The global distribution of oral and maxillofacial surgeons: a mixed-methods study

Despite its role in treating the most dominant non-communicable diseases worldwide, the global workforce of oral and maxillofacial (OM) surgeons is not well-characterized. To address the current deficit in understanding of the global OM surgeon workforce and to elevate oral and maxillofacial surgery (OMS) in the global health discourse, we join other surgical specialties in evaluating global surgical capacity with a descriptive analysis of the distribution of OM surgeons worldwide. A mixed-methods study was implemented using a combination of literature review, in-country contacts, internet searches, and survey data. The survey was distributed globally from January to June 2022. Data regarding OM surgeon workforce estimates were obtained for 104 of 195 United Nations-recognized countries (53.3%). Among countries with available estimates, the median global workforce density was 0.518 OM surgeons per 100,000 population. Twenty-eight countries (26.9%) were reported to have two or fewer OM surgeons. The median OM surgeon workforce density for low-income countries was 0.015 surgeons per 100,000 population, compared to 1.087 surgeons per 100,000 population in high-income countries. low and middle-income countries countries have the least workforce density as well as the least data coverage. More work is needed to better understand the capacity of the global OM surgeon workforce and access to OMS care.

Application Experiences on a GPU-Accelerated Arm-based HPC Testbed

This paper assesses and reports the experience of ten teams working to port, validate, and benchmark several High Performance Computing applications on a novel GPU-accelerated Arm testbed system. The testbed consists of eight NVIDIA Arm HPC Developer Kit systems, each one equipped with a server-class Arm CPU from Ampere Computing and two data center GPUs from NVIDIA Corp. The systems are connected together using InfiniBand interconnect. The selected applications and mini-apps are written using several programming languages and use multiple accelerator-based programming models for GPUs such as CUDA, OpenACC, and OpenMP offloading. Working on application porting requires a robust and easy-to-access programming environment, including a variety of compilers and optimized scientific libraries. The goal of this work is to evaluate platform readiness and assess the effort required from developers to deploy well-established scientific workloads on current and future generation Arm-based GPU-accelerated HPC systems. The reported case studies demonstrate that the current level of maturity and diversity of software and tools is already adequate for large-scale production deployments.

Early weight gain in infants with Robin sequence after mandibular distraction

This retrospective cohort study was performed to assess weight gain in infants with Robin sequence (RS) treated by mandibular distraction osteogenesis (MDO). The primary outcome variable was average daily weight gain for the following time periods: (1) birth to MDO (T1), (2) MDO to distractor removal (T2), (3) distractor removal to 6 months later (T3), and (4) 6 months to 12 months following distractor removal (T4). Published growth curves were used for comparison. Differences were assessed using the Wilcoxon matched-pairs signed rank test. Twenty-two infants were included in the study. During T1, the infants had 9.47 ± 12.61 g/day less weight gain than expected (P = 0.001). However, for T2, T3, and T4, the infants demonstrated 3.48 ± 6.17 g/day (P = 0.028), 2.19 ± 4.47 g/day (P = 0.030), and 1.83 ± 3.25 g/day (P = 0.028) more weight gain than expected. Feeding tube use resulted in improved weight gain during T1 (P < 0.001), but was associated with poorer weight gain in T3 (P = 0.003) and T4 (P = 0.001). In conclusion, infants with RS treated by MDO demonstrated poorer weight gain relative to their peers between birth and the MDO operation. However, from the MDO procedure to 12 months post-distractor removal, infants who had MDO showed faster weight gain than their age-matched peers.

Unseen food images capture the attention of hungry viewers: Evidence from event-related potentials

Motivationally relevant visual targets appear to capture visuospatial attention. This capture is evident behaviorally as faster and more accurate responses, and neurally as an enhanced-amplitude of the N2pc - an index of spatial attention allocation, which is observed even when observers are unaware of the target. In the case of reinforcers such as food or substances of dependence, it is likely that the motivational state of craving accompanying deprivation potentiates this capture. The automaticity of such attentional capture by reward-associated stimuli, as well as its possible interaction with craving, is as yet not completely understood, though it is likely a major explanatory factor in motivated behaviors. For the present experiment, participants completed two EEG recording sessions: one just after eating lunch (sated/non-craving), and the other following a minimum 12-h period of fasting (hungry/craving). For both sessions, participants identified food- and clothing-related targets embedded in an object-substitution masking paradigm, which yielded trials of full target visibility, as well as trials for which targets were present but undetected. Although masking equally disrupted visual awareness of both classes of targets as measured behaviorally, a three-way hunger by visibility by target interaction was observed in the neural data, with unseen food targets eliciting an enhanced N2pc. Interestingly, this subliminal attentional capture by food-related items was observed only during the "hungry" session. No such capture was evident under conditions of full visibility. These findings indicate that attentional capture by food-related images, and reflected in enhancements of the N2pc, is spurred by hunger, and that this effect can be viewed as automatic, or independent of explicit awareness of food-relevant target content.

