Evidence of Antineutrinos from Distant Reactors Using Pure Water at SNO

The SNO+ Collaboration reports the first evidence of reactor antineutrinos in a Cherenkov detector. The nearest nuclear reactors are located 240 km away in Ontario, Canada. This analysis uses events with energies lower than in any previous analysis with a large water Cherenkov detector. Two analytical methods are used to distinguish reactor antineutrinos from background events in 190 days of data and yield consistent evidence for antineutrinos with a combined significance of 3.5σ.

Detection of SARS-CoV-2 in formalin-fixed paraffin-embedded tissue sections using commercially available reagents

Coronavirus Disease-19 (COVID-19), caused by the coronavirus SARS-CoV-2, was initially recognized in Wuhan, China and subsequently spread to all continents. The disease primarily affects the lower respiratory system, but may involve other organs and systems. Histopathologic evaluation of tissue from affected patients is crucial for diagnostic purposes, but also for advancing our understanding of the disease. For that reason, we developed immunohistochemical (IHC) and in situ hybridization (ISH) assays for detection of the. virus. A total of eight autopsy lungs, one placenta, and ten kidney biopsies from COVID-19 patients were stained with a panel of commercially available antibodies for IHC and commercially available RNA probes for ISH. Similarly, autopsy lungs, placentas and renal biopsies from non-COVID-19 patients were stained with the same antibodies and probes. All eight lungs and the placenta from COVID-19 patients stained positive by IHC and ISH, while the kidney biopsies stained negative by both methodologies. As expected, all specimens from non-COVID-19 patients were IHC and ISH negative. These two assays represent a sensitive and specific method for detecting the virus in tissue samples. We provide the protocols and the list of commercially available antibodies and probes for these assays, so they can be readily implemented in pathology laboratories and medical examiner offices for diagnostic and research purposes.

Effect of chemotherapy on cancer stem cells and tumor-associated macrophages in a prospective study of preoperative chemotherapy in soft tissue sarcoma

Background

Cancer stem cells (CSC) may respond to chemotherapy differently from other tumor cells.

Methods

This study examined the expression of the putative cancer stem cell markers ALDH1, CD44, and CD133; the angiogenesis marker CD31; and the macrophage marker CD68 in soft tissue sarcomas (STS) before and after 4 cycles of chemotherapy with doxorubicin and ifosfamide in 31 patients with high-grade soft tissue sarcoma in a prospective clinical trial.

Results

None of the markers clearly identified CSCs in STS samples. Macrophages represented a prominent component in viable tumor areas in pre-treatment STS biopsies, ranging from < 5 to > 50%. Furthermore, macrophages expressed CD44 and ALDH1. Macrophage density correlated with baseline maximum standardized uptake value (SUVmax) on fluoro-deoxyglucose positron emission tomography (PET) imaging. Pre-chemotherapy CD68 staining correlated positively with the baseline SUVmax, and negatively with the percent of viable tumor cells in post-chemotherapy resection samples. In particular, cases with more CD68-positive cells at biopsy had fewer viable tumor cells at resection, suggesting a better response to chemotherapy.

Conclusions

In conclusion, ALDH1, CD44, and CD133 are not likely to be useful markers of CSCs in STS. However, our observation of infiltrating macrophages in STS specimens indicates that these immune cells may contribute significantly to STS biology and response to chemotherapy, and could provide a potential target of therapy. Future studies should investigate macrophage contribution to STS pathophysiology by cytokine signaling.

Electronic supplementary material

The online version of this article (10.1186/s12967-019-1883-6) contains supplementary material, which is available to authorized users.

Fluorescence in situ hybridization for the diagnosis of NPHP1 deletion-related nephronophthisis on renal biopsy

Nephronophthisis is an autosomal recessive tubulointerstitial nephropathy that is a leading genetic etiology of end-stage renal disease in children and young adults. Approximately 60% of patients with a known genetic etiology of nephronophthisis are due to homozygous deletion of the NPHP1 gene. We identified a total of 45 renal biopsies from young patients with chronic kidney disease of undetermined etiology and analyzed them for the possibility of nephronophthisis due to NPHP1 deletion using interphase fluorescence in situ hybridization and/or polymerase chain reaction. Homozygous NPHP1 deletion was identified in 9 patients (20%). In cases with adequate tissue, both assays were performed and showed 100% agreement. Blinded histopathologic analysis was then performed and identified 6 lesions that were significantly more common in biopsies from patients with NPHP1 deletion-proven nephronophthisis than chronic kidney injury of other known etiologies. Many of the classically described nephronophthisis biopsy lesions such as tubular basement membrane duplication, presence of cysts, and mononuclear interstitial inflammation were not significantly associated with this disease when compared with biopsies from patients with chronic kidney injury due to other etiologies. There were, however, morphologic lesions that were strongly associated with NPHP1 deletion including tubular abnormalities such as diverticulum, florets, and macula densa-like change as well as interstitial Tamm-Horsfall aggregates, periglomerular fibrosis, and the absence of arteriosclerosis. Awareness of the histopathologic pattern of injury in nephronophthisis combined with testing for NPHP1 deletion enables renal pathologists to provide a definitive pathologic and genetic diagnosis in a subset of patients with this disease.

