Charge distribution studies in the epi-cadmium neutron induced fission of 238Pu

Studies on charge distribution have been carried out in the epi-cadmium neutron induced fission of 238Pu for the first time. Experimentally fractional cumulative yields (FCY) and independent yields (IY) of various fission products have been measured by using an off-line γ-ray spectrometric technique. From the FCY values, the charge distribution parameters such as the isobaric width parameter (σZ), most probable charge (ZP) and the charge polarization (ΔΖEXPT) as a function of fragment mass were obtained. On the other hand, from the measured IY values, isotopic width parameter (σA), the most probable mass (AP) and the elemental yields (YZ) of Sn, Sb, Te, I, Xe, Cs, Ba, La, Ce and Pr were determined by using a non-linear fit. From the YZ values, the proton even-odd effect (δp) was obtained for the first time. The isobaric and isotopic charge distribution parameters in the 238Pu(nf, f) reaction were compared with the similar data in the thermal neutron induced fission of 238Pu and other actinides to examine the role of excitation energy.

Independent isomeric yield ratios of fission products in the epi-cadmium neutron induced fission of 233U

The independent isomeric yield ratios (IR) of 128,130,132Sb, 131,133Te, 132,134,136I, 135Xe and 138Cs have been measured in the epi-cadmium neutron induced fission of 233U by using an off-line gamma-ray spectrometric technique. The average neutron energy of the epi-cadmium reactor neutron spectrum is 1.9 MeV. The root mean square fragment angular momenta (JRMS) were deduced from the IR values by using spin dependent statistical model analysis. The IR and JRMS values of considered fission products in the epi-cadmium neutron induced fission of 233U were compared with the literature data in the thermal neutron induced fission of 233U to examine the influence of excitation energy on nuclear structure effect.

Clinical uncertainty in large vessel occlusion ischemic stroke: does automated perfusion imaging make a difference? An intra-rater and inter-rater agreement study

BACKGROUND

Limited research exists regarding the impact of neuroimaging on endovascular thrombectomy (EVT) decisions for late-window cases of large vessel occlusion (LVO) stroke.

OBJECTIVE

T0 assess whether perfusion CT imaging: (1) alters the proportion of recommendations for EVT, and (2) enhances the reliability of EVT decision-making compared with non-contrast CT and CT angiography.

METHODS

We conducted a survey using 30 patients drawn from an institutional database of 3144 acute stroke cases. These were presented to 29 Canadian physicians with and without perfusion imaging. We used non-overlapping 95% confidence intervals and difference in agreement classification as criteria to suggest a difference between the Gwet AC1 statistics (κG).

RESULTS

The percentage of EVT recommendations differed by 1.1% with or without perfusion imaging. Individual decisions changed in 21.4% of cases (11.3% against EVT and 10.1% in favor). Inter-rater agreement (κG) among the 29 raters was similar between non-perfusion and perfusion CT neuroimaging (κG=0.487; 95% CI 0.327 to 0.647 and κG=0.552; 95% CI 0.430 to 0.675). The 95% CIs overlapped with moderate agreement in both. Intra-rater agreement exhibited overlapping 95% CIs for all 28 raters. κG was either substantial or excellent (0.81-1) for 71.4% (20/28) of raters in both groups.

CONCLUSIONS

Despite the minimal difference in overall EVT recommendations with either neuroimaging protocol one in five decisions changed with perfusion imaging. Regarding agreement we found that the use of automated CT perfusion images does not significantly impact the reliability of EVT decisions for patients with late-window LVO.

Physician Approaches to Antithrombotic Therapies for Recently Symptomatic Carotid Stenosis

BACKGROUND

Whereas the beneficial effect of antiplatelet therapy for recurrent stroke prevention has been well established, uncertainties remain regarding the optimal antithrombotic regimen for recently symptomatic carotid stenosis. We sought to explore the approaches of stroke physicians to antithrombotic management of patients with symptomatic carotid stenosis.

METHODS

We employed a qualitative descriptive methodology to explore the decision-making approaches and opinions of physicians regarding antithrombotic regimens for symptomatic carotid stenosis. We conducted semi-structured interviews with a purposive sample of 22 stroke physicians (11 neurologists, 3 geriatricians, 5 interventional-neuroradiologists, and 3 neurosurgeons) from 16 centers on four continents to discuss symptomatic carotid stenosis management. We then conducted thematic analysis on the transcripts.

RESULTS

Important themes revealed from our analysis included limitations of existing clinical trial evidence, competing surgeon versus neurologist/internist preferences, and the choice of antiplatelet therapy while awaiting revascularization. There was a greater concern for adverse events while using multiple antiplatelet agents (e.g., dual-antiplatelet therapy (DAPT)) in patients undergoing carotid endarterectomy compared to carotid artery stenting. Regional variations included more frequent use of single antiplatelet agents among European participants. Areas of uncertainty included antithrombotic management if already on an antiplatelet agent, implications of nonstenotic features of carotid disease, the role of newer antiplatelet agents or anticoagulants, platelet aggregation testing, and timing of DAPT.

CONCLUSION

Our qualitative findings can help physicians critically examine the rationale underlying their own antithrombotic approaches to symptomatic carotid stenosis. Future clinical trials may wish to accommodate identified variations in practice patterns and areas of uncertainty to better inform clinical practice.