Motor Conflict: Revealing Involuntary Conditioned Motor Preparation Using Transcranial Magnetic Stimulation

Preparing actions to achieve goals, overriding habitual responses, and substituting actions that are no longer relevant are aspects of motor control often assumed to be driven by deliberate top-down processes. In the present study, we investigated whether motor control could come under involuntary control of environmental cues that have been associated with specific actions in the past. We used transcranial magnetic stimulation (TMS) to probe corticospinal excitability as an index of motor preparation, while participants performed a Go/No-Go task (i.e., an action outcome or no action outcome task) and rated what trial was expected to appear next (Go or No-Go). We found that corticospinal excitability during a warning cue for the upcoming trial closely matched recent experience (i.e., cue–outcome pairings), despite conflicting with what participants expected would appear. The results reveal that in an action–outcome task, neurophysiological indices of motor preparation show changes that are consistent with participants learning to associate a preparatory warning cue with a specific action, and are not consistent with the action that participants explicitly anticipate making. This dissociation with conscious expectancy ratings reveals that conditioned responding and motor preparation can operate independently of conscious expectancies about having to act.

Evidence for functional state transitions in intensively-managed soil ecosystems

Soils are fundamental to terrestrial ecosystem functioning and food security, thus their resilience to disturbances is critical. Furthermore, they provide effective models of complex natural systems to explore resilience concepts over experimentally-tractable short timescales. We studied soils derived from experimental plots with different land-use histories of long-term grass, arable and fallow to determine whether regimes of extreme drying and re-wetting would tip the systems into alternative stable states, contingent on their historical management. Prior to disturbance, grass and arable soils produced similar respiration responses when processing an introduced complex carbon substrate. A distinct respiration response from fallow soil here indicated a different prior functional state. Initial dry:wet disturbances reduced the respiration in all soils, suggesting that the microbial community was perturbed such that its function was impaired. After 12 drying and rewetting cycles, despite the extreme disturbance regime, soil from the grass plots, and those that had recently been grass, adapted and returned to their prior functional state. Arable soils were less resilient and shifted towards a functional state more similar to that of the fallow soil. Hence repeated stresses can apparently induce persistent shifts in functional states in soils, which are influenced by management history.

Influence of production system on the rate of onset of Campylobacter colonization in chicken flocks reared extensively in the United Kingdom

1. Because thermophilic Campylobacter spp. are common in chicken flocks reared extensively, cross-sectional and longitudinal studies were carried out on organic and free-range farms to determine the onset of colonisation (lag phase) and likely sources of flock infection. 2. For 14 organic and 14 free range flocks, there was a difference in lag phases, with the former being colonized at a mean of 14·1 d in comparison with 31·6 d for the latter. Whereas most free-range flocks became colonized when released on to pasture, those reared organically were usually colonized at the housed brooding stage. 3. Further study of organic flocks on three farms over 7 successive crop cycles confirmed that colonisation was strongly influenced by the prevailing husbandry conditions and was not a consequence of the length of the rearing period. 4. Molecular epidemiological investigations on a farm showing the shortest lag phase, using PFGE typing with two different restriction enzymes (SmaI and KpnI) and flaA SVR sequence typing, revealed that potential sources of colonisation for organic chickens were already present on the farm at the time of chick placement. Such sources included the ante area of the brooding house, surrounding pasture and other livestock being kept on the farm. 5. Overall, the study demonstrated that, under UK conditions, the prevalence of colonisation was greater in extensive flocks (95-100%) than it was for conventional broilers (55%), similar to the situation in other countries, but all three management systems showed comparable levels of caecal carriage in positive birds (log(10)/g 6·2-6·7).

Bioremediation of leachate from a green waste composting facility using waste-derived filter media

The evaluation of two waste-derived materials used to treat compost leachate by biofiltration is described in this paper. Nine biofilters were constructed using 240 l, high density polyethylene containers. Three containers were filled without compaction with 200l of each of three types of filter media. Waste-derived filter media (compost and oversize) were compared to a mineral control (granite chips). The filters were fed with compost leachate from a typical green waste composting facility at hydraulic loading rates ranging from 0.05 m3/m3/day to 0.5 m3/m3/day over a period of twelve months. The oversize medium emerged as the most effective demonstrating characteristics of consistency of effluent quality and resilience to stress. The oversize medium produced an effluent of <10mg/l ammoniacal nitrogen on >95% of sampling occasions. The organic component of compost leachate was dominated by compounds that proved to be recalcitrant to biodegradation. The solids content of the treated effluent remained too high to be acceptable for direct discharge to a watercourse without further treatment and if discharge to a watercourse is to be considered, a polishing stage (e.g., reed bed) able to remove solids and dampen occasional peaks of ammoniacal nitrogen should be employed.

Evaluation of the performance of different cleaning treatments in reducing microbial contamination of poultry transport crates

1. The present systems for cleaning the plastic crates (drawers) used to transport live poultry to the processing plant are known to be inadequate for removing microbial contamination. 2. To investigate possible improvements, a mobile experimental rig was constructed and operated in the lairage of a poultry processing plant. The cleaning rig could simulate the conditions of commercial cleaning systems and utilise freshly emptied crates from the processing plant. 3. The aim of the study was to improve cleaning by enhancing the removal of adherent organic material on the crates and by reducing microbial contamination by at least 4 log(10) units. 4. Trials showed that the most effective treatments against Campylobacter were either (a) the combination of soaking at 55 degrees C, brushing for 90 s, washing for 15 s at 60 degrees C, followed by the application of disinfectant (Virkon S in this study) or (b) the use of ultrasound (4 kW) at 65 degrees C for 3 to 6 min, with or without mechanical brushing of crates. 5. Both of these treatments also achieved a 4 log(10) reduction or more in the counts of Enterobacteriaceae but were less effective in reducing aerobic plate counts. 6. It was noted that there was little correlation between the visual assessment of crate cleanliness and microbiological counts. 7. It was concluded that the demonstrated enhanced cleaning could contribute significantly to overall hygiene control in poultry meat production.

