Systematic review of copper intrauterine contraception continuation in young nulliparous women based on intrauterine device type

OBJECTIVES

No copper intrauterine device (IUD) type is known to better suit young nulliparous women who tend to experience higher rates of IUD discontinuation compared with their older parous counterparts. A systematic review to determine which IUDs have higher continuation rates in young nulliparous women was undertaken.

DESIGN

Systematic review and meta-analyses of available evidence based on IUD type.

DATA SOURCES

AMED, BNI, CINAHL, DARE, EMBASE, EMCARE, HMIC, MEDLINE, PsycINFO, PubMed, TRIP, and the Cochrane Library electronic databases were searched from inception to 11 May 2022; as well as the Bandolier, Medicines and Healthcare products Regulatory Agency, Faculty of Sexual and Reproductive Healthcare, Royal College of Obstetricians and Gynaecologists, Department of Health, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines, WHO and Google Scholar websites.

ELIGIBILITY CRITERIA

All studies on IUDs currently available in the UK or comparable (same design and size) to those available in the UK, involving nulliparous women of any age including those aged under 30.

DATA EXTRACTION AND SYNTHESIS

Independently extracted data were assessed as low risk of bias using the Mixed Methods Appraisal Tool. Random effects meta-analyses of proportions were performed where data, including subgroups, were amenable to quantitative synthesis. Heterogeneity was reported using tau² and I² statistics, and sensitivity analyses were also performed.

RESULTS

Nineteen studies involving 13 045 nulliparous women were included but the heterogeneity of participant ages, parity and IUD types made quantitative synthesis of outcome data in totality inappropriate. The highest continuation rate obtained was 91.02% (95% CI 88.01% to 93.64%) for the smaller TCu 380A at 12 months post insertion.

CONCLUSIONS

Evidence for IUD use in young nulliparous women based on IUD type remains limited. Smaller sized IUD types appear better suited to this group of IUD users, however, more research is needed.

PROSPERO REGISTRATION NUMBER

CRD42019120969.

HER2 testing in metastatic breast cancer – is reflex in situ hybridization necessary in cases that are equivocal by immunohistochemistry?

Introduction/Objective

Current guidelines recommend HER2 testing on all primary invasive breast cancers and at least one metastatic lesion. Typical HER2 testing involves immunohistochemistry (IHC), with reflex in situ hybridization (ISH) in the event of equivocal (2+) IHC. ISH testing is time consuming and resource intensive, and there may be situations where it is unnecessary. The incidence of discordance between HER2 negative primary tumors and HER2 IHC2+ metastases that are ISH positive is unknown. We hypothesize that the majority of such cases are non- amplified.

Methods/Case Report

A retrospective review of IHC2+ metastatic lesions further assessed with ISH at our center from 2013-2021 was undertaken. A total of 105 cases were identified after exclusion of cases missing HER2 results, with primaries of unconfirmed origin, and cases of synchronous primary and metastatic disease. IHC and ISH results were recorded, with a detailed slide review of discordant cases.

Results (if a Case Study enter NA)

91/105 metastases had HER2 negative primaries (87%). A metastasis was significantly more likely to be HER2 negative when the primary was HER2 negative (93%) versus positive (43%) (p < 0.0001). 54/91 primaries were IHC2+/ISH negative, and 50/54 (93%) corresponding metastases had identical results. Of the 37 HER2 negative primaries that were IHC0/1+, 35 (95%) corresponding metastatic tumors were ISH negative. Six metastatic lesions in cases with HER2 negative primaries were discordant and slides were reviewed. Characteristics of metastatic tumors suggesting ISH testing was warranted to assess for discordance included IHC heterogeneity, morphological discordance, and increased staining of moderate intensity. These factors were present in all six discordant metastases.

Conclusion

Our results suggest that selective rather than reflex ISH testing on HER2 IHC2+ breast cancer metastases in the context of HER2 negative primary disease may be appropriate when there is careful review of the IHC. Validation of our findings await further studies with larger sample sizes.

Screening method for the detection of residues of amphenicol antibiotics in bovine milk by optical biosensor

An immunobiosensor assay was developed for multi-residue screening in bovine milk of the parent amphenicols, thiamphenicol and florfenicol, along with the metabolite florfenicol amine. A polyclonal antibody raised in a rabbit after immunisation with a florfenicol amine-protein conjugate was employed in the assay. Milk samples were subjected to acetonitrile extraction, reconstituted in buffer and diluted prior to biosensor analysis. Validation data obtained from the analysis of fortified samples has shown that the method has a detection capability of less than 0.25 µg kg^-1 for florfenicol and less than 0.5 µg kg^-1 for florfenicol amine and thiamphenicol. The cross-reactivity profile and validation data for the detection of these amphenicols is presented together with results obtained following the analysis of florfenicol incurred samples using the developed screening method along with a comparison of results obtained from the analysis of the same incurred samples using an MRM³ UPLC-MS/MS confirmatory method. Results are also presented obtained from the analysis of samples from both treated and non-treated animals which were co-housed and which show the potential for cross-contamination.