Effectiveness of self-administered mirror therapy on upper extremity impairments and function of acute stroke patients: study protocol

Background

Many therapeutic interventions are performed by physiotherapists to improve upper extremity function and/or activities of daily living (ADL) in stroke patients. Mirror therapy (MT) is a simple technique that can be self-administered by the patients with intact cognition following patient education by a skilled physiotherapist. However, the effectiveness of self-administered MT in post-stroke patients in upper extremity function remains unclear. Therefore, the objective of this study is to examine the effectiveness of MT in improving upper extremity function and recovery in acute stroke patients.

Methods

This study is a single-center, prospective, randomized, open-label, controlled trial with blinded outcome evaluation (PROBE design), in which a total of 36 eligible acute stroke patients will be randomly assigned to control (n=18) and experimental group (n=18). Participants in the control group will receive regular rehabilitation interventions whereas participants in the experimental group will receive MT education in addition to their regular interventions for 4 weeks.

Study outcome

The primary outcome measure will be upper extremity function that will be measured using the Fugl-Meyer Assessment scale and the Wolf Motor Function Test. The secondary outcome measure will be behaviors related to ADL as estimated using the Modified Barthel Index. Outcome measures will be assessed at baseline and at 4 weeks post-rehabilitation intervention/MT.

Results

A two-way repeated analysis of variance (ANOVA) with time and group effects will be used to analyze between-group differences. The level of significance will be set at P < 0.05.

Conclusion

The results of the study will provide critical information to include self-administered MT as an adjuvant to regular interventions and may facilitate recovery of the upper extremity function of stroke patients.

Trial registration

ClinicalTrials.gov NCT04542772. Registered on 9 September 2020. Protocol version: Final 1.0.

Equipoise in Management of Patients With Acute Symptomatic Carotid Stenosis (Hot Carotid)

Objective

To explore differences in antithrombotic management of patients with acutely symptomatic carotid stenosis ("hot carotid") awaiting revascularization with endarterectomy or stenting (CEA/CAS).

Methods

We used a worldwide electronic survey with practice-related questions and clinical questions about 3 representative scenarios. Respondents chose their preferred antithrombotic regimen (1) in general, (2) if the patient was already on aspirin, or (3) had associated intraluminal thrombus (ILT) and identified clinical/imaging factors that increased or decreased their enthusiasm for additional antithrombotic agents. Responses among different groups were compared using multivariable logistic regression.

Results

We received 668 responses from 71 countries. The majority favored CT angiography (70.2%) to evaluate carotid stenosis, CEA (69.1%) over CAS, an aspirin-containing regimen (88.5%), and a clopidogrel-containing regimen (64.4%) if already on aspirin. Whereas diverse antithrombotic regimens were chosen, monotherapy was favored by 54.4%-70.6% of respondents across 3 scenarios. The preferred dual therapy was low-dose aspirin (75-100 mg) plus clopidogrel (22.2%) or high-dose aspirin (160-325 mg) plus clopidogrel if already on aspirin (12.2%). Respondents favoring CAS more often chose ≥2 agents (adjusted odds ratio [aOR] vs CEA: 2.00, 95% confidence interval 1.36-2.95, p = 0.001) or clopidogrel-containing regimens (aOR: 1.77, 1.16-2.70, p = 0.008). Regional differences included respondents from Europe less commonly choosing multiple agents if already on aspirin (aOR vs United States/Canada: 0.57, 0.35-0.93, p = 0.023), those from Asia more often favoring multiple agents (aOR: 1.95, 1.11-3.43, p = 0.020), vs those from the United States/Canada preferentially choosing heparin-containing regimens with ILT (aOR vs rest: 3.35, 2.23-5.03, p < 0.001). Factors increasing enthusiasm for ≥2 antithrombotics included multiple TIAs (57.2%), ILT (58.5%), and ulcerated plaque (57.4%); 56.3% identified MRI microbleeds as decreasing enthusiasm.

Conclusions

Our results highlight the heterogeneous management and community equipoise surrounding optimal antithrombotic regimens for hot carotids.

Intraluminal Thrombi in the Cervico-Cephalic Arteries

Background and Purpose- Intraluminal thrombus (ILT) is an uncommon finding among patients with ischemic stroke. We report clinical-imaging manifestations, treatment offered, and outcome among patients with ischemic stroke/transient ischemic attack and ILT in their cervico-cephalic arteries. Methods- Sixty-one of 3750 consecutive patients with acute ischemic stroke/transient ischemic attack (within 24 hours of onset) and ILT on initial arch-to-vertex computed tomography angiography from April 2015 through September 2017 constituted the prospective study cohort. Functional outcome was assessed using the modified Rankin Scale score with functional independence at discharge defined as modified Rankin Scale score ≤2. Results- Prevalence of ILT on computed tomography angiography was 1.6% (95% CI, 1.2%-2.1%). Median age was 67 years (interquartile range, 56-73), and 40 subjects (65%) were male. The initial clinical presentation included transient ischemic attack in 12 (20%) and stroke in 49 patients (80%); most strokes (76%) were mild (National Institutes of Health Stroke Scale ≤5). The most common ILT location was cervical carotid or vertebral artery (n=48 [79%]) followed by intracranial (n=11 [18%]) and tandem lesions (n=2 [3%]). The most common initial treatment strategy was combination antithrombotics (heparin with single antiplatelet agent) among 57 patients (93%). Follow-up computed tomography angiography (n=59), after a median 6 days (interquartile range 4-10 days), revealed thrombus resolution in 44 patients (75% [completely in 27%]). Twenty four of 30 patients (80%) with >50% residual carotid stenosis underwent carotid revascularization (endarterectomy in 15 and stenting in 9 patients) without peri-procedural complications a median of 9 days after symptom onset. In-hospital stroke recurrence occurred in 4 patients (6.6%). Functional independence was achieved in 46 patients (75%) at discharge. Conclusions- Patients presenting with acute stroke/transient ischemic attack with ILT on baseline imaging have a favorable clinical course in hospital with low stroke recurrence, high rate of thrombus resolution, and good functional outcome when treated with combination antithrombotic therapy.