Sources and spread of thermophilic Campylobacter spp. during partial depopulation of broiler chicken flocks

The practice of partial depopulation or thinning (early removal of a portion of birds from a commercial broiler flock) is a reported risk factor for Campylobacter colonization of residual birds because of the difficulty in maintaining biosecurity during the thinning process. The effect of this practice was studied in detail for 51 target flocks, each at a different growing farm belonging to one of seven major poultry companies throughout the United Kingdom. On 21 of these farms, the target flock was already colonized by Campylobacter, and at slaughter all cecal samples examined were positive, with a mean of 8 log CFU/g. An additional 27 flocks became positive within 2 to 6 days of the start of thinning and had similarly high levels of cecal carriage at slaughter. Just before the thinning process, Campylobacter was isolated frequently from the farm driveways, transport vehicles, equipment, and personnel. Strains from seven farms on which flocks became colonized after thinning were examined by pulsed-field gel electrophoresis typing. An association was found between strains occurring at specific sampling sites and those isolated subsequently from the thinned flocks. The results indicated that particular strains had spread from one farm to another when the farms were jointly owned by the same company and employed the same bird-catching teams and/or vehicles. These results highlight the need for better hygiene control in relation to catching equipment and personnel and more effective cleaning and disinfection of vehicles and bird-transport crates.

Bacteriophage therapy to reduce salmonella colonization of broiler chickens

Acute enteric infections caused by salmonellas remain a major public health burden worldwide. Poultry, particularly chickens, are known to be the main reservoir for this zoonotic pathogen. Although some progress has been made in reducing Salmonella colonization of broiler chickens by using biosecurity and antimicrobials, it still remains a considerable problem. The use of host-specific bacteriophages as a biocontrol is one possible intervention by which Salmonella colonization could be reduced. A total of 232 Salmonella bacteriophages were isolated from poultry farms, abattoirs, and wastewater in 2004 and 2005. Three phages exhibiting the broadest host ranges against Salmonella enterica serotypes Enteritidis, Hadar, and Typhimurium were characterized further by determining their morphology and lytic activity in vitro. These phages were then administered in antacid suspension to birds experimentally colonized with specific Salmonella host strains. The first phage reduced S. enterica serotype Enteritidis cecal colonization by > or = 4.2 log10 CFU within 24 h compared with controls. Administration of the second phage reduced S. enterica serotype Typhimurium by > or = 2.19 log10 CFU within 24 h. The third bacteriophage was ineffective at reducing S. enterica serotype Hadar colonization. Bacteriophage resistance occurred at a frequency commensurate with the titer of phage being administered, with larger phage titers resulting in a greater proportion of resistant salmonellas. The selection of appropriate bacteriophages and optimization of both the timing and method of phage delivery are key factors in the successful phage-mediated control of salmonellas in broiler chickens.

Kappa opioid receptors in rat spinal cord: sex-linked distribution differences

Activation of kappa opioid receptors (KORs) in the spinal cord can diminish nociception. Humans and rodents show sex differences in the analgesia produced by KOR agonists, and female rats show fluctuations in KOR density and sensitivity across the estrous cycle. However, it is unclear whether there are sex differences in the amount and/or distribution of spinal KORs. In the present study, immunocytochemically labeled KORs were examined in laminae I and II of the lumbosacral spinal dorsal horn of male and normally cycling female Sprague-Dawley rats. The basic pattern of KOR labeling was determined in both sexes using qualitative electron microscopy (EM), and sex-linked differences in the density and subcellular distribution of KOR immunoreactivity were determined with quantitative EM and light microscopy. KOR labeling was visualized with immunoperoxidase for optimally sensitive detection, or with immunogold for precise subcellular localization. By EM, the general pattern of KOR immunoreactivity was similar in males and females. KOR immunoreactivity was common in dendrites, axons, and axon terminals, and was in a few glia and neuronal somata. Most KOR-immunoreactive (-ir) axons were fine-diameter and unmyelinated. Most KOR-ir terminals were small or medium-sized, and a minority formed asymmetric or symmetric synapses with unlabeled dendrites. KOR immunoreactivity was associated both with the plasma membrane and with cytoplasmic organelles, notably including dense core vesicles in terminals. Light microscopic densitometry revealed that KOR immunoreactivity was significantly denser in estrus and proestrus females than in males. By EM, the distribution of KOR-immunogold labeling within axon terminals differed, with a greater proportion of cytoplasmic KOR labeling in estrus females compared with males. In contrast, the abundance and types of KOR-immunoperoxidase-labeled profiles did not show sex-linked differences. We conclude that in both sexes, KORs are positioned to influence both pre- and postsynaptic neurotransmission and are present in morphologically heterogeneous neuron populations. These findings are consistent with complex consequences of KOR activation in the spinal cord. In addition, the presence of increased KOR density and proportionally elevated intracellular KORs in proestrus/estrus females suggests a basis for sex-linked differences in KOR-mediated antinociception.

