie one of the mechanisms leading to the drive and the compulsion to self-administer the drug observed in addicted individuals.

Brain glucose metabolism in violent psychiatric patients: a preliminary study

Positron emission tomography with 18F-deoxyglucose was used to evaluate regional brain glucose metabolism in eight normal subjects and eight psychiatric patients with a history of repetitive violent behavior. Seven of the patients showed widespread areas of low brain metabolism. Although the location of the abnormal regions varied among patients, they showed significantly lower relative metabolic values in medial temporal and prefrontal cortices than did normal comparison subjects. These regions have been implicated as substrates for aggression and impulsivity, and their dysfunction may have contributed to the patients' violent behavior.

In-vitro cervical mucus-sperm penetration tests and outcome of infertility treatments in couples with repeatedly negative post-coital tests

The results of in-vitro cervical mucus-sperm penetration tests and cross-hostility tests in 178 couples with repeatedly negative post-coital tests were recorded. Using a protocol of three cycles with intra-uterine inseminations (IUI) followed by three cycles with ovulation induction + IUI, the association between the cause of infertility, results of the in-vitro tests and the outcome of infertility treatment was investigated. We found that repeatedly negative post-coital tests are a good indicator of a cervical mucus-sperm penetration problem. The cross-hostility test clearly differentiates the abnormal factor in this interaction, and a good performance of the donors' spermatozoa in the cervical mucus correlates with increased pregnancy rate. In male factor infertility, failure of the husbands' spermatozoa to penetrate cervical mucus was not indicative of a deficient fertilization potential in vivo. In these patients a serious attempt should therefore be made to reverse the infertility by treatment with IUI or ovulation induction + IUI before attempting assisted reproduction. Women with polycystic ovaries and repeatedly negative post-coital tests should be investigated for sperm receptivity of the cervical mucus. Low receptivity of the cervical mucus may imply that endometrial receptivity and oocyte quality are also low. Ovulation induction and not IUI alone should therefore be used as the preferred mode of treatment to improve pregnancy rate.

Evaluation of the neurobehavioral functioning of patients before, during, and after bone marrow transplantation

PURPOSE

To evaluate the cognitive and emotional functioning of patients undergoing bone marrow transplantation (BMT) in the protected environment (PE).

PATIENTS AND METHODS

Patients were given tests of cognition and mood before their hospitalization in the PE, after 2 weeks, at discharge, and at 8 months post-BMT. Locus of control, degree of social support, previous biotherapy, and on-treatment psychiatric consultation were also analyzed.

RESULTS

Before BMT, 20% of patients had mild cognitive dysfunction, and nearly 40% had significant anxiety. Although few patients developed problems with cognition or mood during the study, short-term memory deficits nearly doubled at follow-up compared with baseline. Anxiety decreased significantly during hospitalization and remained low at follow-up. In contrast, depression increased throughout hospitalization, but decreased at follow-up. Pre-BMT emotional status and cognitive functioning were highly related to long-term outcome. Type of BMT, locus of control, and degree of social support were related to psychologic distress and cognitive functioning, both during and after BMT. Patient age was not a predictor of neurobehavioral symptoms during or after BMT.

CONCLUSION

Pretransplant emotional and cognitive functioning are important determinants of long-term outcome and quality of life (QOL) in BMT patients. In addition, a few patients undergoing BMT develop short-term memory difficulties and mood disturbance that may persist. Pretransplant identification of patients at risk for neurobehavioral difficulties may guide early interventions during hospitalization. Posttransplant assessment may then be used to develop rehabilitation programs and other interventions for individuals with persisting complaints.

Effects of age, gravidity and male infertility status on cumulative conception rates following artificial insemination with cryopreserved donor semen: analysis of 2998 cycles of treatment in one centre over 10 years

The effects of age, gravidity and male infertility status on cumulative conception rates after donor insemination were investigated in an analysis of 2998 treatment cycles undertaken on 443 patients. It was found that the cumulative conception rates after 3, 6 and 12 cycles of treatment were 21, 40 and 62% respectively for patients < 30 years of age compared with 17, 26 and 44% for those aged > or = 30 years (P = 0.008). There was also a significant difference (P < 0.001) in results depending on course of treatment and the cumulative conception rates were 19% after 3 cycles, 33% after 6 cycles and 54% after 12 cycles of treatment in the first course of treatment compared with 40, 67 and 79% respectively in those who returned for subsequent courses of treatment after having achieved a donor insemination pregnancy in the first treatment course. Gravidity and male infertility status (azoospermia or oligozoospermia/asthenozoospermia) did not significantly affect the cumulative conception rates.

A study of the use of gloves in a large teaching hospital

A study was conducted in the wards and laboratory of a 900-bed teaching hospital to determine the appropriateness of glove use. In the wards the rate of appropriate use was 59%, and in the laboratory it was 90%. In general, in the patient areas gloves were used for specific tasks (70%) whereas in the laboratory use for a specific task was only 32%. Financial savings could be realized by educational programs in infection control directed toward a more rational use of gloves.