Differences in the Contribution of CD4+ T Cells to Proislet and Islet Allograft Rejection Correlate with Constitutive Class II MHC Alloantigen Expression

Allografts of BALB/c (H-2d) fetal proislets facilitated long-term (>100 days) reversal of streptozotocin-induced diabetes in CBA/H (H-2k) mice treated with a combination of anti-CD4 and anti-CD8 mAbs. Anti-CD8 monotherapy was partially effective in restoring normoglycemia but anti-CD4 mAb treatment of host animals failed to promote allograft function. In contrast, allografts of BALB/c adult islets demonstrated indefinite reversal of diabetes in recipient mice treated only with anti-CD8 mAb. Anti-CD4 monotherapy resulted in only transient restoration of normoglycemia. These findings clearly demonstrate (1) a critical role for CD8 T cells in the acute rejection of pancreatic islet tissue allografts and (2) tissue-specific differences in the participation of CD4 T cells as primary effectors in the rejection reaction. Immunohistochemical studies showed that the capacity for CD4 T cells to initiate the rejection of proislet but not adult islet allografts correlates with the presence/absence, respectively, of graft parenchymal cells that constitutively express Class II MHC alloantigens. Proislet grafts, unlike transplants of purified adult islets, contain heterogeneous tissue components including Class II MHC+ve duct epithelium. Thus, the participation of CD8 and CD4 T cells as primary effectors of graft rejection depends on which class or classes of MHC antigens are constitutively expressed on graft parenchymal cells and are available for recognition. Islet tissue in both rejecting proislet and islet allografts showed de novo induction of Class II MHC alloantigens only after severe disruption to islet architecture had been achieved by infiltrating mononuclear cells. Thus, at this stage of advanced allograft injury, CD4 T cells have the potential to act as secondary effectors, possibly by amplifying the inflammatory reaction and thus accelerating graft destruction. The capacity for antirejection mAb therapy to establish transplant tolerance was facilitated in the islet allograft model where it was necessary to target only the CD8 T cell subpopulation.

Complete and sustained response of adult medulloblastoma to first-line sonic hedgehog inhibition with vismodegib

Medulloblastoma is an aggressive primitive neuroectodermal tumor of the cerebellum that is rare in adults. Medulloblastomas fall into 4 prognostically significant molecular subgroups that are best defined by experimental gene expression profiles: the WNT pathway, sonic hedgehog (SHH) pathway, and subgroups 3 and 4 (non-SHH/WNT). Medulloblastoma of adults belong primarily to the SHH category. Vismodegib, an SHH-pathway inhibitor FDA-approved in 2012 for treatment of basal cell carcinoma, has been used successfully in the setting of chemorefractory medulloblastoma, but not as a first-line therapy. In this report, we describe a sustained response of an unresectable multifocal form of adult medulloblastoma to vismodegib. Molecular analysis in this case revealed mutations in TP53 and a cytogenetic abnormality, i17q, that is prevalent and most often associated with subgroup 4 rather than the SHH-activated form of medulloblastoma. Our findings indicate that vismodegib may also block alternate, non-canonical forms of downstream SHH pathway activation. These findings provide strong impetus for further investigation of vismodegib in clinical trials in the first-line setting for pediatric and adult forms of medulloblastoma.

Recurrent bacterial vaginosis: the use of maintenance acidic vaginal gel following treatment

Bacterial vaginosis (BV) frequently recurs after treatment. One option in the management of recurrences is to keep the vaginal pH at 4.5 or less, in order to prevent overgrowth of bacteria, until the normal lactobacilli are re-established. We report the outcome of using maintenance acetic acid vaginal gel, after treatment of BV, in a sample of 49 women with frequent recurrences. Half of the women had no further recurrences, and in those who did there was a significant increase in time to first recurrence (4.8 months) after commencing the gel compared with the previous recurrence (2.1 months). Prior to using acidic gel, the mean recurrence rate in 49 women was 4.4 per woman/year, and this was reduced to 0.6 recurrences per woman/year. As there are few effective therapies for women with recurrent BV, we feel this offers an option that can currently be used in clinical practice.

Haemangioma of the uterine cervix

We describe a rare cause of irregular vaginal bleeding due to a haemangioma of the uterine cervix. Clinical, ultrasound and MRI appearances are shown and options for management discussed.