Determination of Atrazine in Water by Magnetic Particle Immunoassay: Collaborative Study

A collaborative study was performed to determine mean recovery and precision for analysis of atrazine in drinking and surface waters by immunoassay. The study design was based on the blind duplicate test plan for collaborative studies. Three blank waters (municipal drinking water, well water, and surface water) were spiked at 3 atrazine levels. Two water samples with naturally incurred atrazine loads were also spiked with atrazine at 3 levels. In the enzyme-linked immunoassay method, the water sample is mixed with a pesticide–enzyme conjugate and added to paramagnetic particles with triazine-specific antibodies attached. After separation of antibody-bound atrazine and atrazine–enzyme conjugate from free components, the bound enzyme conjugate catalyzes a reaction producing a colored end product. The color developed is inversely proportional to the original concentration of atrazine in the water sample. Fourteen laboratories participated in the collaborative study. Data were analyzed for repeatability and reproducibility, and average recoveries at the spike levels were calculated. Over the concentration range tested, the mean recovery of atrazine spiked into blank and pesticide-contaminated waters was 104%. Overall RSDRaveraged about 40% for atrazine concentrations near the method detection limit (0.05 μg/L) and about 15% at concentrations above 5 times the detection limit (0.25 μg/L). Corresponding single-analyst RSDr values were 24 and 10%. Recovery and precision for the 3 blank water matrixes and the waters that had been naturally contaminated with atrazine showed no significant differences. The magnetic particle immunoassay

Higher discontinuation rate with a standard-sized compared to a small-sized 'gold standard' copper intrauterine device: a case-control review

BACKGROUND

T-shaped intrauterine devices (IUDs) with a copper surface area of 380 mm2 and copper bands on the transverse arms are the most effective types of copper-containing IUDs. A small-sized 'gold standard' IUD is available but there has been little research to compare the effects of this small-sized IUD to its standard-sized counterpart.

AIM

To determine discontinuation rates and reasons for discontinuation at 1 year of the small-sized Mini TT380 Slimline IUD compared with the standard-sized TT380 Slimline.

METHODS

The clinical records of women fitted with Mini TT380 Slimline ('mini') IUDs were compared with those of women fitted with standard-sized TT380 Slimline ('standard') IUDs over a 3-year period (2013-2016).

RESULTS

Clinical records were available for 67 women fitted with a mini IUD (mean age 23 years, 64% nulliparous) and 63 women fitted with a standard IUD (mean age 25 years, 39% nulliparous). At 1 year, twice as many standard IUD users (32%, n=20) had discontinued their IUD use compared with mini IUD users (15%, n=10). Complaints of pain and bleeding were more than double (70%, n=14) in those women who discontinued standard IUD use compared with those who discontinued using the mini IUD (30%, n=3). These differences were statistically significant and were unrelated to parity.

CONCLUSIONS

More women using a standard-sized 'gold standard' IUD rather than its smaller counterpart complained of pain and bleeding, leading to higher discontinuation at 1 year. More research on the association between size and discontinuation of these IUDs is needed.

Large-Displacement Vertical Electrostatic Microactuator Dynamics using Duty-Cycled Softening/Stiffening Parametric Resonance

Electrostatic microactuators with large vertical scanning range (several hundred microns) at high frequency (hundreds to thousands of hertz) and chips sizes compatible with endoscopic microscopy have recently been demonstrated based on parametric resonance. This paper examines the use and modeling of mixed softening/hardening dynamics to help produce large ranges of motion in this class of mirrors. Origin of spring stiffening behavior in actuator design is described, followed by non-dimensional analysis of actuator motion trends. Experimental results are presented for a sample actuator design with up to 480 μm displacement at 1225 Hz and 60 V. Comparison to predicted trends and comments on benefits and limitations of modeling are provided.

Self-taken vaginal swabs versus clinician-taken for detection of candida and bacterial vaginosis: a case-control study in primary care

BACKGROUND

Vaginal discharge and vulvitis are common presenting symptoms in general practice. Few studies have specifically looked at the validity of self-taken low vulvovaginal swabs (LVS) for the diagnosis of vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV).

AIM

To assess if patient self-taken LVS are a valid alternative to clinician-taken high vaginal swabs (HVS) for the detection of VVC and BV.

DESIGN AND SETTING

Case-control study with the patient acting as their own control in an urban sexual health centre in Newcastle upon Tyne, UK.