Abstract WP84: Hemispheric White Matter Sparing and Neurological Outcome After Recanalization Treatment in ESCAPE Trial

Background: Ischemic tolerance differs between white matter (WM) and grey matter. Timely reperfusion may result in preferential sparing of WM. We investigated if the degree of WM sparing after recanalization therapy has an impact on early neurological recovery and functional outcomes.

Methods: Patients from ESCAPE trial were included if they had follow-up MRI brain. WM involvement was scored on a semiquantitative scale which divides hemispheric WM into twelve regions (Figure), adding one point for each area involved. Using receiver operating characteristics analysis and Youden J, optimum cutoff value of WM score for favorable outcome (90-day mRS≤2) was calculated and then used to classify patients into WM spared vs involved groups. Early neurological recovery was compared using difference in median 24-h NIHSS. Multivariable logistic regression was used to test the association between the WM score and outcome.

Results: Among 108 patients, median WM score was 2 (IQR 1-4) in EVT (endovascular thrombectomy) arm (n= 70) and 3 (IQR 1-6) in control arm (n= 38). The threshold of ≤2 (WM spared) had sensitivity 69.1 and specificity of 69.8% for favorable outcome (AUC 0.74; 95% CI, 0.65 to 0.82; P<0.001). WM sparing was independently associated with favorable outcome after adjusting for age, baseline NIHSS, EVT use, cortical involvement, infarct volume and symptomatic hemorrhage (adjusted OR 5.34; 95% CI, 1.62-17.9, P=0.006). These patients had better neurological recovery (median 24-h NIHSS 4 in WMspared vs 11 in WMinvolved group; P <0.001) and lower infarct volumes (8 ml vs 47 ml; P <0.001). Patient with WMspared also had numerically lower incidence of malignant brain edema (0 vs 5.6%; P=0.24), intracerebral hemorrhage (symptomatic 0 vs 7.4%; P=0.12), and mortality (3.7 vs 11.1%; P=0.27) than WM involved group.

Conclusion: White matter sparing was an independent predictor of early neurological recovery, and functional outcomes in the ESCAPE trial.

Abstract WP449: Distribution of Cerebellar Microbleeds and Their Correlation with Underlying Microangiopathy in Patients with Spontaneous Supratentorial Intracerebral Hemorrhage

Background: Cerebral amyloid angiopathy (CAA) and hypertensive cerebral small vessel disease (HTN-cSVD) exhibit distinct distributions of intracerebral hemorrhages (ICHs) and microbleeds (MBs), but little is known about cerebellar hemorrhage patterns and how they relate to the underlying microangiopathy. The Boston criteria for CAA do not discriminate between lobar and deep cerebellar hemorrhages. We investigated if distinct topographical patterns of MBs exists in the cerebellum.

Methods: Patients with spontaneous symptomatic supratentorial ICH were included if they had brain MRI with gradient echo T2*-weighted sequence. Cerebellar MBs were classified into lobar or superficial (cortical/corticosubcortical), deep (dentate/peridentate) and mixed patterns. We compared the frequency and distribution of cerebellar MBs between lobar and deep/mixed ICH and correlated with supratentorial MBs (dichotomized into lobar and deep/mixed MBs).

Results: 130 patients were included (median age 68.6-years [IQR 57.9-79.0]; 50% male); 87 patients (67%) had lobar ICH (possible CAA, n=26; probable CAA, n=37; nonCAA, n=24) and 43 (33%) had deep/mixed ICH. Cerebellar MBs were seen in 26 patients (20.0%); lobar pattern among 16 patients (61.5%), deep in 4 (15.4%), and mixed pattern in 6 patients (23.1%). Lobar ICH patients often had superficial cerebellar MBs (81.3% vs deep/mixed in 18.8%) while deep/mixed ICH patients more often demonstrated deep/mixed cerebellar MBs (66.7% vs superficial in 23.5%) [ P =0.046]. The distribution of supratentorial MBs correlated with the distribution of cerebellar MBs ( P= 0.047). Two patients with possible CAA had MBs confined to superficial cerebellum and incorporation of cerebellar MBs into the Boston criteria would have resulted in their reclassification into probable CAA, while another two probable CAA had deep/mixed cerebellar MBs reclassifying them into nonCAA ICH.

