A Model Predicting the 6-Month Disability of Patients With Traumatic Brain Injury to Assess the Quality of Care in Intensive Care Units: Results from the CREACTIVE Study

Assessing quality of care is essential for improving the management of patients experiencing traumatic brain injury (TBI). This study aimed at devising a rigorous framework to evaluate the quality of TBI care provided by intensive care units (ICUs) and applying it to the Collaborative Research on Acute Traumatic Brain Injury in Intensive Care Medicine in Europe (CREACTIVE) consortium, which involved 83 ICUs from seven countries. The performance of the centers was assessed in terms of patients' outcomes, as measured by the 6-month Glasgow Outcome Scale-Extended (GOS-E). To account for the between-center differences in the characteristics of the admitted patients, we developed a multinomial logistic regression model estimating the probability of a four-level categorization of the GOS-E: good recovery (GR), moderate disability (MD), severe disability (SD), and death or vegetative state (D/VS). A total of 5928 patients admitted to the participating ICUs between March 2014 and March 2019 were analyzed. The model included 11 predictors and demonstrated good discrimination (area under the receiver operating characteristic [ROC] curve in the validation set for GR: 0.836, MD: 0.802, SD: 0.706, D/VS: 0.890) and calibration, both overall (Hosmer-Lemeshow test p value: 0.87) and in several subgroups, defined by prognostically relevant variables. The model was used as a benchmark for assessing quality of care by comparing the observed number of patients experiencing GR, MD, SD, and D/VS to the corresponding numbers expected in each category by the model, computing observed/expected (O/E) ratios. The four center-specific ratios were assembled with polar representations and used to provide a multidimensional assessment of the ICUs, overcoming the loss of information consequent to the traditional dichotomizations of the outcome in TBI research. The proposed framework can help in identifying strengths and weaknesses of current TBI care, triggering the changes that are necessary to improve patient outcomes.

Sardinian Infants of Diabetic Mothers: A Metabolomics Observational Study

Gestational diabetes mellitus (GDM) is a condition characterized by glucose intolerance, with hyperglycemia of varying severity with onset during pregnancy. An uncontrolled GDM can lead to an increased risk of morbidity in the fetus and newborn, and an increased risk of obesity or developing type 2 diabetes, hypertension or neurocognitive developmental impairment in adulthood. In this study, we used nuclear magnetic resonance (NMR) spectroscopy and gas chromatography-mass spectrometry (GS-MS) to analyze the urinary metabolomic profile of newborns of diabetic mothers (NDMs) with the aim of identifying biomarkers useful for the monitoring of NDMs and for early diagnosis of predisposition to develop related chronic diseases. A total of 26 newborns were recruited: 21 children of diabetic mothers, comprising 13 in diet therapy (NDM-diet) and 8 in insulin therapy (NDM-insulin), and 5 control children of non-diabetic mothers (CTR). Urine samples were collected at five time points: at birth (T1), on the third day of life (T2), one week (T3), one month (T4) and six months postpartum (T5). At T1, variations were observed in the levels of seven potential biomarkers (acetate, lactate, glycylproline/proline, isocitrate, N,N-dimethylglycine, N-acetylglucosamine and N-carbamoyl-aspartate) in NMD-insulin infants compared to NDM-diet and CTR infants. In particular, the altered metabolites were found to be involved in several metabolic pathways such as citrate metabolism, glycine, serine and threonine metabolism, arginine and proline metabolism, amino sugar and nucleotide sugar metabolism, and pyruvate metabolism. In contrast, these changes were not visible at subsequent sampling times. The impact of early nutrition (maternal and formula milk) on the metabolomic profile was considered as a potential contributing factor to this finding.

Comparative Effectiveness of Intracranial Pressure Monitoring on 6-Month Outcomes of Critically Ill Patients With Traumatic Brain Injury

Importance

While the relationship between persistent elevations in intracranial pressure (ICP) and poorer outcomes is well established for patients with traumatic brain injury (TBI), there is no consensus on how ICP measurements should drive treatment choices, and the effectiveness of ICP monitoring remains unknown.

Objective

To evaluate the effectiveness of ICP monitoring on short- and mid-term outcomes of patients with TBI.