METHOD

Females aged 16-65 years attending with symptomatic vaginal discharge, vulval irritation, genital pain, and an offensive genital smell were recruited into the study. Participants took a self-taken LVS before vaginal examination, during which a clinician took an HVS (reference standard). Main outcome measures were the diagnosis of BV or VVC infection.

RESULTS

A total of 104 females were enrolled. Of those, 45 were diagnosed with VVC and 26 with BV. The sensitivities of self-taken LVS for VVC and BV were 95.5% and 88.5% respectively. Cohen's κ coefficient showed 'strong agreement' for the detection of both VVC and BV. Vulval itching was the most common symptom associated with VVC (69%), whereas 50% of females diagnosed with BV presented with an offensive discharge. Both symptoms had poor positive predictive values (0.63 and 0.50, respectively).

CONCLUSION

Self-taken LVS appears to be a valid alternative to clinician-taken HVS for detecting VVC and BV infections. Symptoms were found to be a poor indicator of underlying infection.

Position paper: recommendations for a digital mammography quality assurance program V4.0

In 2001 the ACPSEM published a position paper on quality assurance in screen film mammography which was subsequently adopted as a basis for the quality assurance programs of both the Royal Australian and New Zealand College of Radiologists (RANZCR) and of BreastScreen Australia. Since then the clinical implementation of digital mammography has been realised and it has become evident that existing screen-film protocols were not appropriate to assure the required image quality needed for reliable diagnosis or to address the new dose implications resulting from digital technology. In addition, the advantages and responsibilities inherent in teleradiology are most critical in mammography and also need to be addressed. The current document is the result of a review of current overseas practice and local experience in these areas. At this time the technology of digital imaging is undergoing significant development and there is still a lack of full international consensus about some of the detailed quality control (QC) tests that should be included in quality assurance (QA) programs. This document describes the current status in digital mammography QA and recommends test procedures that may be suitable in the Australasian environment. For completeness, this document also includes a review of the QA programs required for the various types of digital biopsy units used in mammography. In the future, international harmonisation of digital quality assurance in mammography and changes in the technology may require a review of this document. Version 2.0 represented the first of these updates and key changes related to image quality evaluation, ghost image evaluation and interpretation of signal to noise ratio measurements. In Version 3.0 some significant changes, made in light of further experience gained in testing digital mammography equipment were introduced. In Version 4.0, further changes have been made, most notably digital breast tomosynthesis (DBT) testing and QC have been addressed. Some additional testing for conventional projection imaging has been added in order that sites may have the capability to undertake dose surveys to confirm compliance with diagnostic reference levels (DRLs) that may be established at the National or State level. A key recommendation is that dosimetry calculations are now to be undertaken using the methodology of Dance et al. Some minor changes to existing facility QC tests have been made to ensure the suggested procedures align with those most recently adopted by the Royal Australian and New Zealand College of Radiologists and BreastScreen Australia. Future updates of this document may be provided as deemed necessary in electronic format on the ACPSEM's website ( https://www.acpsem.org.au/whatacpsemdoes/standards-position-papers and see also http://www.ranzcr.edu.au/quality-a-safety/radiology/practice-quality-activities/mqap ).

Chancroid – desperate patient makes own diagnosis

We report a case of chancroid in a white heterosexual man in the United Kingdom. This patient was seen by four separate health services over a period of five weeks with excruciatingly painful penile ulcers. Despite several negative herpes simplex virus polymerase chain reaction tests and a self-diagnosis of chancroid, he was repeatedly offered multiple courses of aciclovir. This case highlights the need for awareness of alternative diagnoses in persistent cases of genital ulcer disease.

Testing for her2 in breast cancer: current pathology challenges faced in Canada

This review is designed to highlight several key challenges in the diagnosis of human epidermal growth factor receptor 2 (her2)-positive breast cancer currently faced by pathologists in Canada: Pre-analysis issues affecting the accuracy of her2 testing in non-excision sample types: core-needle biopsies, effusion samples, fine-needle aspirates, and bone metastasesher2 testing of core-needle biopsies compared with surgical specimensCriteria for retesting her2 status upon disease recurrenceLiterature searches for each topic were carried out using the medline, Embase, International Pharmaceutical Abstracts, and biosis databases. In addition, the congress databases of the American Society of Clinical Oncology (2005-2011) and the San Antonio Breast Cancer Symposium (2007-2011) were searched for relevant abstracts.All authors are expert breast pathologists with extensive experience of her2 testing, and several participated in the development of Canadian her2 testing guidelines. For each topic, the authors present an evaluation of the current data available for the guidance of pathology practice, with recommendations for the optimization or improvement of her2 testing practice.

Diagnosis versus recovery

The Recovery and Wellness Movement is the framework within which we ask the chronically mentally ill to understand how they might best manage their lives.