Prevalence and organ distribution of leukocyte chemotactic factor 2 amyloidosis (ALECT2) among decedents in New Mexico

Leukocyte chemotactic factor 2 (LECT2) amyloidosis is one of the most recently described types of amyloidosis. Since its description, it has been found to be one the most common types of amyloidosis in large series of amyloid cases involving the kidney and liver in the United States, where it primarily affects patients of Hispanic ethnicity. We sought to investigate the prevalence of this disease among Hispanic adult decedents who had an autopsy performed at the New Mexico Office of the Medical Investigator and determine the organ distribution of amyloid deposition. LECT2 amyloid deposits were identified within the kidney in 3.1% of Hispanic decedents. It was consistently deposited in the liver, spleen, adrenals, and lungs but did not involve the myocardium or brain. LECT2 amyloidosis is likely not rare among Hispanics in the Southwest United States and could represent an important but under-recognized etiology of chronic kidney disease in this population.

A computer-aided approach to detect the fetal behavioral states using multi-sensor Magnetocardiographic recordings

We propose a novel computational approach to automatically identify the fetal heart rate patterns (fHRPs), which are reflective of sleep/awake states. By combining these patterns with presence or absence of movements, a fetal behavioral state (fBS) was determined. The expert scores were used as the gold standard and objective thresholds for the detection procedure were obtained using Receiver Operating Characteristics (ROC) analysis. To assess the performance, intraclass correlation was computed between the proposed approach and the mutually agreed expert scores. The detected fHRPs were then associated to their corresponding fBS based on the fetal movement obtained from fetal magnetocardiogaphic (fMCG) signals. This approach may aid clinicians in objectively assessing the fBS and monitoring fetal wellbeing.

Glucose: Detection and analysis

Glucose is an aldosic monosaccharide that is centrally entrenched in the processes of photosynthesis and respiration, serving as an energy reserve and metabolic fuel in most organisms. As both a monomer and as part of more complex structures such as polysaccharides and glucosides, glucose also plays a major role in modern food products, particularly where flavor and or structure are concerned. Over the years, many diverse methods for detecting and quantifying glucose have been developed; this review presents an overview of the most widely employed and historically significant, including copper iodometry, HPLC, GC, CZE, and enzyme based systems such as glucose meters. The relative strengths and limitations of each method are evaluated, and examples of their recent application in the realm of food chemistry are discussed.

Development of a 96-well plate iodine binding assay for amylose content determination

Cereal starch amylose/amylopectin (AM/AP) is critical in functional properties for food and industrial applications. Conventional methods of AM/AP are time consuming and labor intensive making it difficult to screen the large sample sets necessary for evaluating breeding samples and investigating environmental impact on starch development. The objective was to adapt and optimize the iodine binding assay in a 96-well plate format for measurement at both λ 620 nm and λ 510 nm. The standard curve for amylose content was scaled to a 96-well plate format and demonstrated R(2) values of 0.999 and 0.993 for single and dual wavelengths, respectively. The plate methods were applicable over large ranges of amylose contents: high amylose maize starch at 61.7±2.3%, normal wheat starch at 29.0±0.74%, and a waxy maize starch at 1.2±0.9%. The method exhibited slightly greater amylose content values than the Concanavalin A method for normal type starches; but is consistent with cuvette scale iodine binding assays.

Effect of nitrogen fertilization and cover cropping systems on sorghum grain characteristics

Cover crop treatments and nitrogen (N) fertilization rates were investigated for their impact on sorghum grain quality attributes. Sorghum was planted in field plots treated with differing cover cropping systems and fertilization rates. The size (weight and diameter) and hardness of the kernels were influenced by both the cover crop and N rates. The protein content increased as the N rate increased and also with the addition of cover crops to the system. The protein digestibility values and starch granule size distributions were not affected by N rate or the cover cropping treatments. Soil properties were tested to determine relationships with grain quality attributes. The utilization of cover crops appears to increase the protein content without causing a deleterious effect on protein digestibility. The end-product quality is not hampered by the use of beneficial cropping systems necessary for sustainable agriculture.

Detection of PAX2 deletions and duplications using multiplex ligation-dependent probe amplification

BACKGROUND

Renal coloboma syndrome (RCS) is a rare inherited disorder caused by mutations in the PAX2 gene. Clinical testing is currently performed by bidirectional Sanger sequencing of all 12 coding exons of the PAX2 gene, which detects point mutations or small insertion/deletion mutations. Large genomic deletions of PAX2 have been identified in 3/90 known RCS families, accounting for approximately (3%) of RCS cases. In these cases, the deletion was detected by cytogenetic techniques such as G-banding or array comparative genomic hybridization. While these methods would be sufficient to identify whole gene deletions, they may not be able to identify smaller rearrangements affecting single exons. Similarly, such deletions would not be detected by Sanger sequencing.