Conclusion: Distinct superficial and deep cerebellar MB patterns can be distinguished which segregate with lobar and deep/mixed ICH locations, suggesting differential cerebellar involvement by CAA and HTN-cSVD. If validated, lobar (superficial) cerebellar MBs might be used to further improve the accuracy of the Boston criteria for CAA.

Abstract TP171: Eloquence of White Matter Tracts in Acute Ischemic Stroke Patients

Background: Clinical assessment scores after acute ischemic stroke are only moderately correlated with structural brain damage since lesion location is also an important confounding factor. Many studies have investigated gray matter eloquence but, general understanding about the importance of specific white matter (WM) tract involvement is limited. The aim of this study was to investigate the eloquence of major WM tracts with respect to 24 hours post-stroke NIHSS.

Methods: Lesions in follow-up FLAIR MRI datasets acquired 1-7 days after acute stroke onset due to proximal MCA or ICA occlusion were manually segmented and non-linearly registered to a common atlas. Voxel-based lesion-symptom mapping (VLSM) using sparse canonical correlation analysis was used to generate a statistical eloquence map with normalized t-scores ranging from 0 to 1 with the 24h NIHSS as outcome score. The JHU probabilistic WM atlas was used to quantify the individual tract eloquence.

Results: 96 patients were included in this study (50 females, mean age 66.4±14.0 years, median NIHSS 5, IQR 2-9.5). Multivariate VLSM resulted in a major left-hemispheric and smaller right-hemispheric cluster of significant voxels overlapping with four WM tracts. The left corticospinal tract (motor function) showed an overlap of 3.52% (maximum t-score: 0.31; mean: 0.17±0.05), the right corticospinal tract an overlap of 7.33% (maximum t-score: 0.54; mean: 0.26±0.01), the left anterior thalamic radiation (sensory and motor relay) an overlap of 5.89% (maximum t-score: 0.44, mean: 0.18±0.07), and the inferior fronto-occipital fasciculus (auditory and visual association) an overlap of 21.31% (maximum t-score: 0.34, mean: 0.21±0.06).

Conclusions: The significantly affected WM tracts identified are related to motor and cognition function, predominantly assessed by NIHSS, highlighting the importance of white matter tract involvement for recovery and rehabilitation.

Long-term neurological, vascular, and mortality outcomes after stroke

Background

Despite improved survival and short-term (90-day) outcomes of ischemic stroke patients, only sparse data exist describing the sustained benefits of acute stroke care interventions and long-term prognosis of stroke survivors.

Aim

We review the contemporary literature assessing long-term (5 years or more) outcomes after stroke and acute stroke treatment.

Summary of review

Acute stroke unit care and intravenous thrombolysis have sustained benefits over longer follow-up, but few data exist on the long-term outcome after endovascular thrombectomy (EVT). A large proportion of stroke survivors face challenges of residual disability and neuropsychiatric sequelae (especially affective disorders and epilepsy) which affects their quality of life and is associated with poorer prognosis due to increase in stroke recurrences/mortality. Nearly, a quarter of stroke survivors have a recurrent stroke at 5 years, and nearly double that at 10 years. Mortality after recurrent stroke is high, and half of the stroke survivors are deceased at 5 years after stroke and three fourth at 10 years. Long-term all-cause mortality is largely due to conditions other than stroke. Both stroke recurrence and long-term mortality are affected by several modifiable risk factors, and thus amenable to secondary prevention strategies.

Conclusions

There is a need for studies reporting longer term effects of acute interventions, especially EVT. Better preventive strategies are warranted to reduce the vascular and non-vascular mortality long after stroke.

Improving care for acute in-hospital ischemic strokes—A narrative review

In-hospital strokes, that is new strokes occurring among hospitalized patients, account for 6.5–15% of all strokes. Compared to community-onset stroke patients, in-hospital stroke patients tend to have worse functional and mortality outcomes. This review addresses the characteristics of acute in-hospital ischemic strokes, reasons these patients have worse outcomes compared to community-onset stroke patients, and future steps to improve outcomes.

Tuberculosis-tobacco integration in the South-East Asia Region: policy analysis and implementation framework

SETTING

Despite overwhelming evidence for the association between tuberculosis (TB) and tobacco use, it remains neglected in the context of policy, planning and practice. There is limited evidence about the extent of integration of TB and tobacco control programmes in South-East Asia Region (SEAR) countries.

OBJECTIVE

To assess the level of TB-tobacco integration in 11 SEAR countries.

DESIGN

Cross-sectional study using a structured questionnaire addressed to TB and tobacco focal points at the World Health Organization Country Offices.

RESULTS

Apart from India, no country in the SEAR has a formal coordination mechanism for national TB and tobacco control programmes or a system of referral for tobacco users among TB patients for treatment of tobacco dependence. There is no joint planning, joint training or joint supervision and monitoring in any country.

CONCLUSION

There is poor integration between TB and tobacco control programmes in most SEAR countries. This assessment fed into the development of a regional framework for TB-tobacco integration, which outlines three strategies: 1) integrated patient-centred care and prevention; 2) joint TB tobacco actions covering policy development, planning, training and monitoring; and 3) research and innovation. Every country in the region should adopt the TB-tobacco integration framework to improve programme performance.