The epistemological and cultural primacy of a patient′s psychiatric diagnosis minimizes effective involvement in the Recovery Movement.

The aim of this presentation is to present both the implications to the patient in being trapped in any diagnostic labyrinth and how she/he can“escape” into a DIFFERENT awareness of the meaning of her/his diagnosis while still actively pursueing meaningful Recovery goals.

Various cognitive behavior techniques will be discussed to highlight both how patients should understand the real albeit limited value of their diagnoses as well as understand the necessary self-evaluation and attitudinal changes that will allow them to understand how best to participate in the Recovery Movement. The desired result: Both patients and mental health professionals will learn to minimize any heuristic value in even the term-“Patient.”

Growth of Cerium Oxide Buffer Layers and Superconducting thin films on Silicon

Films of CeO2 have been grown on Si and glass substrates using the laser ablation deposition technique. X-ray diffraction measurements for the films deposited on glass indicated that they are the same as films grown on Si covered with the native oxide. This evidence supports a picture in which chemical rather than crystal-lographic effects constrain the film growth. The crystal quality for films grown on Si was shown to improve with increasing film thickness away from the amorphous layer. Low cooling rates as well as reduced film thickness were effective in avoiding the formation of micro-cracks. The surface morphology was shown to be dependent on the laser wave-length as well as the oxygen partial pressure. Thin films of YBa2Cu3O7δ could easily be grown on CeO2/Si showing c-axis orientation, whereas the growth of BiSrCaCuO (2212) on CeO2/Si resulted in the two films mixing with each other.

A synchrotron tomographic energy-dispersive diffraction imaging study of the aerospace alloy Ti 6246

A titanium alloy sample (#6246) containing a linear friction weld has been imaged nondestructively using tomographic energy-dispersive diffraction imaging (TEDDI). The diffraction patterns measured at each point of the TEDDI image permitted identification of the material and phases present (±5%). The image also showed the preferred orientation and size–strain distribution present within the sample without the need for any further sample preparation. The preferred orientation was observed in clusters with average dimensions very similar to the experimental spatial resolution (400 µm). The length scales and preferred orientation distributions were consistent with orientation imaging microscopy measurements made by Szczepanski, Jha, Larsen & Jones [Metall. Mater. Trans. A(2008),39, 2841–2851] where the microstructure development was linked to the grain growth of the parent material. The use of a high-energy X-ray distribution (30–80 keV) in the incident beam reduced systematic errors due to the source profile, sample and air absorption. The TEDDI data from each voxel were reduced to an angle-dispersive form and Rietveld refined to a mean χ2of 1.4. The mean lattice parameter error (δd/d) ranged from ∼10−4for the highly crystalline regions to ∼10−3for regions of very strong preferred orientation and internal strain. The March–Dollase preferred orientation errors refined to an average value of ±2%. A 100% correlation between observed fluorescence and diffraction peak broadening was observed, providing further evidence for vicinal strain broadening.

Updated recommendations from the Canadian National Consensus Meeting on HER2/neu testing in breast cancer

Testing for her2/neu in breast cancer at the time of primary diagnosis is now the standard of care. Accurate and standardized testing methods are of prime importance to ensure the proper classification of the patient’s her2/neu status. A meeting of pathologists from across Canada was convened to update the Canadian her2/neu testing guidelines. This National her2/neu Testing Committee reviewed the recently published American Society of Clinical Oncology/ College of American Pathologists (asco/cap) guidelines for her2/neu testing in breast cancer. The updated Canadian her2/neu testing guidelines are based primarily on the asco/cap guidelines, with some modifications. It is anticipated that widespread adoption of these guidelines will further improve the accuracy of her2/neu testing in Canada.

Social health outcomes following thermal injuries: a retrospective matched cohort study

INTRODUCTION

Over 50% of children admitted with burns are aged under 3 years. US studies suggest that up to 26% of childhood burns are non-accidental, although UK reports are lower (1-16%).

OBJECTIVES

To determine the social health outcomes of burned children as regards the number of children abused, neglected or "in need" before the age of 6 years compared with matched controls.

METHODS

A retrospective matched cohort study. 145 children aged under 3 years admitted for burns in 1994-1997 were matched with controls for sex, age and enumeration district and followed up until 2003. Electronic routine databases provided study data on local authority care episodes and Social Services referrals by age 6 years.

RESULTS

89.0% of cases had accidental burns and four cases (2.8%) had non-accidental burns. No case was attributed to neglect. By their sixth birthday cases were statistically more likely to have been referred to Social Services with 14 (9.7%) of the burned children having been abused or neglected versus two (1.4%) controls (95% CI 0.030 to 0.13, p = 0.004). Forty six (32%) cases versus 26 (18%) controls were defined as "in need" (95% CI 0.047 to 0.23, p = 0.006).