AIM

The aim of this study was to determine whether mutation-negative RCS probands harbor a genomic deletion or duplication involving one or more exons of the PAX2 gene. We evaluated this hypothesis in 46 patients with a clinical suspicion of RCS in whom no mutations were identified.

RESULTS

We developed a multiplex ligation-dependent probe amplification assay to detect gene deletion/duplication in all 12 exons of the PAX2 gene. Of the 46 PAX2 mutation-negative samples tested, none demonstrated deletions or duplications in the PAX2 gene. This suggests that deletions or duplications in PAX2 are unlikely to significantly contribute to the pathogenesis of RCS, beyond the known 3% of cases that have been attributed to whole gene deletions. Given these results, we hypothesize that other genes and/or locus control regions regulating PAX2 may be involved in the pathogenesis of PAX2 mutation-negative cases of RCS.

Primary amebic meningoencephalitis deaths associated with sinus irrigation using contaminated tap water

BACKGROUND

Naegleria fowleri is a climate-sensitive, thermophilic ameba found in the environment, including warm, freshwater lakes and rivers. Primary amebic meningoencephalitis (PAM), which is almost universally fatal, occurs when N. fowleri-containing water enters the nose, typically during swimming, and N. fowleri migrates to the brain via the olfactory nerve. In 2011, 2 adults died in Louisiana hospitals of infectious meningoencephalitis after brief illnesses.

METHODS

Clinical and environmental testing and case investigations were initiated to determine the cause of death and to identify the exposures.

RESULTS

Both patients had diagnoses of PAM. Their only reported water exposures were tap water used for household activities, including regular sinus irrigation with neti pots. Water samples, tap swab samples, and neti pots were collected from both households and tested; N. fowleri were identified in water samples from both homes.

CONCLUSIONS

These are the first reported PAM cases in the United States associated with the presence of N. fowleri in household plumbing served by treated municipal water supplies and the first reports of PAM potentially associated with the use of a nasal irrigation device. These cases occurred in the context of an expanding geographic range for PAM beyond southern tier states with recent case reports from Minnesota, Kansas, and Virginia. These infections introduce an additional consideration for physicians recommending nasal irrigation and demonstrate the importance of using appropriate water (distilled, boiled, filtered) for nasal irrigation. Furthermore, the changing epidemiology of PAM highlights the importance of raising awareness about this disease among physicians treating persons showing meningitislike symptoms.

Occult tumors presenting with negative imaging: analysis of the literature

Object

Some patients presenting with neurological symptoms and normal findings on imaging studies may harbor occult brain tumors that are undetectable on initial imaging. The purpose of this study was to analyze the cases of occult brain tumors reported in the literature and to determine their modes of presentation and time to diagnosis on imaging studies.

Methods

A review of the literature was performed using PubMed. The authors found 15 articles reporting on a total of 60 patients with occult tumors (including the authors' illustrative case).

Results

Seizures were the mode of initial presentation in a majority (61.7%) of patients. The initial imaging was CT scanning in 55% and MRI in 45%. The mean time to diagnosis for occult brain tumors was 10.3 months (median 4 months). The time to diagnosis (mean 7.5 months, median 3.2 months) was shorter (p = 0.046) among patients with seizures. Glioblastoma multiforme (GBM) was found more frequently among patients with seizures (67.6% vs 34.8%, p = 0.013). The average time to diagnosis of GBM was shorter than the time to diagnosis of other tumors; the median time to diagnosis was 3.2 months for GBM and 6 months for other tumors (p = 0.04). There was no predilection for side or location of occult tumors. In adult patients, seizures may be predictive of left-sided tumors (p = 0.04).

Conclusions

Based on the results of this study, the authors found that in patients with occult brain tumors, the time to diagnosis is shorter among patients with seizures and also among those with GBM.

Congenital megaconial myopathy due to a novel defect in the choline kinase Beta gene

OBJECTIVES

To describe the first American patient with a congenital muscle dystrophy characterized by the presence in muscle of gigantic mitochondria displaced to the periphery of the fibers and to stress the potential origin and effects of the mitochondrial changes.

DESIGN

Case report and documentation of a novel mutation in the gene encoding choline kinase beta (CHKB).

SETTING

Collaboration between 2 tertiary care academic institutions.

PATIENT

A 2-year-old African American boy with weakness and psychomotor delay.

INTERVENTIONS

Detailed clinical and laboratory studies, including muscle biopsy, biochemical analysis of the mitochondrial respiratory chain, and sequencing of the CHKB gene.

MAIN OUTCOME MEASURES

Definition of unique mitochondrial changes in muscle.

RESULTS

This patient had the same clinical and laboratory features reported in the first cohort of patients, but he harbored a novel CHKB mutation and had isolated cytochrome c oxidase deficiency in muscle.

CONCLUSIONS

Besides confirming the phenotype of CHKB mutations, we propose that this disorder affects the mitochondria-associated membrane and the impaired phospholipid metabolism in the mitochondria-associated membrane causes both the abnormal size and displacement of muscle mitochondria.