Design, Setting, and Participants

CREACTIVE was a prospective cohort study that started in March 2014 and lasted 5 years. More than 8000 patients with TBI were enrolled at 83 intensive care units (ICUs) from 7 countries who joined the CREACTIVE Consortium. Patients with TBI who met the Brain Trauma Foundation guidelines for ICP monitoring were selected for the current analyses, which were performed from January to November 2022.

Exposure

Patients who underwent ICP monitoring within 2 days of injury (exposure group) were propensity score-matched to patients who were not monitored or who underwent monitoring 2 days after the injury (control group).

Main Outcome and Measure

Functional disability at 6 months as indicated by Glasgow Outcome Scale-Extended (GOS-E) score.

Results

A total of 1448 patients from 43 ICUs in Italy and Hungary were eligible for analysis. Of the patients satisfying the ICP-monitoring guidelines, 503 (34.7%) underwent ICP monitoring (median [IQR] age: 45 years [29-61 years]; 392 males [77.9%], 111 females [22.1%]) and 945 were not monitored (median [IQR] age: 66 years [48-78 years]; 656 males [69.4%], 289 females [30.6%]). After matching to balance the variables, worse 6-month recovery was observed for monitored patients compared with nonmonitored patients (death/vegetative state: 39.2% vs 40.6%; severe disability: 33.2% vs 25.4%; moderate disability: 15.7% vs 14.9%; good recovery: 11.9% vs 19.1%, respectively; P = .005). Monitored patients received medical therapies significantly more frequently.

Conclusions and Relevance

In this cohort study, ICP monitoring was associated with poorer recovery and more frequent medical interventions with their relevant adverse effects. Optimizing the value of ICP monitoring for TBI requires further investigation on monitoring indications, clinical interventions, and management protocols.

Forced into shape: Mechanical forces in Drosophila development and homeostasis

Mechanical forces play a central role in shaping tissues during development and maintaining epithelial integrity in homeostasis. In this review, we discuss the roles of mechanical forces in Drosophila development and homeostasis, starting from the interplay of mechanics with cell growth and division. We then discuss several examples of morphogenetic processes where complex 3D structures are shaped by mechanical forces, followed by a closer look at patterning processes. We also review the role of forces in homeostatic processes, including cell elimination and wound healing. Finally, we look at the interplay of mechanics and developmental robustness and discuss open questions in the field, as well as novel approaches that will help tackle them in the future.

Hospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury

BACKGROUND

We leveraged the data of the international CREACTIVE consortium to investigate whether the outcome of traumatic brain injury (TBI) patients admitted to intensive care units (ICU) in hospitals without on-site neurosurgical capabilities (no-NSH) would differ had the same patients been admitted to ICUs in hospitals with neurosurgical capabilities (NSH).

METHODS

The CREACTIVE observational study enrolled more than 8000 patients from 83 ICUs. Adult TBI patients admitted to no-NSH ICUs within 48 h of trauma were propensity-score matched 1:3 with patients admitted to NSH ICUs. The primary outcome was the 6-month extended Glasgow Outcome Scale (GOS-E), while secondary outcomes were ICU and hospital mortality.

RESULTS

A total of 232 patients, less than 5% of the eligible cohort, were admitted to no-NSH ICUs. Each of them was matched to 3 NSH patients, leading to a study sample of 928 TBI patients where the no-NSH and NSH groups were well-balanced with respect to all of the variables included into the propensity score. Patients admitted to no-NSH ICUs experienced significantly higher ICU and in-hospital mortality. Compared to the matched NSH ICU admissions, their 6-month GOS-E scores showed a significantly higher prevalence of upper good recovery for cases with mild TBI and low expected mortality risk at admission, along with a progressively higher incidence of poor outcomes with increased TBI severity and mortality risk.

CONCLUSIONS

In our study, centralization of TBI patients significantly impacted short- and long-term outcomes. For TBI patients admitted to no-NSH centers, our results suggest that the least critically ill can effectively be managed in centers without neurosurgical capabilities. Conversely, the most complex patients would benefit from being treated in high-volume, neuro-oriented ICUs.