Seroepidemiology of Toxoplasma gondii in dogs in Trinidad and Tobago

A cross-sectional study was conducted to determine the seroprevalence of Toxoplasma gondii agglutinins and to investigate the relationship between various risk factors and occurrence of toxoplasmosis in dogs in Trinidad. Of a total 250 dogs, comprising domestic, hunting and stray dogs, 80 (32.0%) were positive for T. gondii agglutinins at a titre of > or =1:32 using a latex agglutination test. Stray dogs (60.5%) had statistically significantly higher (P<0.001) seroprevalence for toxoplasmosis than hunting dogs (30.5%) and domestic dogs (25.5%). Amongst dogs whose ages were known, the prevalence of toxoplasmosis was significantly highest (P=0.037) in dogs in the >2-3 years age group compared with other age groups. Dogs that consumed home-cooked foods had a seroprevalence of 32.9% compared with those fed commercial dog foods (17.2%) and dogs fed both home-cooked and commercial foods (21.0%). However, the difference was not statistically significant (P>0.05; chi(2)). The rather high prevalence of toxoplasmosis in stray dogs is a good indication of the extent of the infection in the environment.

The epidemiology of cardiovascular defects, part 2: a study based on data from three large registries of congenital malformations

There were three objectives of this study: to investigate possible specificity in the association between specific cardiac defects and chromosomal anomalies; to evaluate ways of categorizing cardiac defects into larger groups with epidemiological similarities that could indicate similarities in etiology or pathogenesis; and to analyze the relationship between specific cardiac defects and diabetes. We pooled data on infants (aged 1 year or younger) with congenital cardiovascular defects from three large birth defect registries in California, Sweden, and France. The registries in Sweden and France obtained data through reporting from various sources; in California, medical records were reviewed. For severe congenital heart defects, the percentage of infants with identified chromosomal anomalies varied between 0.9% for d-TGV to 68.4% for ECD. In general, specific cardiac conditions have different risk factors. For example, conotruncal defects have been traditionally grouped, but the data presented in this paper indicates more differences for risk factors for the components of conotruncal defects: tetralogy of Fallot, d-TGV, common truncus, and DORV. In general, we suggest the strategy of "splitting" rather than "lumping" when searching for specific genetic factors and/or teratogens. Adequate analysis thus requires large registries or collaboration among registries. The findings did not support constellations between mothers' diabetes and specific defects.

The epidemiology of cardiovascular defects, part I: a study based on data from three large registries of congenital malformations

To analyze complex and noncomplex cardiac malformations regarding prevalence and in relation to demographic variables, we pooled data on infants (age 1 year or younger) with congenital cardiovascular defects from three large birth defect registries in California, Sweden, and France. Altogether, 12,932 infants had one or more congenital heart defects out of 4.4 million live births and stillbirths. The registries in Sweden and France obtained data through reporting from various sources; in California, medical records were reviewed. As expected, definitions and ascertained conditions differed among each of the registries. The total rates for severe defects were similar (1.43 per 1,000), but differed for specific defects. Clear differences in epidemiological characteristics existed for specific defects; for example, severe cardiac defects sex ratios were significantly high for hypoplastic left heart syndrome, d-transposition of great vessels, double outlet right ventricle, total anoralous pulmonary venous return, tetralogy of Fallot, and significantly low for pulmonary atresia without ventricular septal defect and endocardial cushion defect. Few defects were similar for several epidemiological characteristics, but, for example, the combination of ventricular and atrial septal defects appeared equivalent with endocardial cushion defect under some circumstances, yet behaved differently with regard to associated noncardiovascular defects.

Neurons with mu opioid receptors interact indirectly with enkephalin-containing neurons in the rat dentate gyrus

In the dentate gyrus, mu opioid receptors (MORs) and their enkephalin agonists have overlapping distributions and influence excitability and plasticity. Released endogenous enkephalins can activate at least some of these MORs; however, whether these interactions involve synaptically associated profiles or more distant associations and whether some subcellular compartments (e.g., terminals or dendrites) are more likely to be targeted than others are not known. To elucidate the relationships between potential sites of enkephalin release and MORs, MOR1 and leucine-enkephalin (LE) immunoreactivities were localized in the hilus by electron microscopy, using immunoperoxidase and immunogold markers. Of the 573 MOR-immunoreactive (ir) profiles analyzed, most were axons and terminals (51 and 30%, respectively), and fewer were dendrites (12%), glia (3%), or unclassifiable (4%). Most MOR-ir profiles resembled interneuron processes, while most LE-ir terminals resembled mossy fibers. One third of MOR-ir profiles were within 3 microm and approximately half were within 4 microm of the nearest LE-ir profile. In contrast, few (3%) MOR-ir profiles contacted LE-ir profiles; only 16% of these contacts included observable synapses, and very few profiles (0.5%) colocalized MOR and LE immunoreactivity. MOR-ir axons, terminals, and dendrites were not distributed differently relative to LE-ir profiles. These results suggest that activation of hilar MORs by LE usually involves short-range volume transmission and that dendritic MORs are as likely as axonal and terminal MORs to be activated by released LE. However, the greater abundance of MOR-ir axons and terminals compared to dendrites indicates that presynaptic profiles are a more prominent target for enkephalins and exogenous MOR agonists such as morphine.

Complications in tunneled CVL versus PICC lines in very low birth weight infants

OBJECTIVE

Comparison of complications associated with tunneled central venous lines (TCVLs) versus peripherally inserted central catheters (PICCs) in infants <1500 g.

STUDY DESIGN

A retrospective cohort study at a university medical center. A total of 96 catheters were placed in 60 infants between 4/94 and 3/99. A retrospective review of these infants' medical record was done to review associated complications of catheter placement.