Headache in cerebral venous sinus thrombosis revisited: Exploring the role of vascular congestion and cortical vein thrombosis

Background and purpose

Headache constitutes the most common symptom of cerebral venous sinus thrombosis (CVST), but its pathophysiology is unclear. We sought to investigate the potential mechanism for headache genesis in patients with CVST based on its imaging correlates.

Methods

A subgroup of CVST patients having headache as the predominant symptom without significant parenchymal lesion were retrospectively analysed for imaging features of vascular congestion (VC), in addition to cortical venous (CVT) and dural sinus thrombosis (DST) on magnetic resonance imaging. Headache and imaging patterns were classified into lateralized and nonlateralized phenotypes and their correlation was sought.

Results

Among 41 patients included, 28 had lateralized headache (LH group; 15 males; mean age 32.25 ± 9.19 years) while 13 had nonlateralized headache (non-LH group; six males; mean age 27.15 ± 8.65 years). Headache characteristics in both the groups were quite similar. Imaging showed VC in 39 of 41 and CVT among 35 of 41 patients, which were lateralized in 23 of 39 and 18 of 35 patients, respectively. Nearly all lateralized imaging patterns (21 of 23 for VC and 17 of 18 for CVT) occurred in the LH group and ipsilateral to (concordant) headache, while the non-LH group showed lateralized VC and CVT in only two and one patient respectively. Sinus thrombosis was lateralized in both groups irrespective of headache laterality. Whole cohort headache-imaging laterality (including patients with nonlateralized headache and nonlateralized imaging) concordance was 31 of 39, 24 of 35 and 18 of 41 for vascular congestion, cortical vein thrombosis and dural sinus thrombosis respectively.

Conclusion

Co-localization of VC and CVT with overlying headache might provide a possible explanation of headache and its laterality in patients with CVST.

Clinical and biochemical phenotypes of adults with monoallelic and biallelic CYP24A1 mutations: evidence of gene dose effect

Mutations of the CYP24A1 gene can result in hypercalcemia, hyerpercalciuria, and nephrolithiasis, but disease severity is variable. Clinical and biochemical phenotypes were correlated with gene sequence information in a family with two CYP24A1 mutations. A gene dose effect was apparent with monoallelic mutations demonstrating milder disease manifestations than biallelic mutations.

INTRODUCTION

The objective was to examine the spectrum of clinical and biochemical phenotypes in a family with monoallelic and biallelic mutations of CYP24A1 after identification of the proband with two mutations of the CYP24A1 gene: (A) p.R396W and (B) E143del-Het.

METHODS

Clinical and biochemical phenotypes were correlated with CYP24A1 sequence information in the proband and four siblings, a daughter, and two nieces of the proband. The subjects' medical histories were evaluated, and measurement of serum minerals, vitamin D metabolites, PTH, bone turnover markers, and urinary calcium and sequencing of the CYP24A1 gene were performed.

RESULTS

The proband had nephrolithiasis, osteopenia, hypercalcemia, hypercalciuria, elevated serum 1,25(OH)2D, undetectable 24,25(OH)2D, and inappropriately low PTH concentrations. Two subjects with biallelic (A/B) mutations had nephrolithiasis, marked hypercalciuria (583 ± 127 mg/24 h, mean ± SD), compared with five subjects with monoallelic mutations (A or B) with a urine calcium of 265 ± 85 mg/24 h. Two subjects with monoallelic mutations had nephrolithiasis and one had non-PTH dependent hypercalcemia. Five subjects had high 1,25(OH)2D measurements, including three with monoallelic mutations. The 25OHD/24,25(OH)2D ratio, in subjects with biallelic mutations was 291 versus 19.8 in the subjects with monoallelic mutations.

CONCLUSIONS

In this family, adults with CYP24A1 mutations a gene dose effect is apparent: subjects with biallelic, compound heterozygous mutations (A/B) have a more severe clinical and biochemical phenotype, whereas, subjects with monoallelic mutations demonstrate milder disease manifestations which are not easily characterized through biochemical assessment.

Impact of modular training on tobacco control on the knowledge of health workers in two jurisdictions of northern India

BACKGROUND

National Tobacco Control Programme was launched in India in year 2007-08. It was realized that community health workers can play an important role of agents for positive change to bring down the tobacco morbidity and mortality in the country. Keeping this in view, a health worker guide was developed by the Government of India, Ministry of Health and Family Welfare (GOI) in collaboration with The Union South-East Asia (The Union) in the year 2010. The guide provides the information needed by the most basic level of health workers to effectively address the problem of tobacco use in the community. A modular training was conducted in two jurisdictions in India (namely, Chandigarh and Hamirpur (Himachal Pradesh)) to assess the usefulness of the guide as training material for community health workers in undertaking tobacco control activities at community and village levels.

MATERIALS AND METHODS

A total of 271 participants were trained, which included 133 from Chandigarh and 138 from Hamirpur. The pre and post-training assessment of knowledge of health worker was done.

RESULTS

There was marked increase in post-test scores as compared to the pretest scores. The health workers scoring more than 60% increased from 40% in the pretest to over 80% in the post-test. Only three workers had a post-test score of less than 30% against 54 workers in the pretest.