CONCLUSION

Although most burns were deemed accidental, 2.8% were categorised as non-accidental at presentation. Almost a third of the burned children went on to be "in need". Children with a burn appear to be at higher risk of further abuse or neglect compared with controls. A burn therefore could be a surrogate marker indicating need for closer supervision and follow-up by professionals.

Adjuvant trastuzumab for breast cancer outside of clinical trials: Cardiotoxicity and economic evaluation

6585

Background: Clinical and economic evaluations of adjuvant trastuzumab (aTZ) in breast cancer (BC) are based on clinical trial outcomes. Population based studies however provide unique opportunities to examine outcomes in a real world setting. We previously examined aTZ uptake in all patients diagnosed with stage I-III BC over one year in Nova Scotia, Canada (Snow et al SABCS 2007). We now report cardiotoxic events (CE) and an economic evaluation based on our previous cohort. Methods: A retrospective chart review of all patients treated with aTZ was conducted to abstract clinical-pathological characteristics, treatment details, CEs/significant LVEF declines, and associated medical resource utilization (MRU). Cardiac risk scores (CRS) (Rastogi et al ASCO 2007) were also computed for all patients. Biserial correlation was performed to detect differences in CRS scores among subgroups. Costs associated with aTZ were based on MRU; unit costs were derived from the literature and local resources. A probabilistic model (Skedgel et al ASCO 2008) was utilized to examine the cost per quality adjusted life year gained (QALYG) at a 25-year horizon with budget impact calculated in 2009 Cdn $. Results: Of a total population of 630 patients with stage I-III BC, 37 (5.9%) received aTZ as per HERA trial treatment schedule; two (5.4%) had a CE (one death) and five (13.5%) experienced significant LVEF decline. CEs and LVEF declines were higher in patients with baseline LVEF 50–55% vs. > 55% (10% vs. 4% and 20% vs. 11%, respectively). CRS accurately predicted the observed CE rate, and was also predictive of significant LVEF decline (p = 0.056). Compared to previous estimates, the mean cost per patient of $46,070 (95%CI: $38,541-$54,422) was lower and the cost-utility of $60,439/QALYG was more favourable. Based on the observed aTZ utilization rate, a budget impact of $59.9m (95%CI: 42.5 m-79.9 m) for 2009 in Canada is expected. Conclusions: CEs and significant LVEF declines in this population based cohort appear comparable to that reported in clinical trials. Based on the aTZ costs per patient in this study, the cost-utility of aTZ is more favourable than previous estimates although the associated budget impact remains substantial.

No significant financial relationships to disclose.

Using the chronic care model to tackle depression among older adults who have long-term physical conditions

Effective psychological and pharmacological treatments are available, but for depressed older adults with long-term physical conditions, the outcome of routine care is generally poor. This paper introduces the chronic care model, a systemic approach to quality improvement and service redesign, which was developed by Ed Wagner and colleagues. The model highlights six key areas that need to be addressed, if depression is to be tackled more effectively in this neglected patient group: delivery system design, patient-provider relationships, decision support, clinical information systems, community resources and healthcare organization. Three influential programmes, the Improving Mood Promoting Access to Collaborative Treatment programme, the Prevention of Suicide in Primary Care Elderly Collaborative Trial, and the Program to Encourage Active, and Rewarding Lives for Seniors, have shown that when the model is adopted, significant improvements in outcomes can be achieved. The paper concludes with a case study, which illustrates the difference that adopting the chronic care model can make. Radical changes in working practices may be required, to implement the model in practice. However, Greg Simon, a leading researcher in the field of depression care, has suggested that there is already sufficient evidence to justify a shift in emphasis from research towards dissemination and implementation.

Context- but not familiarity-dependent forms of object recognition are impaired following excitotoxic hippocampal lesions in rats

Dual-process models of recognition memory in animals propose that recognition memory is supported by two independent processes that reflect the operation of distinct brain structures: a familiarity process that operates independently of the hippocampus and a context-dependent (episodic) memory process that is dependent on the hippocampus. A novel variant of an object recognition procedure was used to examine this proposal. Healthy rats showed a preference for exploring a novel object rather than a familiar object: a familiarity-dependent recognition effect. They also showed a preference for exploring a familiar object that was presented in a different spatiotemporal context rather than a familiar object that was presented either in a different spatial or temporal context: a context-dependent form of recognition that is sensitive to "what" object has been presented "where" and "when." Rats with excitotoxic hippocampal lesions showed the familiarity-dependent but not the context-dependent form of recognition. The results provide support for dual-process theories of recognition memory.