RESULTS

Both groups had similar weights and gestational ages. The duration of catheterization was 28 days in TCVLs and 11 days in PICCs (p<0.05). Total, infectious, and mechanical complications between the two groups were similar. Survival function estimates showed no difference between the two groups up to the 15th day of catheterization.

CONCLUSION

There is no difference in efficacy or associated complications between the two groups. If one could anticipate needing a catheter longer than 15 days, then a TCVL might be the better choice.

When a hernia is not a hernia: the evaluation of inguinal hernias in the cirrhotic patient

Herniorrhapy in patients with advanced portal hypertension and ascites should be approached with caution, and treated conservatively whenever possible. Cirrhosis increases the risk of significant perioperative complications such as infection, recurrence, and ascites leak. This paper reports two patients operated on for suspected inguinal hernias. The first patient was referred for elective repair of a presumed inguinal hernia before liver transplantation. The second patient presented with a history of an incarcerated inguinal hernia that was previously reduced in the emergency center. After examination by residents and senior faculty the patients were scheduled for elective herniorrhaphy. Intraoperatively no inguinal hernia could be identified in either patient. However, massively dilated veins (1.5-2.0 cm in diameter) were noted entering with the spermatic cord at the internal inguinal ring. In both cases the veins were clamped, transected, and suture ligated at the internal ring. Given the unusual presentation of these dilated veins in both patients we advocate the use of preoperative Doppler ultrasound in patients with cirrhosis and suspected inguinal hernias.

The topography of tactile working memory

To investigate the contribution of topographically organized brain areas to tactile working memory, we asked human subjects to compare the frequency of two vibrations presented to the same fingertip or to different fingertips. The vibrations ranged from 14 to 24 Hz and were separated by a retention interval of variable length. For intervals <1 sec, subjects were accurate when both vibrations were delivered to the same fingertip but were less accurate when the two vibrations were delivered to different fingertips. For 1 or 2 sec intervals, subjects performed equally well when comparing vibrations delivered either to the same finger or to corresponding fingers on opposite hands, but they performed poorly when the vibrations were delivered to distant fingers on either hand. These results suggest that working memory resides within a topographic framework. As a further test, we performed an experiment in which the two comparison vibrations were presented to the same fingertip but an interference vibration was presented during the retention interval. The interpolated vibration disrupted accuracy most when delivered to the same finger as the comparison vibrations and had progressively less effect when delivered to more distant fingers. We conclude that topographically organized regions of somatosensory cortex contribute to tactile working memory, possibly by holding the memory trace across the retention interval. One stimulus can be accurately compared with the memory of a previous stimulus if they engage overlapping representations, but activation of the common cortical territory by an interpolated stimulus can disrupt the memory trace.

A comparison of the pentaammine(pyridyl)ruthenium(II) and 4-(dimethylamino)phenyl groups as electron donors for quadratic non-linear optics

Hyper-Rayleigh scattering and Stark spectroscopic studies show that the complex salts [1-4]PF6 have larger static first hyperpolarizabilities beta 0 than [5-8]PF6, because the higher HOMO energy of a (RuII(NH3)5)2+ centre more than offsets the superior pi-orbital overlap in the purely organic chromophores.

Extra-abdominal pneumodissection after laparoscopic antireflux surgery

The presence of pneumoperitoneum during laparoscopic antireflux surgery can lead to the dissection of carbon dioxide into the mediastinum, retroperitoneum, subcutaneous tissues, and neck (pneumodissection). The purpose of this study is to describe the incidence, extent, duration and pathways of pneumodissection during laparoscopic antireflux surgery. Twenty patients who underwent laparoscopic antireflux surgery from August 1998 through May 1999 were studied. Physical examination and chest radiographs were performed in the recovery room and each day postoperatively. Noncontrast computerized tomography (CT) of the neck, chest, and upper abdomen was also performed on postoperative day one. Subcutaneous emphysema and radiologic evidence of pneumodissection occurred commonly and typically resolved within 4 days postoperatively. The incidence of pneumomediastinum (85%) seen on CT scan was similar to that of pneumodissection into the neck (80%). The most common pathway of dissection of gas was through the anterior mediastinum and into the neck through the carotid space. Other findings on CT scan revealed pneumoperitoneum in 70 per cent, pneumoretroperitoneum in 10 per cent, and pneumothorax in 0 per cent. The dissection of gas into the mediastinum, neck, and subcutaneous tissues is very common after laparoscopic antireflux surgery. Subcutaneous emphysema on physical examination and radiographic pneumodissection typically resolves within 3 to 4 days. After this time one should consider the presence of any substantial amount of gas as a potential complication related to the procedure.

Object orientation agnosia: a failure to find the axis?