Prognostic Value of a Combination of Circulating Biomarkers in Critically Ill Patients with Traumatic Brain Injury: Results from the European CREACTIVE Study

Individualized patient care is essential to reduce the global burden of traumatic brain injury (TBI). This pilot study focused on TBI patients admitted to intensive care units (ICUs) and aimed at identifying patterns of circulating biomarkers associated with the disability level at 6 months from injury, measured by the extended Glasgow Outcome Scale (GOS-E). The concentration of 107 biomarkers, including proteins related to inflammation, innate immunity, TBI, and central nervous system, were quantified in blood samples collected on ICU admission from 80 patients. Patients were randomly selected among those prospectively enrolled in the Collaborative Research on Acute Traumatic Brain Injury in Intensive Care Medicine in Europe (CREACTIVE) observational study. Six biomarkers were selected to be associated with indicators of primary or secondary brain injury: three glial proteins (glial cell-derived neurotrophic factor, glial fibrillary acidic protein, and S100 calcium-binding protein B) and three cytokines (stem cell factor, fibroblast growth factor [FGF] 23 and FGF19). The subjects were grouped into three clusters according to the expression of these proteins. The distribution of the 6-month GOS-E was significantly different across clusters (p < 0.001). In two clusters, the number of 6-month deaths or vegetative states was significantly lower than expected, as calculated according to a customization of the corticosteroid randomization after significant head injury (CRASH) scores (observed/expected [O/E] events = 0.00, 95% confidence interval [CI]: 0.00-0.90 and 0.00, 95% CI: 0.00-0.94). In one cluster, less-than-expected unfavorable outcomes (O/E = 0.50, 95% CI: 0.05-0.95) and more-than-expected good recoveries (O/E = 1.55, 95% CI: 1.05-2.06) were observed. The improved prognostic accuracy of the pattern of these six circulating biomarkers at ICU admission upon established clinical parameters and computed tomography results needs validation in larger, independent cohorts. Nonetheless, the results of this pilot study are promising and will prompt further research in personalized medicine for TBI patients.

Metabolomics Analysis of Amniotic Fluid in Euploid Foetuses with Thickened Nuchal Translucency by Gas Chromatography-Mass Spectrometry

Persistence of a fetal thickened nuchal translucency (NT), one of the most sensitive and specific individual markers of fetal disorders, is strongly correlated with the possibility of a genetic syndrome, congenital infections, or other malformations. Thickened NT can also be found in normal pregnancies. Several of its pathophysiological aspects still remain unexplained. Metabolomics could offer a fresh opportunity to explore maternal-foetal metabolism in an effort to explain its physiological and pathological mechanisms. For this prospective case-control pilot study, thirty-nine samples of amniotic fluids were collected, divisible into 12 euploid foetuses with an enlarged nuchal translucency (>NT) and 27 controls (C). Samples were analyzed using gas chromatography mass spectrometry. Multivariate and univariate statistical analyses were performed to find a specific metabolic pattern of >NT class. The correlation between the metabolic profile and clinical parameters was evaluated (NT showed an R2 = 0.75, foetal crown-rump length showed R2 = 0.65, pregnancy associated plasma protein-A showed R2 = 0.60). Nine metabolites significantly differing between >NT foetuses and C were detected: 2-hydroxybutyric acid, 3-hydroxybutyric, 1,5 Anydro-Sorbitol, cholesterol, erythronic acid, fructose, malic acid, threitol, and threonine, which were linked to altered pathways involved in altered energetic pathways. Through the metabolomics approach, it was possible to identify a specific metabolic fingerprint of the fetuses with >NT.

PROSAFE: a European endeavor to improve quality of critical care medicine in seven countries

BACKGROUND

Long-lasting shared research databases are an important source of epidemiological information and can promote comparison between different healthcare services. Here we present PROSAFE, an advanced international research network in intensive care medicine, with the focus on assessing and improving the quality of care. The project involved 343 ICUs in seven countries. All patients admitted to the ICU were eligible for data collection.

METHODS

The PROSAFE network collected data using the same electronic case report form translated into the corresponding languages. A complex, multidimensional validation system was implemented to ensure maximum data quality. Individual and aggregate reports by country, region, and ICU type were prepared annually. A web-based data-sharing system allowed participants to autonomously perform different analyses on both own data and the entire database.

RESULTS

The final analysis was restricted to 262 general ICUs and 432,223 adult patients, mostly admitted to Italian units, where a research network had been active since 1991. Organization of critical care medicine in the seven countries was relatively similar, in terms of staffing, case mix and procedures, suggesting a common understanding of the role of critical care medicine. Conversely, ICU equipment differed, and patient outcomes showed wide variations among countries.