Genetic alterations in colorectal cancer

Colorectal cancer (CRC) is the third most common cancer in men and the second most common cancer in women worldwide. Both genetic and epigenetic alterations are common in CRC and are the driving force of tumorigenesis. The adenoma-carcinoma sequence was proposed in the 1980s that described transformation of normal colorectal epithelium to an adenoma and ultimately to an invasive and metastatic tumor. Initial genetic changes start in an early adenoma and accumulate as it transforms to carcinoma. Chromosomal instability, microsatellite instability and CpG island methylator phenotype pathways are responsible for genetic instability in colorectal cancer. Chromosomal instability pathway consist of activation of proto-oncogenes (KRAS) and inactivation of at least three tumor suppression genes, namely loss of APC, p53 and loss of heterozogosity (LOH) of long arm of chromosome 18. Mutations of TGFBR and PIK3CA genes have also been recently described. Herein we briefly discuss the basic concepts of genetic integrity and the consequences of defects in the DNA repair relevant to CRC. Epigenetic alterations, essential in CRC tumorigenesis, are also reviewed alongside clinical information relevant to CRC.

Development of the penile urethra in the tammar wallaby

Hypospadias is increasingly common, and requires surgery to repair, but its aetiology is poorly understood. The marsupial tammar wallaby provides a unique opportunity to study hypospadias because penile differentiation occurs postnatally. Androgens are responsible for penile development in the tammar, but the majority of differentiation, in particular formation and closure of the urethral groove forming the penile urethra in males, occurs when there is no measurable sex difference in the concentrations of testosterone or dihydrotestosterone in either the gonads or the circulation [corrected]. Phalluses were examined morphologically from the sexually indifferent period (when androgens are high) to well after the time that the phallus becomes sexually dimorphic. We show that penile development and critical changes in the positioning of the urethra occur in the male phallus begin during an early window of time when androgens are high. Remodelling of the urethra in the male occurs between days 20-60. The critical period of time for the establishment urethral closure occurs during the earliest phases of penile development. This study suggests that there is an early window of time before day 60 when androgen imprinting must occur for normal penile development and closure of the urethral groove.

Association of common variants in the human eyes shut ortholog (EYS) with statin-induced myopathy: evidence for additional functions of EYS

INTRODUCTION

Of the nearly 38 million people in the USA who receive statin therapy, 0.1-0.5% experience severe or life-threatening myopathic side effects.

METHODS

We performed a genome-wide association study (GWAS) in a group of patients with severe statin myopathy versus a statin-tolerant group to identify genetic susceptibility loci.

RESULTS

Replication studies in independent groups of severe statin myopathy (n = 190) and statin-tolerant controls (n = 130) resulted in the identification of three single-nucleotide polymorphisms (SNPs), rs9342288, rs1337512, and rs3857532, in the eyes shut homolog (EYS) on chromosome 6 suggestive of an association with risk for severe statin myopathy (P = 0.0003-0.0008). Analysis of EYS cDNA demonstrated that EYS gene products are complex and expressed with relative abundance in the spinal cord as well as in the retina.

CONCLUSION

Structural similarities of these EYS gene products to members of the Notch signaling pathway and to agrin suggest a possible functional role in the maintenance and regeneration of the structural integrity of skeletal muscle.

Bio-magnetic signatures of fetal breathing movement

The purpose of fetal magnetoencephalography (fMEG) is to record and analyze fetal brain activity. Unavoidably, these recordings consist of a complex mixture of bio-magnetic signals from both mother and fetus. The acquired data include biological signals that are related to maternal and fetal heart function as well as fetal gross body and breathing movements. Since fetal breathing generates a significant source of bio-magnetic interference during these recordings, the goal of this study was to identify and quantify the signatures pertaining to fetal breathing movements (FBM). The fMEG signals were captured using superconducting quantum interference devices (SQUIDs) The existence of FBM was verified and recorded concurrently by an ultrasound-based video technique. This simultaneous recording is challenging since SQUIDs are extremely sensitive to magnetic signals and highly susceptible to interference from electronic equipment. For each recording, an ultrasound-FBM (UFBM) signal was extracted by tracing the displacement of the boundary defined by the fetal thorax frame by frame. The start of each FBM was identified by using the peak points of the UFBM signal. The bio-magnetic signals associated with FBM were obtained by averaging the bio-magnetic signals time locked to the FBMs. The results showed the existence of a distinctive sinusoidal signal pattern of FBM in fMEG data.

To what degree is digital imaging reliable? Validation of femoral neck shaft angle measurement in the era of picture archiving and communication systems

OBJECTIVES

This study investigates the reliability of femoral neck shaft angle (NSA) measurements made with the software and images available in routine clinical practice.