Semen and cervical mucus parameters and success in artificial insemination

Over the last 2 years, data on cervical mucus, thawed semen and their interaction in vitro have been collected at the time of insemination in all patients referred to our clinic for artificial insemination by donor (AID). A total of 37 patients have become pregnant, including one who became pregnant twice, and 27 patients have completed a course of 6-12 inseminations or withdrawn without becoming pregnant after a minimum of four cycles of treatment. A comparison of data from these two groups reveals significant differences in cellularity, penetrability and ferning of the cervical mucus and in the motility of spermatozoa in the thawed semen. In a comparison of sperm parameters in the same semen sample prior to freezing and after thawing, those samples which were fertile showed a lower reduction in motility due to freezing and thawing. Studies on the in vitro interaction between mucus and spermatozoa show that, in certain combinations, the mucus appears to induce abnormalities in the midpiece region or the tail, which impair sperm progression. Collection and analysis of data from up to three inseminations per cycle demonstrates that there is considerable variation between patients in the stability of their periovulatory mucus and has also allowed a number of patients with 'problem mucus' to be identified.

Computed tomography in the diagnosis of malignant brain tumours: do all patients require biopsy?

A proportion of patients with computed tomographic (CT) scan appearances of malignant brain tumour undergo conservative management, despite the absence of histological confirmation of the diagnosis. Concern that this policy risked misdiagnosing a benign tumour prompted us to examine the accuracy of CT scanning in diagnosing malignant lesions. The study was designed to determine whether within a group of 300 patients with intracerebral mass lesions of known pathology, two sub-groups existed: one with appearances so specific for malignant glioma that biopsy was unnecessary, and the other in which the appearances were characteristic of malignancy, though not specific for glioma. Three neuroradiologists independently reviewed the CT scans, together with brief clinical details. When diagnosing malignant tumours, all made errors: nine benign lesions were considered to be malignant. When diagnosing malignant glioma, one neuroradiologist made errors, but the other two adopted a more cautious approach and were accurate. The restricted a "certain" diagnosis to about one in five scans considered to show malignant tumour. Those diagnosed specifically as malignant glioma were intrinsic, irregular, mixed density lesions, exhibiting variable enhancement and infiltrating the peri-ventricular tissues, especially the corpus callosum. Using these criteria, they could correctly identify a small proportion of patients with malignant gliomas. In all other patients, biopsy remains the only means of obtaining a definitive diagnosis.

Amyloid angiopathy and granulomatous angiitis of the central nervous system: a case responding to corticosteroid treatment

A 73-year-old woman presented with multifocal cerebral dysfunction of 1 month's duration. Cranial CT scanning revealed unusual widespread abnormalities. Brain biopsy showed amyloid angiopathy affecting vessels in the meninges and cerebral cortex, with associated granulomatous angiitis. There was no clinical evidence of extracranial vasculitis. Corticosteroid therapy produced striking clinical and radiological improvement.

Diagnosis of masses presenting within the ventricles on computed tomography

The radiological and clinical features of 90 histologically verified intraventricular masses were reviewed. Computed tomography (CT) and plain X-rays were available in all and angiograms in over half the cases. The localisation, effects on the adjacent brain substance and the presence and degree of hydrocephalus was evident on CT. Two-thirds of colloid cysts presented as pathognomonic anterior third ventricular hyperdense masses and the other third were isodense; an alternative diagnosis should be considered for low density masses in this situation. Plexus papillomas and carcinomas mainly involved the trigone and body of a lateral ventricle of young children and caused asymmetrical hydrocephalus; the third ventricle was occasionally affected also in children and the fourth ventricle more frequently and usually in adults. Two-thirds were hyperdense, one-third of mixed or lower density. The meningiomas were dense trigonal tumours of adults generally arising in the choroid plexus, but two tentorial meningiomas passed through the choroidal fissure and caused a predominantly intraventricular mass. Gliomas frequently thickened the septum and generally involved the frontal segments of the lateral ventricles. They may be supplied by perforating as well as by the choroidal arteries, which supply most other vascularised masses within the ventricles. Only 10% of our cases did not fall into one of the former categories; these included low density non-enhancing dermoid or epidermoid tumours and higher density enhancing metastatic or angiomatous masses.

Bacteriophage typing of Corynebacterium diphtheriae

Bacteriophage types of over 3,000 strains of Corynebacterium diphtheriae isolated in Canada have been determined. The typing scheme used involved the use of nine phages. Results indicated that phage types correlate with biotypes to a large degree. Corynecin types were also determined for a limited number of cultures, and results indicated that the indicator strains presently available are unsuitable for the typing of C. diphtheriae strains isolated in North America. The distribution of phage types is similar throughout Canada, and the types present correspond to types reported from other countries. Phage typing could be of value in the study of circumscribed outbreaks and in epidemiological surveillance of types over long periods.