NK Cells Lyse T Regulatory Cells in Human Infection with An Intracellular Pathogen (B167)

Previously we found that regulatory T cells (CD4+CD25+Foxp3+ cells, Tregs) expand in response to M.tuberculosis (M. TB) through mechanism that depend on prostaglandin E2 production. In the current study, we determined the role of NK cells in regulating Tregs expansion in human M. TB infection. M. TB whole cell lysate (TB lysate) resulted in regulatory T cell expansion (15.33±1.02% vs 1.5±0.22%, P<0.001). Addition of monokine-activated NK cells (IL-12, IL-15 and IL-18) markedly inhibited Treg expansion (6.2±1.2% vs 15±1.5%, P<0.001) but freshly isolated NK cells had no effect. NK cells activated with TB lysate-stimulated monocytes also reduced Tregs expansion (13.2±0.3% to 3.4±1.4%, P<0.001) confirming the physiological relevance of this effect. Reduced Tregs expansion was not due to inhibition of PGE2 production or because of IFN γ. Monokine activated NK cells lysed TB lysate-expanded Tregs, but not freashly isolated Tregs (% specific lysis of 21±3% vs 1±1% P<0.001), nor T regs depleted T cells. Anti-NKG2D and anti-NKp46 reduced the % specific lysis of expanded Tregs from 22±3% to 7±3% and 8±3%, respectively (P<0.001) but abs to CD16, DNAM-1, and 2B4 had no effect. NKG2D ligand, ULBP1 expression was markedly upregulated on expanded T regs, compared to T regs depleted cells ( 31±5% vs 2.1 ±0.4%, P=0.002) and freshly isolated Tregs (4.6±1.1%). Anti -ULBP1 significantly inhibited the NK mediated lysis of expanded Tregs (specific lysis of 27±4% vs 9±2%, P<0.001) but abs to ULBP2, ULBP3 and MICA/B had no effect. These finding suggest that NK cells reduce the frequency of M.TB-expanded T regs by direct lysis.

17-Beta estradiol administration attenuates deficits in sustained and divided attention in young ovariectomized rats and aged acyclic female rats

Recent evidence suggests that estrogen may interact with the basal forebrain cholinergic system to influence learning. The authors examined whether the loss of estrogen following ovariectomy (Experiment 1) or the disruption to the estrogen cycle during aging (Experiment 2) impaired performance of the 5-choice serial reaction time task (5-CSRT)--a sustained and divided attention task sensitive to cholinergic challenges in rats. In Experiment 1, posttraining ovariectomy in young rats did not disrupt baseline performance but did impair performance when attention was challenged by variation in the intertrial interval (ITI) or in the intermittent presentation of a novel distracting auditory stimulus. Administration of 17-beta estradiol rescued these impairments. Through the use of a within-subjects design, Experiment 2 revealed that 17-beta estradiol did not influence the baseline performance of 21-month-old female rats trained on the 5-CSRT task from a young age but did improve performance when attention was challenged by varying the ITI or by presenting a distracting auditory cue. The results indicate that 17-beta estradiol administration can improve specific components of attention in young ovariectomized rats and gonadally intact aged female rats.

Maternal temperature during labour using low-dose (ambulatory) epidural analgesia with bupivacaine and fentanyl

Maternal temperature is known to increase during labour with conventional epidural analgesia mixtures. To date, the effect of newer low-dose (ambulatory) epidural concentrations on maternal temperature has not been studied. Twenty-six women in established labour received epidural analgesia with 0.1% bupivacaine and 2 microg/ml fentanyl. Tympanic membrane (core) temperature was measured every 30 min during labour. There was no significant overall rise in maternal temperature during labour with the use of an ambulatory epidural mixture. One patient exhibited an increase in temperature of 0.8 degrees C to 38 degrees C after 720 min and another of 1.1 degrees C to 38.1 degrees C after 630 min. We conclude that, whilst overall maternal temperature does not increase following low-dose epidural analgesia, individual increases may still occur after 10 h.