METHODS

Using the Centricity Enterprise™ (GE Healthcare Pty Ltd Piscataway, NJ) picture archiving and communication system (PACS), the NSA of the proximal femur was measured from anteroposterior radiographs of adult hips. 3 independent observers, using a standardised technique, performed a total of 120 measurements.

RESULTS

The Pearson's correlation coefficient for the intraobserver agreement was 0.98 (p<0.01) and for interobserver measurements 0.86 (p<0.01). Bland-Altman plots revealed the limits of intraobserver agreement to be ±2.5°, but interobserver limits of agreement to be ±6°. The intraclass correlation coefficient (ICC) was also calculated. The interobserver ICC was 0.62 (0.42-0.78, 95% confidence interval (CI); p<0.001). The intraobserver ICC was 0.98 (0.95-0.99, 95% CI; p<0.001).

CONCLUSION

PACS software has many advantages, but when using systems that can display angle measurements to one-tenth of a degree caution must be exercised to ensure that reliability of these measurements is not overestimated. We found that in the context of measuring the NSA of the proximal femur the reliability of the measurement, even under the best conditions, is only ±6° for different observers.

A novel approach to track fetal movement using multi-sensor magnetocardiographic recordings

Changes in fetal magnetocardiographic (fMCG) signals are indicators for fetal body movement. We propose a novel approach to reliably extract fetal body movements based on the field strength of the fMCG signal independent of its frequency. After attenuating the maternal MCG, we use a Hilbert transform approach to identify the R-wave. At each R-wave, we compute the center-of-gravity (cog) of the coordinate positions of MCG sensors, each weighted by the magnitude of the R-wave amplitude recorded at the corresponding sensor. We then define actogram as the distance between the cog computed at each R-wave and the average of the cog from all the R-waves in a 3-min duration. By applying a linear de-trending approach to the actogram we identify the fetal body movement and compare this with the synchronous occurrence of the acceleration in the fetal heart rate. Finally, we apply this approach to the fMCG recorded simultaneously with ultrasound from a single subject and show its improved performance over the QRS-amplitude based approach in the visually verified movements. This technique could be applied to transform the detection of fetal body movement into an objective measure of fetal health and enhance the predictive value of prevalent clinical testing for fetal wellbeing.

Female feathering in sebright cocks is due to conversion of testosterone to estradiol in skin

Sebright cocks develop a female feathering pattern but revert to normal male feathering after castration. Administration of testosterone to castrated cocks causes male comb development and reappearance of female feathering. Dihydrotes-tosterone treatment supports development of a male comb but does not induce female feathering. Since testosterone but not dihydrotestosterone is converted to estradiol in the skin of the Sebright, the female feathering appears to be the result of increased conversion of testosterone to estradiol.

Cholesterol synthesis in the squirrel monkey: relative rates of synthesis in various tissues and mechanisms of control

Cholesterol synthesis has been extensively investigated in various tissues of lower mammals; however, there is little specific information concerning cholesterologenesis in the primate. Furthermore, experiments in whole animals suggest that important differences may exist in the features of cholesterologenesis in the dog and rat versus the monkey and man. Using the new world squirrel monkey, therefore, we performed the present studies to determine the rates of cholesterologenesis in various tissues per unit weight, to define the relative rates of whole organ synthesis, and to evaluate the operation of control mechanisms in these tissues.In control animals fed a low cholesterol chow diet, the liver and ileum were the two most active sites for cholesterologenesis followed, in order, by the colon, esophagus, and proximal small bowel. Rates of synthesis in 10 other tissues tested were considerably lower than these found in the gastrointestinal tract. When rates of whole organ synthesis were calculated, three tissues, i.e., liver, bowel, and skin, accounted for 92% of the total demonstrable synthetic activity.Following cholesterol feeding utilizing either a solid chow or liquid formula diet, marked suppression of hepatic cholesterologenesis occurred while synthesis in other organs remained essentially unaltered. Similarly, fasting animals for periods up to 96 hr resulted in suppression of synthesis in the liver, but not in various levels of the intestine. Finally, biliary diversion for 48 hr caused a twofold increase in hepatic cholesterologenesis and a six- to eightfold increase in sterol synthesis in the small but not the large intestine.

Biosynthetic origin of serum cholesterol in the squirrel monkey: evidence for a contribution by the intestinal wall

The possibility that the intestinal wall serves as a biosynthetic site for serum cholesterol has been examined in two types of studies in the squirrel monkey. First, animals were fed cholesterol in order to inhibit cholesterol synthesis in the liver, and the intestinal lymph ducts were cannulated. After the administration of acetate-2-(14)C it was possible to demonstrate that cholesterol synthesized by the intestinal wall enters intestinal lymph and thereby in the intact animal enters the circulating pool. Second, an attempt to quantitate the significance of this intestinal contribution has been made in animals fed cholesterol-3-(3)H and injected with cholesterol-4-(14)C for long periods. By an application of the technique of analysis utilizing the isotopic steady state we estimated as a minimal value that in the squirrel monkey 1.5-2.0 mg of cholesterol synthesized in the intestinal wall reaches the circulation each day.