CONCLUSION

The understanding on tobacco control had increased significantly after the training in each group. It is strongly recommended that such training should be replicated to all community health workers across all the states in India.

Intersubgeneric hybridization between Glycine max and G. tomentella: production of F₁, amphidiploid, BC₁, BC₂, BC₃, and fertile soybean plants

KEY MESSAGE

This paper describes methods for unlocking genetic treasure from wild perennial Glycine species of Australia for soybean improvement. The genetic resources of the ca. 26 species of the genus Glycine subgenus Glycine have not been exploited to broaden the genetic base of soybean (Glycine max; 2n = 40). The objectives of this study were to develop methods for producing F1, amphidiploid, BC1, BC2, BC3, and fertile soybean plants from crosses of soybean and the genus Glycine subgenus Glycine species, in order to utilize the subgenus Glycine germplasm in soybean breeding. Soybean cultivars were hybridized with six accessions of 78-chromosome G. tomentella as well as one accession each of 40-chromosome G. tomentella, G. argyrea and G. latifolia. They were chosen because they exhibit resistance to soybean rust. We were successful in producing fertile soybean from soybean cv. 'Dwight' and 78-chromosome G. tomentella accession PI 441001, while other hybrids were discontinued either at F1 or amphidiploid stage. The F1 seeds aborted prior to reaching maturity, so developing seeds from 19 to 21 day old pods were cultured aseptically in various media formulations. Seed maturation and multiple embryo generation media were developed. F1 plants with shoots and roots (2n = 59) were transplanted to pots in greenhouse. Amphidiploid (2n = 118) plants were backcrossed to 'Dwight'. BC1 (2n = 79) plants were propagated through in vitro and 43 mature BC2F1 seeds were harvested. Fifteen surviving BC2F1 plants were morphologically distinct, sterile, and had chromosome numbers ranging 2n = 56-59. Chromosome numbers of the BC3F1 plants ranged 2n = 40-49. Derived fertile soybeans were first planted in the field in 2008 and are being evaluated for yield, resistance to pathogens and pests and tolerance to salt through material transfer agreement.

Can vitamin D metabolite measurements facilitate a "treat-to-target" paradigm to guide vitamin D supplementation?

Substantial variability exists in the serum 25(OH)D increase observed in response to vitamin D supplementation. Measurement of circulating cholecalciferol and 24,25(OH)₂D, as indicators of vitamin D absorption and degradation, respectively, account for approximately half of the variation in serum 25(OH)D observed following supplementation.

INTRODUCTION

Vitamin D supplementation produces a variable response in serum 25(OH)D. This variability likely reflects, in part, differences in vitamin D absorption and/or degradation. Despite this variation in response, virtually all expert recommendations endorse a fixed vitamin D supplementation dose, an approach also used in most prospective studies. Such utilization of a single vitamin D dose does not assure attaining any pre-specified target 25(OH)D level, thereby compromising clinical care and prospective supplementation trials. This study begins addressing this weakness by exploring the feasibility of vitamin D metabolite measurements to predict serum 25(OH)D level attained following supplementation.

METHODS

Ninety-one community-dwelling postmenopausal women with baseline 25(OH)D of 10-30 ng/mL received oral vitamin D₃, 2300 or 2500 IU, daily for 4-6 months. Serum 25(OH)D, cholecalciferol (D₃), and 24,25(OH)₂D were measured before and at the end of supplementation to determine if metabolite concentrations allow prediction of the 25(OH)D level attained.

RESULTS

From baseline and follow-up data, we derived a multiple linear regression model predicting posttreatment 25(OH)D as follows: final 25(OH)D = 8.3 + (1.05*initial 25(OH)D) - (7.7*initial 24,25(OH)₂D) + (0.53*final D₃) + (4.2*final 24,25(OH)₂D). This model has an adjusted R(2) = 0.55, thus accounting for approximately half of the observed variance in the final 25(OH)D level.

CONCLUSIONS

The contributions of circulating cholecalciferol and 24,25(OH)₂D to this predictive model can be considered as indicators of intestinal absorption and clearance, respectively. This paradigm requires further study; it may allow efficient "treat-to-25(OH)D-target" strategies useful in optimizing prospective studies and clinical practice.

Evidence for gonadotrophin secretory and steroidogenic abnormalities in brothers of women with polycystic ovary syndrome

STUDY QUESTION

Are there abnormalities in gonadotrophin secretion, adrenal steroidogenesis and/or testicular steroidogenesis in brothers of women with polycystic ovary syndrome (PCOS)?

SUMMARY ANSWER

Brothers of women with PCOS have increased gonadotrophin responses to gonadotrophin releasing hormone (GnRH) agonist stimulation and alterations in adrenal and gonadal steroidogenesis.

WHAT IS KNOWN ALREADY

PCOS is a complex genetic disease. Male as well as female first-degree relatives have reproductive features of the syndrome. We previously reported that brothers of affected women have elevated circulating dehydroepiandrosterone sulfate levels.

STUDY DESIGN, SIZE, DURATION

This was a case-control study performed in 29 non-Hispanic white brothers of 22 women with PCOS and 18 control men.