A dissociation between the ability to recognize misoriented objects and to determine their orientation has been reported in a small number of patients with vascular lesions. In this article, we describe a 57-year-old man with probable Alzheimer' s disease who shows the same dissociation. Neuroimaging findings indicated marked hypometabolism in the posterior cortical regions, particularly the postero-superior parietal lobes. Clinically, the patient had good object recognition accompanied by severely impaired spatial abilities. The experimental investigations comprised a variety of tasks in which he identified misoriented objects, evaluated the orientation of single objects, or discriminated the orientation of simultaneously presented items. Results revealed that his object recognition was independent of orientation and was largely mediated by salient features. With respect to orientation judgements, the patient displayed a profound inability to judge the orientation of nonupright objects, but remarkably intact (though largely implicit) knowledge of the upright orientation. Strikingly, his orientation judgements were also more accurate for upside-down objects than for other orientations (i.e., 90 degrees ). We interpret these results as evidence that judgements about object orientation are facilitated when the orientation of the principal axis of the object matches that of an internal representation. We propose that the inability to determine other orientations may be due to the failure of an "axis-finding" mechanism implemented in the posterior parietal lobes, that translates between object-centered and eye-centered coordinates appropriate for guiding visual scanning.

trans-4-[(4-dimethylaminophenyl)-iminomethyl]-N-methyllpyridinium para-toluenesulfonate

In the title compound, C15H18N3+*C7H7O3S-, the phenylene and pyridyl rings are somewhat twisted with respect to each other, forming a dihedral angle of 23.49 (6) degrees. The compound contains a dipolar chromophoric cation, but crystallizes in the centrosymmetric space group P2(1)/n and is thus not expected to display quadratic non-linear optical effects.

Kappa opioid receptor density is consistent along the rostrocaudal axis of the female rat spinal cord

Kappa opioid receptors (KORs) were immunocytochemically localized at four different levels of the spinal cord of normally-cycling female rats in estrus or diestrus. KOR labeling was primarily observed in fine processes and a few neuronal cell bodies in the superficial dorsal horn and the dorsolateral funiculus. Quantitative light microscopic densitometry of the superficial dorsal horn revealed that there were no significant differences in KOR densities among spinal segments C1--C2, T2, T13--L1, and L6--S1 in either the estrus or diestrus phases. These results suggest that the potential for KOR-mediated antinociceptive responses is consistent along the rostrocaudal axis of the female rat spinal cord.

Contextual control over the expression of fear in rats conditioned under a benzodiazepine

RATIONALE

Benzodiazepines disrupt fear conditioning, but this disruption is context-specific; if rats have been conditioned under a benzodiazepine, their fear is recovered if they are tested in a different context. The present experiments investigated how the conditioning context controls fear in rats conditioned under a benzodiazepine.

OBJECTIVES

The experiments had three aims: (1) to replicate the finding that fear is recovered when rats are tested in a different context, (2) to test whether the conditioning context reduces fear generally or only for the specific stimulus conditioned in that context and (3) to test whether latent inhibition of the conditioning context reduces its control over fear.

METHODS

Rats were injected with the benzodiazepine midazolam (1.25 mg/kg) or saline and exposed to a conditioned stimulus (CS) and shock in a distinctive chamber. Latent inhibition of the chamber was induced by extensively preexposing the rats to the chamber. The day after conditioning, fear was assessed by presenting the CS while rats were in either the conditioning chamber or a different chamber.

RESULTS

The midazolam-induced reduction of fear was reversed (i.e. fear was partially recovered) if rats were tested in the different context, and was completely prevented if the conditioning context had been latently inhibited. These two effects were not additive since, when the conditioning context had been latently inhibited, rats showed less fear in the different context than in the conditioning context.

CONCLUSIONS

We argue that midazolam does not disrupt conditioning, but imbues the conditioning context with control over retrieval of the CS-shock association. In this regard, the effects of midazolam closely parallel those of extinction.

The heritability of attitudes: a study of twins

The genetic basis of individual differences in attitudes was examined in a survey of 195 pairs of monozygotic twins and 141 pairs of same-sex dizygotic twins. A principal components analysis of the 30 attitude items in the survey identified 9 attitude factors, of which 6 yielded significant heritability coefficients. Nonshared environmental factors accounted for the most variance in the attitude factors. Possible mediators of attitude heritability were also assessed, including personality traits, physical characteristics, and academic achievement. Analyses showed that several of these possible mediators correlated at a genetic level with the heritable attitude factors, suggesting that the heritability of the mediator variables might account for part of the heritable components of some attitudes. There was also some evidence that highly heritable attitudes were psychologically "stronger" than less heritable attitudes.

The topography of tactile learning in humans

The spatial distribution of learned information within a sensory system can shed light on the brain mechanisms of sensory-perceptual learning. It has been argued that tactile memories are stored within a somatotopic framework in monkeys and rats but within a widely distributed network in humans. We have performed experiments to reexamine the spread of tactile learning across the fingertips. In all experiments, subjects were trained to use one fingertip to discriminate between two stimuli. Experiment 1 required identification of vibration frequency, experiment 2 punctate pressure, and experiment 3 surface roughness. After learning to identify the stimuli reliably, subjects were tested with the trained fingertip, its first and second neighbors on the same hand, and the three corresponding fingertips on the opposite hand. As expected, for all stimulus types, subjects showed retention of learning with the trained fingertip. However, the transfer beyond the trained fingertip varied according to the stimulus type. For vibration, learning did not transfer to other fingertips. For both pressure and roughness stimuli, there was limited transfer, dictated by topographic distance; subjects performed well with the first neighbor of the trained finger and with the finger symmetrically opposite the trained one. These results indicate that tactile learning is organized within a somatotopic framework, reconciling the findings in humans with those in other species. The differential distribution of tactile memory according to stimulus type suggests that the information is stored in stimulus-specific somatosensory cortical fields, each characterized by a unique receptive field organization, feature selectivity, and callosal connectivity.