Understanding dynamics of the system using Hilbert phases: an application to study neonatal and fetal brain signals

The Hilbert phase phi(t) of a signal x(t) exhibits slips when the magnitude of their successive phase difference |phi(t(i+1))-phi(t(i))| exceeds pi. By applying this approach to periodic, uncorrelated, and long-range correlated data, we show that the standard deviation of the time difference between the successive phase slips Deltatau normalized by the percentage of slips in the data is characteristic of the correlation in the data. We consider a 50x50 square lattice and model each lattice point by a second-order autoregressive (AR2) process. Further, we model a subregion of the lattice using a different set of AR2 parameters compared to the rest. By applying the proposed approach to the lattice model, we show that the two distinct parameter regions introduced in the lattice are clearly distinguishable. Finally, we demonstrate the application of this approach to spatiotemporal neonatal and fetal magnetoencephalography signals recorded using 151 superconducting quantum interference device sensors to identify the sensors containing the neonatal and fetal brain signals and discuss the improved performance of this approach over the traditionally used spectral approach.

Magnetomyographic recording and identification of uterine contractions using Hilbert-wavelet transforms

We propose a multi-stage approach using Wavelet and Hilbert transforms to identify uterine contraction bursts in magnetomyogram (MMG) signals measured using a 151 magnetic sensor array. In the first stage, we decompose the MMG signals by wavelet analysis into multilevel approximate and detail coefficients. In each level, the signals are reconstructed using the detail coefficients followed by the computation of the Hilbert transform. The Hilbert amplitude of the reconstructed signals from different frequency bands (0.1-1 Hz) is summed up over all the sensors to increase the signal-to-noise ratio. Using a novel clustering technique, affinity propagation, the contractile bursts are distinguished from the noise level. The method is applied on simulated MMG data, using a simple stochastic model to determine its robustness and to seven MMG datasets.

Design of a light stimulator for fetal and neonatal magnetoencephalography

The design, safety analysis and performance of a fetal visual stimulation system suitable for fetal and neonatal magnetoencephalography studies are presented. The issue of fetal, neonatal and maternal safety is considered and the maximum permissible exposure is computed for the maternal skin and the adult eye. The risk for neonatal eye exposure is examined. It is demonstrated that the fetus, neonate and mother are not at risk.

Primary central nervous system lymphoma

Primary central nervous system lymphoma (PCNSL) is an uncommon extranodal non-Hodgkin lymphoma. Its incidence has increased during the last 3 decades and has been reported in both immunocompromised and immunocompetent patients. Immunocompromised patients are affected at a younger age compared with immunocompetent patients. It presents with raised intracranial pressure and focal neurologic and neuropsychiatric symptoms. The lesions are typically solitary. The majority of the lesions are located in the periventricular area, whereas in a few cases they are located in the supratentorial area. Diffuse large B-cell lymphomas constitute most PCNSLs, whereas T-cell, low-grade, anaplastic, and Hodgkin lymphomas are rarely encountered. The morphology of PCNSL shows a characteristic angiocentric pattern and is positive for B-cell markers by immunohistochemistry. The differential diagnosis of PCNSL includes central nervous system gliomas, metastatic tumors, demyelinating disorders, subacute infarcts, and space-occupying lesions due to an infectious etiology. The understanding of the molecular mechanisms involved in the pathogenesis of PCNSL and the identification of molecular biomarkers have lagged behind that of systemic nodal lymphomas. Primary central nervous system lymphomas are treated with combined radiotherapies and chemotherapies. The prognosis for PCNSL is worse than for other extranodal lymphomas.

Scaling analysis of paces of fetal breathing, gross-body and extremity movements

Using detrended fluctuation analysis (DFA), we studied the scaling properties of the time instances (occurrence) of the fetal breathing, gross-body, and extremity movements scored on a second by second basis from the recorded ultrasound measurements of 49 fetuses. The DFA exponent α of all the three movements of the fetuses varied between 0.63 and 1.1. We found an increase in α obtained for the movement due to breathing as a function of the gestational age while this trend was not observed for gross-body and extremity movements. This trend was argued as the indication of the maturation of lung and functional development of respiratory aspect of the fetal central nervous system. This result may be useful in discriminating normal fetuses from high-risk fetuses.