CONCLUSIONS

PROSAFE is a permanent, stable, open access, multilingual database for clinical benchmarking, ICU self-evaluation and research within and across countries, which offers a unique opportunity to improve the quality of critical care. Its entry into routine clinical practice on a voluntary basis is testimony to the success and viability of the endeavor.

Cargo transport through the nuclear pore complex at a glance

Bidirectional transport of macromolecules across the nuclear envelope is a hallmark of eukaryotic cells, in which the genetic material is compartmentalized inside the nucleus. The nuclear pore complex (NPC) is the major gateway to the nucleus and it regulates nucleocytoplasmic transport, which is key to processes including transcriptional regulation and cell cycle control. Accordingly, components of the nuclear transport machinery are often found to be dysregulated or hijacked in diseases. In this Cell Science at a Glance article and accompanying poster, we provide an overview of our current understanding of cargo transport through the NPC, from the basic transport signals and machinery to more emerging aspects, all from a 'cargo perspective'. Among these, we discuss the transport of large cargoes (>15 nm), as well as the roles of different cargo properties to nuclear transport, from size and number of bound nuclear transport receptors (NTRs), to surface and mechanical properties.

Molecular determinants of large cargo transport into the nucleus

Nucleocytoplasmic transport is tightly regulated by the nuclear pore complex (NPC). Among the thousands of molecules that cross the NPC, even very large (>15 nm) cargoes such as pathogens, mRNAs and pre-ribosomes can pass the NPC intact. For these cargoes, there is little quantitative understanding of the requirements for their nuclear import, especially the role of multivalent binding to transport receptors via nuclear localisation sequences (NLSs) and the effect of size on import efficiency. Here, we assayed nuclear import kinetics of 30 large cargo models based on four capsid-like particles in the size range of 17-36 nm, with tuneable numbers of up to 240 NLSs. We show that the requirements for nuclear transport can be recapitulated by a simple two-parameter biophysical model that correlates the import flux with the energetics of large cargo transport through the NPC. Together, our results reveal key molecular determinants of large cargo import in cells.

The liquid state of FG-nucleoporins mimics permeability barrier properties of nuclear pore complexes

Nuclear pore complexes (NPCs) regulate all cargo traffic across the nuclear envelope. The transport conduit of NPCs is highly enriched in disordered phenylalanine/glycine-rich nucleoporins (FG-Nups), which form a permeability barrier of still elusive and highly debated molecular structure. Here we present a microfluidic device that triggered liquid-to-liquid phase separation of FG-Nups, which yielded droplets that showed typical properties of a liquid state. On the microfluidic chip, droplets were perfused with different transport-competent or -incompetent cargo complexes, and then the permeability barrier properties of the droplets were optically interrogated. We show that the liquid state mimics permeability barrier properties of the physiological nuclear transport pathway in intact NPCs in cells: that is, inert cargoes ranging from small proteins to large capsids were excluded from liquid FG-Nup droplets, but functional import complexes underwent facilitated import into droplets. Collectively, these data provide an experimental model of how NPCs can facilitate fast passage of cargoes across an order of magnitude in cargo size.

Bioorthogonal double-fluorogenic siliconrhodamine probes for intracellular super-resolution microscopy

A series of double-fluorogenic siliconrhodamine probes were synthesized. These tetrazine-functionalized, membrane-permeable labels allowed site-specific bioorthogonal tagging of genetically manipulated intracellular proteins and subsequent imaging using super-resolution microscopy.

Fluorogenic Tetrazine-Siliconrhodamine Probe for the Labeling of Noncanonical Amino Acid Tagged Proteins

Tetrazine-bearing fluorescent labels enable site-specific tagging of proteins that are genetically manipulated with dienophile modified noncanonical amino acids. The inverse electron demand Diels-Alder reaction between the tetrazine and the dienophile fulfills the criteria of bioorthogonality allowing fluorescent labeling schemes of live cells. Here, we describe the detailed synthetic and labeling protocols of a near infrared emitting siliconrhodamine-tetrazine probe suitable for super-resolution imaging of residue-specifically engineered proteins in mammalian cells.