The new materials processing beamline at the SRS Daresbury, MPW6.2

A new beamline (MPW6.2) has been designed and built for the study of materials during processing where three synchrotron techniques, SAXS, WAXS and XAS, are available simultaneously. It has been demonstrated that Rietveld refinable data can be collected from silicon SRM 640b over a 60 degrees range in a time scale of 1 s. The data have been refined to a chi(2) of 2.4, the peaks fitting best to a Pearson VII function or with fundamental parameters. The peak halfwidths have been found to be approximately constant at 0.06 degrees over a 120 degrees angular range indicating that the instrumental resolution function has matched its design specification. A quantitative comparison of data sets collected on the same isotactic polypropylene system on MPW6.2 and DUBBLE at the ESRF shows a 17% improvement in angular resolution and a 1.8 improvement in peak-to-background ratio with the RAPID2 system; the ESRF data vary more smoothly across detector channels. The time-dependent wide-angle XRD was tested by comparing a hydration reaction of gypsum-bassanite-anhydrite with energy-dispersive data collected on the same system on the same time scale. Three sample data sets from the reaction were selected for analysis and gave an average chi(2) of 3.8. The Rietveld-refined lattice parameters are a good match with published values and the corresponding errors show a mean value of 3.3 x 10(-4). The data have also been analysed by the Pawley decomposition phase-modelling technique demonstrating the ability of the station to quickly and accurately identify new phases. The combined SAXS/WAXS capability of the station was tested with the crystallization and spinodal decomposition of a very dilute polymer system. Our measurements show that the crystallization of a high-density co-polymer (E76B38) as low as 0.5% by weight can be observed in solution in hexane. The WAXS and SAXS data sets were collected on the same time scale. The SAXS detector was calibrated using a collagen sample that gave 30 orders of diffraction in 1 s of data collection. The combined XRD and XAS measurement capability of the station was tested by observing the collapse and re-crystallization of zinc-exchanged zeolite A (zeolite Zn/Na-A). Previous studies of this material on station 9.3 at the SRS were compared with those from the new station. A time improvement of 38 was observed with better quality counting statistics. The improved angular resolution from the WAXS detector enabled new peaks to be identified.

Practice parameter: neuroimaging of the neonate: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society

OBJECTIVE

The authors reviewed available evidence on neonatal neuroimaging strategies for evaluating both very low birth weight preterm infants and encephalopathic term neonates.

IMAGING FOR THE PRETERM NEONATE

Routine screening cranial ultrasonography (US) should be performed on all infants of <30 weeks' gestation once between 7 and 14 days of age and should be optimally repeated between 36 and 40 weeks' postmenstrual age. This strategy detects lesions such as intraventricular hemorrhage, which influences clinical care, and those such as periventricular leukomalacia and low-pressure ventriculomegaly, which provide information about long-term neurodevelopmental outcome. There is insufficient evidence for routine MRI of all very low birth weight preterm infants with abnormal results of cranial US.

IMAGING FOR THE TERM INFANT

Noncontrast CT should be performed to detect hemorrhagic lesions in the encephalopathic term infant with a history of birth trauma, low hematocrit, or coagulopathy. If CT findings are inconclusive, MRI should be performed between days 2 and 8 to assess the location and extent of injury. The pattern of injury identified with conventional MRI may provide diagnostic and prognostic information for term infants with evidence of encephalopathy. In particular, basal ganglia and thalamic lesions detected by conventional MRI are associated with poor neurodevelopmental outcome. Diffusion-weighted imaging may allow earlier detection of these cerebral injuries.

RECOMMENDATIONS

US plays an established role in the management of preterm neonates of <30 weeks' gestation. US also provides valuable prognostic information when the infant reaches 40 weeks' postmenstrual age. For encephalopathic term infants, early CT should be used to exclude hemorrhage; MRI should be performed later in the first postnatal week to establish the pattern of injury and predict neurologic outcome.

Recreational injury and its relation to socioeconomic status among school aged children in the US

OBJECTIVES

This study described epidemiologic patterns of recreational injuries among school aged children in the US and assessed the relation of these patterns to socioeconomic status.

METHODS

Combined data from the 1997-98 National Health Interview Surveys for 38 458 children aged 6-17 years regarding non-fatal recreational injury episodes that received medical attention, reported by a household adult, were analysed. Logistic regression analysis was used to assess the association between recreational injury and socioeconomic status while controlling for confounding factors.

RESULTS

The annualized rate of recreational injury was 91.2 episodes per 1,000 children, with an increased risk associated with a higher family income status or being non-Hispanic white. For children from not poor families, most injury episodes occurred in sport facilities, whereas for children from poor and near poor families, most occurred outside the home.

CONCLUSION

Recreational injury is a significant health problem for school aged children in the US. Non-Hispanic white children and children from affluent families are at increased risk of recreational injury.

Psychostimulants for hypersomnia (excessive daytime sleepiness) in myotonic dystrophy

BACKGROUND

Excessive daytime sleepiness is a common symptom of myotonic dystrophy. Psychostimulants are drugs increasingly used to treat hypersomnia in myotonic dystrophy.

OBJECTIVES

To search systematically for, and combine all evidence from, randomised trials relating to the effects of psychostimulants in myotonic dystrophy patients with hypersomnia.

SEARCH STRATEGY

We searched the Cochrane Neuromuscular Disease Trial Register (searched May 2001) for randomised trials concerning psychostimulants in myotonic dystrophy, we searched of the bibliographies of identified papers and we contacted the authors of the papers.

SELECTION CRITERIA

We considered all randomised or quasi randomised trials that have evaluated any type of psychostimulants (versus a placebo or no treatment) in children or adults with proven myotonic dystrophy and hypersomnia.