PARTICIPANTS/MATERIALS, SETTING, METHODS

PCOS brothers and control men were of comparable age, weight and ethnicity. Adrenocorticotrophic hormone (ACTH) and GnRH agonist stimulation tests were performed. Gonadotrophin responses to GnRH agonist as well as changes in precursor-product steroid pairs (delta, Δ) across steroidogenic pathways in response to ACTH and GnRH agonist were examined.

MAIN RESULTS AND THE ROLE OF CHANCE

Basal total (T) levels did not differ, but dehydroepiandrosterone (DHEA) levels (0.13 ± 0.08 brothers versus 0.22 ± 0.09 controls, nmol/l, P = 0.03) were lower in brothers compared with control men. ACTH-stimulated Δ17-hydroxypregnenolone (17Preg)/Δ17-hydroxyprogesterone (17Prog) (7.8 ± 24.2 brothers versus 18.9 ± 21.3 controls, P = 0.04) and ΔDHEA/Δandrostenedione (AD) (0.10 ± 0.05 brothers versus 0.14 ± 0.08 controls, P = 0.04) were lower in brothers than in the controls. GnRH agonist-stimulated Δ17Prog/ΔAD (0.28 ± 8.47 brothers versus 4.79 ± 10.28 controls, P = 0.003) was decreased and luteinizing hormone (38.6 ± 20.6 brothers versus 26.0 ± 9.8 controls, IU/l, P = 0.02), follicle-stimulating hormone (10.2 ± 7.5 brothers versus 4.8 ± 4.1 controls, IU/l P = 0.002), AD (1.7 ± 1.4 brothers versus 0.9 ± 1.5 controls, nmol/l, P = 0.02) and ΔAD/ΔT (0.16 ± 0.14 brothers versus 0.08 ± 0.12 controls, P = 0.005) responses were increased in brothers compared with controls.

LIMITATIONS, REASONS FOR CAUTION

The modest sample size may have limited our ability to observe other possible differences in steroidogenesis between PCOS brothers and control men.

WIDER IMPLICATIONS OF THE FINDINGS

Decreased ACTH-stimulated Δ17Preg/Δ17Prog and ΔDHEA/ΔAD responses suggested increased adrenal 3β-hydroxysteroid dehydrogenase activity in the brothers. Decreased Δ17Prog/ΔAD and increased ΔAD/ΔT responses to GnRH agonist stimulation suggested increased gonadal 17,20-lyase and decreased gonadal 17β-hydroxysteroid dehydrogenase activity in the brothers. Increased LH and FSH responses to GnRH agonist stimulation suggested neuroendocrine alterations in the regulation of gonadotrophin secretion similar to those in their proband sisters. These changes in PCOS brothers may reflect the impact of PCOS susceptibility genes and/or programming effects of the intrauterine environment.

STUDY FUNDING/COMPETING INTERESTS

This research was supported by P50 HD044405 (A.D.), K12 HD055884 (L.C.T.), U54 HD034449 (A.D., R.S.L.) from the National Institute of Child Health and Development. Some hormone assays were performed at the University of Virginia Center for Research in Reproduction Ligand Assay and Analysis Core that is supported by U54 HD28934 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Partial support for some of the clinical studies was provided by UL1 RR025741 and UL1 TR000150 (Northwestern University Clinical and Translational Sciences Institute) from the National Center for Research Resources, National Institutes of Health, which is now the National Center for Advancing Translational Sciences. The authors have no conflict of interest to declare.

Pharmacokinetics of daily versus monthly vitamin D3 supplementation in non-lactating women

This study compared serum cholecalciferol and 25-hydroxyvitamin D (25(OH)D) concentrations over four weeks in healthy, non-pregnant, non-lactating females aged 18-40 years, who were randomized to oral cholecalciferol 5000 international units (IU) daily for 28 days or a single dose of 150 000 IU. The study was conducted in Rochester, MN in March and April of 2010. We found no difference in mean 25(OH)D between treatment groups on study day 0 or day 28 (P=0.14 and 0.28, respectively). The daily group had 11 more days of detectable serum cholecalciferol than the single-dose group (P<0.001). There was no difference observed in cholecalciferol area under the curve (AUC28) between groups (P=0.49). However, the single-dose group had a significantly greater mean 25(OH)D AUC28 compared with the daily group (P<0.001).

Public opinion about smoking and smoke free legislation in a district of North India

Context: A growing number of cities, districts, counties and states across the globe are going smoke-free. While an Indian national law namely Cigarettes and Other Tobacco Products Act (COTPA) exists since 2003 and aims at protecting all the people in our country; people still smoke in public places. Aim: This study assessed knowledge and perceptions about smoking, SHS and their support for Smoke-free laws among people residing in Mohali district, Punjab. Materials and Methods: This cross-sectional study was conducted in Mohali district of Punjab, India. A sample size of 1600 people was obtained. Probability Proportional to Size technique was used for selecting the number of individuals to be interviewed from each block and also from urban and rural population. Statistical Analysis Used: We estimated proportions and tested for significant differences by residence, smoking status, literacy level and employment level by means of the chi-square statistics. Statistical software SPSS for Windows version 20 was used for analysing data . Results: The overall prevalence of current smoking among study participants was 25%. Around 96% were aware of the fact that smoking is harmful to health, 45% viewed second-hand smoke to be equally harmful as active smoking, 84.2% knew that smoking is prohibited in public places and 88.3% wanted the government to take strict actions to control the menace of public smoking. Multivariate logistic regression analysis showed that people aged 20 years and above, unemployed, urban, literate and non-smokers had significantly better perception towards harms of smoking. The knowledge about smoke free provisions of COTPA was significantly better among males, employed individuals, urban residents, and literate people. Conclusions: There was high knowledge about deleterious multi-dimensional effects of smoking among residents and a high support for implementation of COTPA. Efforts should be taken to make Mohali a "smoke-free district".