Qualitative improvement of rabbit burgers using Zingiber officinale Roscoe powder

The object of this study was to evaluate the effect of Zingiber officinale powder on physical-chemical traits, microbiological growth and sensory properties of rabbit burger. Raw burgers (only meat and meat added with 1 and 2% w/w ginger powder) were stored at 4°C for 1, 4 and 7 d and then cooked. Ginger modified the colour of both raw and cooked burgers, leading to more yellow hue and reducing lightness. Aspect of burgers were affected by ginger powder addition, leading to a noticeable difference between the samples. During storage time, the highest modifications were recorded for control samples, followed by burgers with added ginger. Sensory evaluation highlighted that ginger enhanced the juiciness of the burgers; moreover, burgers with ginger powder presented a significant delay in microbial growth. Ginger powder might be considered as a potential ingredient in rabbit meat products to increase their quality and extend their shelf-life.

Shining a Light on Phase Separation in the Cell

Phase separation of proteins is recognized as an important aspect of cellular organization and disease mechanisms. Shin et al. introduce a novel optogenetic tool, which enables different phase-space regimes inside living cells to be assessed and the transition paths between them to be studied with unprecedented spatiotemporal control.

Debugging Eukaryotic Genetic Code Expansion for Site-Specific Click-PAINT Super-Resolution Microscopy

Super‐resolution microscopy (SRM) greatly benefits from the ability to install small photostable fluorescent labels into proteins. Genetic code expansion (GCE) technology addresses this demand, allowing the introduction of small labeling sites, in the form of uniquely reactive noncanonical amino acids (ncAAs), at any residue in a target protein. However, low incorporation efficiency of ncAAs and high background fluorescence limit its current SRM applications. Redirecting the subcellular localization of the pyrrolysine‐based GCE system for click chemistry, combined with DNA‐PAINT microscopy, enables the visualization of even low‐abundance proteins inside mammalian cells. This approach links a versatile, biocompatible, and potentially unbleachable labeling method with residue‐specific precision. Moreover, our reengineered GCE system eliminates untargeted background fluorescence and substantially boosts the expression yield, which is of general interest for enhanced protein engineering in eukaryotes using GCE.

Meat physical quality and muscle fibre properties of rabbit meat as affected by the sire breed, season, parity order and gender in an organic production system

<p>The aim of the study was to evaluate some meat physical quality and muscle fibre properties of rabbit meat when considering 2 sire breeds (SB: Vienna Blue [VB]; Burgundy Fawn [BF]; both coloured and slow-growing breeds), several parity orders (P: 1, 2, ≥3), gender (G), and 2 slaughter seasons (SS: spring, summer) in an organic production system. The effect of storage time (ST) at frozen state (2 mo at –20°C) of <em>Longissimus lumborum</em> (LL) meat was also evaluated. Animals were slaughtered when they reached 2.8 kg of live weight. Then, pH and L*a*b* colour values of <em>Biceps femoris</em> (BF) and LL muscles, water loss and Warner-Bratzler shear force of LL and hind leg (HL) meat, and the fibre typing and enzymatic activity of LL muscle were analysed. LL meat from females showed higher b* values than males (0.04 vs. –1.25; P&lt;0.05). Significant (P&lt;0.05) SB×P, SB×G and P×G interactions were observed for the b* value of LL: VB and BF crossbreds presented a higher b* value when born as P≥3 and P2 respectively, VB females showed higher b* value than VB males, and P2 and P≥3 produced males with a significantly lower b* value. HL thawing losses were significantly (P&lt;0.05) higher in rabbits slaughtered in summer than in those slaughtered in spring, whereas the opposite result was obtained for LL meat (P&lt;0.01). Cooking loss of LL meat was significantly lower in P2 group than P≥3 group (P&lt;0.05). The lactate dehydrogenase activity in LL muscle was higher in VB than in BF crossbreds (930 vs. 830 IU; P&lt;0.05), albeit not supported by differences in fibre type distribution. The ST significantly (P&lt;0.01) reduced pH, a* and b* colour values, and increased lightness of LL meat. It was concluded that the crossbreeds derived from VB and BF genotypes and farmed organically did not show remarkable sexual dimorphism, considering their elder slaughter age than rabbits reared under intensive conditions. Physical quality of meat was mainly affected by slaughter season, indicating that in the organic rearing system, specific attention needs to be paid to the farming environmental conditions.</p>

Effect of turmeric powder (Curcuma longa L.) and ascorbic acid on antioxidant capacity and oxidative status in rabbit burgers after cooking