DATA COLLECTION AND ANALYSIS

Potentially relevant papers were scrutinised by two reviewers and the selection of eligible studies was agreed by them and a third reviewer. Data were extracted by one reviewer and checked by a second reviewer.

MAIN RESULTS

Primary outcome We found no trial that assessed the effect of a psychostimulant on the results of the maintenance of wakefulness tests. Secondary outcomes Only one eligible trial was found. In this crossover double blind study of 10 patients with myotonic dystrophy, the efficacy of selegiline was evaluated against a placebo on the multiple sleep latency test. There was no difference between the selegiline and placebo periods in mean improvement in the multiple sleep latency test scale.

REVIEWER'S CONCLUSIONS

There is no evidence to support the use of a psychostimulant to treat hypersomnia in myotonic dystrophy. Randomised trials are needed to evaluate the efficacy and safety of psychostimulants.

Regulating safety in an unsafe world (risk reduction for and with communities)

Safety regulators and the public they serve often have contrasting views on risk perception and the veracity of institutional estimates of risk and harm. Conflict and distrust between these groups is often a result of a lack of public involvement in decision making on safety related matters. Such concerns also emerge from differences in professional training, authority and experience between the groups. Fire services internationally, carryout fire safety assessments on behalf of communities. This assessment role is unusual in that unlike conventional approaches to regulatory safety assessment, fire fighters are direct end-users of their own regulatory assessment and closer to the people they protect. This paper discusses how fire services are beginning to seek closer links with communities by defining clear regulatory frameworks for conventional safety assessments and conceptual frameworks that allow a redefinition of their role towards establishing partnerships with communities to promote sustained safety.

Evaluation and management of children younger than two years old with apparently minor head trauma: proposed guidelines

OBJECTIVE

In children <2 years old, minor head trauma (HT) is a common injury that can result in skull fracture and intracranial injury (ICI). These injuries can be difficult to detect in this age group; therefore, many authors recommend a low threshold for radiographic imaging. Currently, no clear guidelines exist regarding the evaluation and management of head-injured infants. We sought to develop guidelines for management based on data and expert opinion that would enable clinicians to identify children with complications of HT and reduce unnecessary imaging procedures. METHODS.

EVIDENCE

References addressing pediatric HT were generated from a computerized database (Medline). The articles were reviewed and evidence tables were compiled. EXPERT PANEL: The multidisciplinary panel was comprised of nine experts in pediatric HT.

CONSENSUS PROCESS

A modified Delphi technique was used to develop the guidelines. Before the one meeting, panel members reviewed the evidence and formulated answers to specific clinical questions regarding HT in young children. At the meeting, guidelines were formulated based on data and expert consensus.

RESULTS

A management strategy was developed that categorizes children into 4 subgroups, based on risk of ICI. Children in the high-risk group should undergo a computed tomography (CT) scan. Those in the intermediate risk group with symptoms of possible ICI should either undergo CT scan or observation. Those in the intermediate risk group with some risk for skull fracture or ICI should undergo CT and/or skull radiographs or observation. Those in the low-risk group require no radiographic imaging.

CONCLUSIONS

We have developed a guideline for the evaluation of children <2 years old with minor HT. The effect of these guidelines on clinical outcomes and resource utilization should be evaluated.

Effect of chronic excess of tumour necrosis factor-alpha on contractile proteins in rat skeletal muscle

The effect of chronic tumour necrosis factor-alpha (TNF-alpha) treatment on the synthesis of specific myofibrillar proteins such as heavy chain myosin, light chain myosin and G-actin in rat diaphragm were evaluated. Muscles (diaphragm) from control and experimental groups (TNF-alpha i.v. at 50 microg/kg body wt for 5 days) were incubated in the presence of 35S-methionine for 2 h. Myofibrillar protein extracts were prepared and protein was electrophoresed on sodium dodecyl sulphate-polyacrylamide gels. Heavy chain myosin, light chain myosin and G-actin were identified by Western blot analysis using specific monoclonal antibodies. Polyacrylamide gel electrophoresis (PAGE) followed by Western blot analysis revealed two types of heavy chain myosin (206 and 212 kD), all four types of light chain myosin (15, 16.5, 18 and 20 kD) and a single type of G-actin (42 kD). Chronic TNF-alpha treatment produced a significant decline in the synthesis of all types of myofibrillar proteins, namely heavy chain myosin, light chain myosin and G-actin. TNF-alpha impaired peptide-chain initiation in diaphragm muscle which was reversed by the branched-chain amino acids (BCAA) therapy of TNF-alpha treated rats. These findings indicate a significant role for TNF-alpha in the translational regulation of protein synthesis in skeletal muscle.