Effect of fibrin glue on lymphatic drainage after modified radical mastectomy: a prospective randomized trial

Fibrin as a tissue sealant has been used since the turn of the century for hemostasis. The development of cryoprecipitate and the resultant availability of higher concentrations of fibrinogen have led to a resurgence of interest in this material. Fibrin glue has since been shown to be effective for numerous applications throughout the field of surgery. Animal studies have shown fibrin glue to be effective at reducing drain output after mastectomy. Human studies, however, have been equivocal. Our objectives were to determine whether the use of fibrin glue would decrease lymphatic drainage after modified radical mastectomy and subsequently reduce time to drain removal. A prospective randomized trial was conducted consisting of 27 women. All women received modified radical mastectomy. At the completion of the mastectomy they were randomized to receive either standard closure or the application of fibrin glue before standard closure. Patients were then monitored for daily drain output, time to drain removal, and wound complications. A total of 14 women received fibrin glue and 13 received no glue. Those patients receiving fibrin glue had a significantly higher average drain output than patients who did not receive glue (1308 vs 754 cm3; P = 0.012). Time to drain removal was also increased by 4 days, although this did not reach statistical significance. The overall complication rate was higher for the fibrin glue group, although again, this did not reach significance. The application of fibrin glue significantly increased drain total drain output after modified radical mastectomy. Time to drain removal was increased as was the complication rate. On the basis of these data fibrin glue cannot be recommended for routine use in modified radical mastectomy.

Suprachiasmatic nucleus projections to the paraventricular thalamic nucleus in nocturnal rats (Rattus norvegicus) and diurnal nile grass rats (Arviacanthis niloticus)

The circadian pacemaker of the suprachiasmatic nucleus (SCN) is likely to control the timing of the sleep-wake cycle in mammals by modulating the daily activity patterns of brain regions important in sleep and wakefulness. One such brain region is the paraventricular nucleus of the thalamus (PVT). In both nocturnal rats and the diurnal rodent Arvicanthis niltoicus (Nile grass rat), expression of Fos (the product of the immediate-early gene c-fos) in the PVT increases at times of day when the animals are most active. To compare the projections of the SCN to the PVT in these two species, the retrograde tracer cholera toxin (beta subunit; CTbeta) was microinjected into the PVT and the SCN was examined to identify labeled neurons. Further, the PVT-projecting SCN cells containing either arginine vasopressin (AVP) or gastrin releasing peptide (GRP) were also compared between species. In both nocturnal rats and diurnal Nile grass rats, the SCN sends a substantial projection to the PVT. In both species, many PVT-projecting SCN neurons contain AVP, and few contain GRP. Other work has shown that some AVP-containing neurons of the SCN function differently in rats and Nile grass rats. Projections from functionally distinct SCN neurons to the PVT may contribute to the difference in the temporal distribution of sleep and wakefulness seen between these two species.

Contextual control over conditioned responding in a latent inhibition paradigm

We used 1-, 2-, and 3-context designs to study the control exerted by contexts over freezing in rats exposed to a conditioned stimulus (CS) in advance of its pairing with a shock unconditioned stimulus. The latent inhibition observed when preexposure, conditioning, and testing occurred in the same context was attenuated if preexposure occurred in a different context to conditioning and testing. Latent inhibition (i.e., attenuated performance) was restored in a CS-specific manner if preexposure and testing occurred in the same context and conditioning in a different one. Latent inhibition was also reduced by a long retention interval but remained specific for a particular context-CS relation. Finally, CS preexposure resulted in contextual control over the expression of excitatory conditioned performance. The results are discussed in terms of memory, associative, and associative-performance models of CS-preexposure effects.

Contextual control over conditioned responding in an extinction paradigm

Four experiments studied contextual control over rats' freezing to conditioned stimuli (CSs) that had been paired with shock and were then extinguished. In Experiment 1, rats were exposed to a CS A-shock and a CS B-shock pairing in Context C. CS A was then extinguished in Context A, and CS B in Context B. Freezing was renewed when each CS was presented in the context where the other CS had been extinguished. In Experiments 2-4, rats were exposed to a CS A-shock pairing in A and a CS B-shock pairing in B. They were then exposed to Context C where one, both, or neither of the CSs were extinguished, or where both CSs continued to be reinforced. On test, the rats froze more to CS A than to CS B in Context A, and more to CS B than to CS A in Context B, but only if the CSs had been extinguished. Thus, after extinction, rats use contexts to regulate retrieval not only of their memory for extinction, but also of their memory for the original conditioning episode.

HIV postexposure prophylaxis for children and adolescents

HIV postexposure prophylaxis (PEP) is now a well-established part of the management of health care workers after occupational exposures to HIV. Use of PEP for adults exposed to HIV after sexual contact or injection drug use in nonoccupational settings remains controversial with limited data available. There is even less information available concerning HIV PEP for children and adolescents after accidental needlestick injuries or sexual assault. The objective was to describe the current practice of and associated problems with HIV PEP for children and adolescents at an urban academic pediatric emergency department. A retrospective review of all children and adolescents offered HIV PEP between June 1997-June 1998 was conducted. Ten pediatric and adolescent patients were offered HIV PEP, six patients after sexual assault, four patients after needle stick injuries. There were two small children 2 and 3 years of age and eight adolescents. Of these 10 patients, eight were started on HIV PEP. The regimens used for PEP varied; zidovudine, lamivudine, and indinavir were prescribed for in seven patients and zidovudine, lamivudine, and nelfinavir for one other. All 10 patients were HIV negative by serology at baseline testing and all available for follow-up testing (5 of 10) remained HIV negative at 4 to 28 weeks. Only two patients completed the full course of 4 weeks of antiretroviral therapy. Financial concerns, side effects, additional psychiatric and substance abuse issues as well as the degree of parental involvement influenced whether PEP and clinical follow-up was completed. HIV PEP in the nonoccupational setting for children and adolescents presents a medical and management challenge, and requires a coordinated effort at the initial presentation to the health care system and at follow-up. The difficulties encountered in the patients in our series need to be considered before initiating prophylaxis. A provisional management approach to HIV PEP in children and adolescents is proposed.