<p>The aim of this study was to evaluate the effects of turmeric powder and ascorbic acid on lipid oxidation and antioxidant capacity in cooked rabbit burgers. The burgers were derived from 3 different formulations (C, control, with no additives; Tu with 3.5% of turmeric powder and AA with 0.1% of ascorbic acid) and were stored at 4°C for 0 and 7 d and cooked. The lipid oxidation (thiobarbituric acid reactive substances [TBARS]) and antioxidant capacity (2,2-azinobis-[3 ethylbenzothiazoline-6-sulfonic acid] {ABTS}, 1,1-diphenyl-2-pircydrazyl [DPPH] and ferric reducing ability [FRAP]) were evaluated. A significant interaction between storage time and formulation (P&lt;0.001) was observed for DPPH, FRAP and TBARS in cooked burgers. At day 0 and day 7, the DPPH value was higher in Tu and AA compared to C burgers. At day 0, C showed a lower level of FRAP than the Tu and AA burgers. At day 7, the FRAP values tended to decrease but remained significantly higher in Tu and AA compared to C burgers. Lipid oxidation at day 0 in Tu and AA showed lower TBARS values compared to C burgers. The addition of 3.5% turmeric powder in rabbit burgers exerts an antioxidant effect during storage and it seems more effective in controlling lipid oxidation than ascorbic acid after cooking.</p>

Labeling of virus components for advanced, quantitative imaging analyses

In recent years, investigation of virus-cell interactions has moved from ensemble measurements to imaging analyses at the single-particle level. Advanced fluorescence microscopy techniques provide single-molecule sensitivity and subdiffraction spatial resolution, allowing observation of subviral details and individual replication events to obtain detailed quantitative information. To exploit the full potential of these techniques, virologists need to employ novel labeling strategies, taking into account specific constraints imposed by viruses, as well as unique requirements of microscopic methods. Here, we compare strengths and limitations of various labeling methods, exemplify virological questions that were successfully addressed, and discuss challenges and future potential of novel approaches in virus imaging.

Characterization of DNA methylation as a function of biological complexity via dinucleotide inter-distances

We perform a statistical study of the distances between successive occurrences of a given dinucleotide in the DNA sequence for a number of organisms of different complexity. Our analysis highlights peculiar features of the CG dinucleotide distribution in mammalian DNA, pointing towards a connection with the role of such dinucleotide in DNA methylation. While the CG distributions of mammals exhibit exponential tails with comparable parameters, the picture for the other organisms studied (e.g. fish, insects, bacteria and viruses) is more heterogeneous, possibly because in these organisms DNA methylation has different functional roles. Our analysis suggests that the distribution of the distances between CG dinucleotides provides useful insights into characterizing and classifying organisms in terms of methylation functionalities.

Satisfaction of patients' next of kin in a 'Hub & Spoke' ICU network

This study aimed to gauge the opinions of patients' next of kin regarding transfer of patients from the specialist 'Hub' intensive care unit, to 'Spoke' intensive care units near home. We included 213 consecutive patients with severe trauma or severe acute neurological conditions admitted to the Hub intensive care unit over a 21-month period, who were repatriated to Spoke intensive care units for ongoing intensive care. One year after admission to the Hub intensive care unit, two thirds of patients' next of kin said they would have preferred patients to have been treated only in the Hub intensive care unit, and not repatriated. They perceived Hub intensive care unit care to be important, and would have preferred that their relatives be hospitalised there until intensive treatment was completed. The next of kin's preference was associated with severe acute neurological conditions (p ≤ 0.0001). Although centralised Hub & Spoke intensive care unit networks are appropriate to ensure specialised care, repatriation to local hospitals may not be appropriate for patients with severe neurological conditions.

Treatment default among patients initiating HAART at the Korle-Bu Teaching Hospital in Accra, Ghana

BACKGROUND

Loss-to-follow-up (LTFU) during highly active antiretroviral therapy (HAART) may lead to treatment failure and increased mortality among HIV-infected patients. We investigated LTFU rate among HIV-infected patients at Korle-Bu Teaching Hospital (KBTH), and sought to identify sub-groups at-risk for treatment default in order to improve outcomes among high-risk patients.