Microscope enabling multimodality imaging, angle-resolved scattering, and scattering spectroscopy

We present the design, construction, and initial characterization of a multifunctional imaging/scattering spectroscopy system built around a commercial inverted microscope platform. The system enables co-registered brightfield, Fourier-filtered darkfield, and fluorescence imaging; monochromatic angle-resolved scattering measurements; and white-light wavelength-resolved scattering spectroscopy from the same field of view. A fiber-based illumination system provides illumination-wavelength flexibility and a good approximation to a point source. The performance of the system in its various data acquisition modes is experimentally verified using fluorescent microspheres. This multifunctional instrument provides a platform for studies on adherent cells from which the biophysical implications of subcellular light scattering can be studied in conjunction with sensitive fluorescence-based techniques.

Cushing’s syndrome in a clinic population with diabetes

BACKGROUND

A recent report has suggested that occult Cushing's syndrome (CS) may be present in a significant number of patients with type 2 diabetes mellitus. The aim of this study was to determine whether any patients in our clinic population with diabetes had this condition.

METHODS

One hundred and seventy-one consecutive overweight attendees at the diabetic clinic were enrolled in a study to assess the presence of occult CS. The initial screen was with the 1 mg overnight dexamethasone suppression test and follow-up testing, where indicated was with a 24 h collection for urine-free cortisol.

RESULTS

Thirty-one of 171 patients had a positive result from the overnight dexamethasone suppression test. Follow-up testing with 24 h urine-free cortisol reduced the number of patients with positive results to 3. Two of these were shown to have alcoholic pseudo-CS. The third patient has had several high urine-free cortisol results, in the presence of normal scans of pituitary and adrenals. He has no stigmata of CS and is being observed.

CONCLUSION

Based on the results of our study, there would appear to be little value in screening type 2 diabetics for CS, in the absence of clinical suspicion.

Bacterial vaginal flora in relation to changing oestrogen levels

Hormonal changes may be important in the onset and clearance of bacterial vaginosis. We studied vaginal flora and serum oestradiol levels of 55 women at baseline and during hormonal treatment. None developed bacterial vaginosis (BV) from normal vaginal flora, 69% of women had normal flora at baseline increasing to 91% following hormonal treatment. The mean oestradiol level with BV was 39.07 ng/L compared with 176.41 ng/L with normal flora. Non-smokers had a mean oestradiol level of 173.95 ng/L compared with 118.67 ng/L in smokers. Recombinant follicle-stimulating hormone resulted in a mean oestradiol rise of 113.9 ng/L. The mean rise was 330.4 ng/L with improved vaginal flora but only 15.1 ng/L in persistently abnormal or worsening flora. A rise in oestradiol in this group of women was associated with a significant reduction of abnormal flora. Reversion from BV to normal flora was associated with a greater rise in oestradiol than where abnormal flora persisted or worsened. This study supports a possible hormonal influence in the natural history of BV. The lower oestradiol levels in smokers may help explain their increased risk of BV.

Patients' attitudes to the presence of medical students in a genitourinary medicine clinic: a cross sectional survey

OBJECTIVES

It is recommended that medical students learn how to take a sexual history and gain experience in genital examination, but patients' reluctance may make this difficult to achieve, especially for male students.

METHODS

We performed a survey of 250 male and 250 female patients attending a genitourinary medicine (GUM) clinic to determine their attitudes towards the involvement of medical students during their visit. Data were collected on the patients' age, ethnic origin, parity, number of visits to the clinic, and the sex of the student.

RESULTS

92.8% of women and 79.2% of men participated. Younger women and men, those visiting the clinic for the first time, and women with no children were less likely to accept a student of either sex to take their history or observe their examination. Women were less likely than men to accept students of either sex to take their sexual history or be present during their examination, but were more likely than men to accept only same sex students.

CONCLUSIONS

There was a high level of acceptability for the involvement of medical students; only 12.5% of women and 15% of men declined any medical student participation. Older women with children, and older men, were more likely to accept a student of either sex for all parts of the consultation. This information can be used to enhance the experience of male and female students and to minimise distress for those patients who are less likely to accept the presence of a medical student.

Management of metronidazole-resistant Trichomonas vaginalis--a new approach

Metronidazole-resistant trichomoniasis is an infrequent but challenging problem with no universally successful treatment. Since 1994, we have been using a combination regimen consisting of high-dose tinidazole plus a broad-spectrum antibiotic, i.e. doxycycline or ampicillin, and clotrimazole pessaries, for 7--14 days in this condition. A retrospective case review identified 11 cases of resistant trichomonas between 1994 and 2002. In the absence of resistance testing, resistance was defined clinically. Nine of the 11 patients were cured; one patient did not attend follow-up. In the women who attended for follow-up, the cure rate was 90%. We have found the combination of tinidazole, a broad-spectrum antibiotic, and clotrimazole pessaries to be a tolerable and effective treatment for metronidazole-resistant Trichomonas vaginalis. Although a variety of total doses of tinidazole were used in our patients, based on our findings, and those of others, we would recommend giving tinidazole 2 g twice daily for 14 days (total dose 56 g).