Lymphoma arising in an S-pouch after total proctocolectomy for ulcerative colitis: report of a case

The gastrointestinal tract is the most common extranodal site of primary non-Hodgkin's lymphoma. We present a case of a 50-year-old male with primary B cell lymphoma arising in an S-pouch eight years after a total proctocolectomy for ulcerative colitis. After chemoradiotherapy the patient remained asymptomatic, with an intact S-pouch. Pouch conservation is feasible in patients with primary lymphoma of the pouch, using chemoradiotherapy and close follow-up examinations.

Contextual control over conditioned responding in an extinction paradigm

Four experiments studied contextual control over rats' freezing to conditioned stimuli (CSs) that had been paired with shock and were then extinguished. In Experiment 1, rats were exposed to a CS A-shock and a CS B-shock pairing in Context C. CS A was then extinguished in Context A, and CS B in Context B. Freezing was renewed when each CS was presented in the context where the other CS had been extinguished. In Experiments 2-4, rats were exposed to a CS A-shock pairing in A and a CS B-shock pairing in B. They were then exposed to Context C where one, both, or neither of the CSs were extinguished, or where both CSs continued to be reinforced. On test, the rats froze more to CS A than to CS B in Context A, and more to CS B than to CS A in Context B, but only if the CSs had been extinguished. Thus, after extinction, rats use contexts to regulate retrieval not only of their memory for extinction, but also of their memory for the original conditioning episode.

Contextual control over conditioned responding in a latent inhibition paradigm

We used 1-, 2-, and 3-context designs to study the control exerted by contexts over freezing in rats exposed to a conditioned stimulus (CS) in advance of its pairing with a shock unconditioned stimulus. The latent inhibition observed when preexposure, conditioning, and testing occurred in the same context was attenuated if preexposure occurred in a different context to conditioning and testing. Latent inhibition (i.e., attenuated performance) was restored in a CS-specific manner if preexposure and testing occurred in the same context and conditioning in a different one. Latent inhibition was also reduced by a long retention interval but remained specific for a particular context-CS relation. Finally, CS preexposure resulted in contextual control over the expression of excitatory conditioned performance. The results are discussed in terms of memory, associative, and associative-performance models of CS-preexposure effects.

Motivational state regulates the content of learned flavor preferences

Rats acquired a preference for an aqueous odor (almond) presented in simultaneous compound with sucrose. Separate presentations of saccharin reduced this preference in rats with ad-lib access to food during training or at test, but not in rats that were hungry during both training and test. In contrast, separate presentations of sucrose reduced the preference for the almond irrespective of deprivation state during training and test. We interpret the results to mean that a hungry rat forms odor-taste and odor-calorie associations, and its motivational state on test determines which of these associations controls the preference. In contrast, a rat that is not hungry during training only forms an odor-taste association, and its performance on test is independent of its level of hunger.

Ipsilateral and contralateral transfer of tactile learning

We examined the spatial organization of perceptual learning in a cortex-dependent task. Rats learned a tactile task using four whiskers on one side of the snout, all others being clipped. These trained whiskers were then clipped and prosthetic whiskers were attached. Subsequent performance was found to be determined by the location of the prosthetic whiskers. There was partial transfer of learning to neighbouring whisker positions. In addition, there was partial transfer of learning to whisker positions on the other side of the snout, but only if the prosthetic whiskers were symmetrically opposite the trained whiskers. These findings suggest that neural changes underlying perceptual learning are distributed according to the topographic organization of the sensory cortical map.

Motivational state regulates the content of learned flavor preferences

Rats acquired a preference for an aqueous odor (almond) presented in simultaneous compound with sucrose. Separate presentations of saccharin reduced this preference in rats with ad-lib access to food during training or at test, but not in rats that were hungry during both training and test. In contrast, separate presentations of sucrose reduced the preference for the almond irrespective of deprivation state during training and test. We interpret the results to mean that a hungry rat forms odor-taste and odor-calorie associations, and its motivational state on test determines which of these associations controls the preference. In contrast, a rat that is not hungry during training only forms an odor-taste association, and its performance on test is independent of its level of hunger.

Delayed diagnosis of fatal medium-chain acyl-CoA dehydrogenase deficiency in a child

A 5-year-old white female presented with coma and died unexpectedly. She had a history of recurrent episodes of febrile illnesses associated with lethargy and coma. Postmortem investigation revealed a fatty liver, leading to a suspicion of inborn error of fatty acid oxidation. The diagnosis of medium-chain acyl-CoA dehydrogenase (MCAD) deficiency was suggested by abnormal acylcarnitine profile with increased octanoylcarnitine in the blood, and confirmed by fatty acid oxidation studies and mutation analysis in skin fibroblast cultures. This case emphasizes the need to consider fatty acid oxidation disorders in all children who present with hypoglycemia with absent or mild ketones in the urine and high anion gap metabolic acidosis.