STUDY DESIGN

We conducted a cross-sectional retrospective chart review of 290 HIV-infected patients who initiated HAART at KBTH between January 1, 2008, and June 31, 2008. Patients were classified as LTFU if they did not return for regularly scheduled care within the study period. Chi-square and t-tests were used to compare demographic and clinical characteristics of patients continuing treatment and those who defaulted.

RESULTS

Of the 290 patients who initiated HAART, 41 (14%) defaulted, and 7 (2%) died during the 18-month study period. The mean age was 38.7 ± 9.4 years and 184 (64%) were female. The mean baseline CD4 cell count was 183 ± 144 cells/µl. Age, gender, educational level, marital status, presence of opportunistic infection, body mass index, baseline CD4 cell count, WHO disease stage 3 or 4, HAART initiation while pregnant, incidence of poor adherence, and time to initiating HAART after clinic enrollment were not associated with treatment default (P> 0.05).

CONCLUSION

A majority of patients initiating HAART in an urban Ghanaian clinic remained in care through one-year of follow-up. Patients who defaulted therapy were indistinguishable demographically and clinically from those who remained in care. Standardized pre-treatment adherence counseling sessions may have influenced the favorable outcomes.

Learning ability of 1-d-old partridges (Alectoris rufa) from eggs laid by hens fed with different n-3 fatty acid concentrations

1. The diets of commercial strains of laying partridge are usually lower in polyunsaturated fatty acids (PUFA) and n-3 fatty acids than the diets of wild partridges. The aim of this experiment was to examine the effects of three different PUFA and n-3 concentrations in partridge laying diets. 2. Offspring learning ability (passive avoidance test of 1-d-old chicks) was used to assess the effect of three different maternal diets (144 chicks were tested for each diet). A negative experience, allowing the bird to peck a bead bathed in a bitter liquid (methyl anthranilate-MA), was used for this purpose. The adults had been fed one of three different diets with n-3 contents of 0.48, 4.04 or 7.60 g/kg. 3. There was better memory retention in the offspring of adults fed the intermediate n-3 content compared to those fed the lower content. Discrimination ratio (DR) of the latency time toward the wrong (red) bead was less for the lower n-3 content (0.48) than for the middle n-3 PUFA content (0.43). DR of the number of pecks toward the wrong beads was greater for the lower n-3 content (0.51) than for the middle n-3 PUFA content (0.71). 4. The partridges fed the diet containing the lowest concentration of n-3 and PUFA were unable to express the expected behavioural score (neural embryo development index) given the genetic characteristics of the animals.

[Occult child abuse (opinions, considerations, personal observations)]

At the beginning of the statement the authors point out some lesser aspects of child's ill-treatment (previously suggested by them in other occasions) as expressions of very strict educational systems which strongly limit childrens' freedom or impose them several extrascholastic activities (such as: athletics, music with participation in competitive examination, studies of foreign languages, Latin and so on) where the child must excel in (composex of the "leader-child"). Then these authors suggest using the term "abuse" to mean lexically every excessive, undue, arbitrary use and not only "sexual". They point out the seriousness of abuse as far as juvenile exploitation is concerned both in case of manual labour and prostitution. But the pay particularly attention to the problem of sport when it is gone in for too intensively (as athletics). These authors infact sum up the harms that sport can cause when it is gone in for during the age under the stabilized puberty. Physical harms may occur especially during the practice of risky sports such as: Alpine skiing, cycling on the road, swimming combined with diving, fencing, boxing) and during tiring condition, while psychic harms can entail a fall in scholastic performances, irritability, insomnia, anxiety. The authors depreciate the behaviour of those parents who stimulate their children' aggressiveness during competitions and scold them when their performances are insufficient, or give them forbidden stimulants of hormonal anabolic drugs instead of taking care of their children in order to keep away from the arms mentioned above. However, after all these observations and considerations about competitive sports in juvenile age, these authors can firmly state that all this could be meant as an important aspects of the juvenile exploitation that must be taken in great consideration.

[Lumbar vertebral synovial cyst]

Intraspinal facet synovial cyst is an uncommon cause of low back pain and sciatica that should be recognised in patients who are symptomatic, in particular in the presence of degenerated facet joints. CT and MRI are diagnostic imaging modalities of choice. Arthrography remains an important procedure to confirm the diagnostic, as avoiding surgery is particularly valuable in older patients.