Refining compliance surveys to measure the smokefree status of jurisdictions using the Delphi method

SETTING

Compliance assessment surveys are cost-effective means of assessing smokefree status in a jurisdiction. Assigning weights to assessment criteria (indicators) can also inform law implementers and policy makers about the effectiveness of the enforcement of smokefree rules.

OBJECTIVE

To develop a standardised measure for compliance surveys using the Delphi method in India.

DESIGN

Tobacco control experts from India comprising different constituencies and jurisdictions met for a half-day workshop in August 2012 to deliberate on how weights can be assigned to criteria for smokefree status. Using the Delphi method, the relevance and ranking of criteria from an existing protocol for measuring compliance was evaluated.

RESULTS

Consensus was reached on all five compliance survey indicators through three rigorous rounds of discussion. The highest priority was assigned to the absence of the act of smoking in public places (33%), followed by the display of no-smoking signage in public places (32%), absence of cigarette butts or bidi stubs (15%), absence of smoking aids (10%) and absence of tobacco smoke and ash (10%).

CONCLUSION

Tobacco control advocates can effectively inform local policy makers using weights that prioritise directed enforcement and targeted interventions, which in turn will ensure stronger compliance and sustainable smokefree settings.

Genomic diversity and multiple origins of tetraploid (2n = 78, 80) Glycine tomentella

Among 15 wild perennial species of the genus Glycine Willd. subgenus Glycine, G. tomentella is exceptional. It is composed of four cytotypes (2n = 38, 40, 78, 80), is diverse in morphological features, and covers a wide geographical area. The objectives of this study were to uncover the genomic diversity in 78- and 80-chromosome cytotypes through a multidisciplinary approach, using cytogenetic, biochemical, and molecular methods, to verify previously identified isozyme groupings and to determine their possible origins. The cytogenetic observations, total seed protein and protease inhibitor profile comparisons, and the phylogenetic analysis of restriction fragment length polymorphisms identified three distinct groups (T1, T5, T6) among aneutetraploid (2n = 78) and four distinct groups (T2, T3, T4, T7) among tetraploid (2n = 80) G. tomentella accessions. The groupings were congruent with those of isozyme analysis. Tetraploid accessions from Indonesia were assigned to a new group, T7, based on the present study. Morphology, cytology, and seed protein banding patterns of synthetic tetraploids indicated that the T1 and T5 group aneutetraploids were composed of D3D3EE and AAEE genomes, respectively, and the T2 group tetraploid accessions consisted of AAD3D3 genomes. Various groups within the 78- and 80-chromosome G. tomentella were suggested to have originated in Australia by allopolyploidization, most likely through multiple independent events.

Occupational stress and social support in naval personnel

BACKGROUND

Data show that naval personnel have a high incidence of stress related disorders. A high prevalence of occupational stress was seen in a previous survey carried out on Indian Naval personnel. However, the role of social support in reducing occupational stress was not studied. To study occupational stress in Indian Naval personnel and to study the effect of social support on occupational stress.

METHODS

5077 naval personnel were surveyed using study questionnaires which included Occupational Stress Inventory, Multidimensional Scale of Perceived Social Support, and the General Health Questionnaire (GHQ)-12 item version as a measure of psychological health. The data was statistically analysed using chi square test and other non-parametric tests.

RESULTS

High occupational stress was seen in personnel serving afloat (66.47%) as compared to those serving ashore (51.55%) and on submarines (53.72%). Among personnel serving afloat, occupational stress was highest among Junior Sailors as compared to Senior Sailors and Officers. Occupational stress was linked to poor psychological health as measured by the GHQ and younger age. Perceived social support was effective in reducing occupational stress in Officers and Senior Sailors but not in Junior Sailors where paradoxically it seemed to lead to greater occupational stress.

CONCLUSIONS

High occupational stress was seen in more than half the service personnel studied. Occupational stress is mitigated by social support in Officers and Senior Sailors but not in Junior Sailors.

Compliance surveys: an effective tool to validate smoke-free public places in four jurisdictions in India

Smoke-free initiatives have gained significant momentum since India enacted comprehensive smoke-free legislation in October 2008. The International Union Against Tuberculosis and Lung Disease has actively supported various levels of government, legislators, civil society, and communities across the country to implement smoke-free public places and comply with the law. On World No Tobacco Day 2010, four jurisdictions demonstrated that public places within their jurisdictions were smoke-free. These jurisdictions cover a wide spectrum of demographic and geographic variation and include an entire state. The demonstration of being 'smoke-free' in these jurisdictions was supported by a simple survey that documented compliance with the smoke-free law in the country.

Diagnostic characteristics of late-night salivary cortisol using liquid chromatography-tandem mass spectrometry

OBJECTIVE

The objective of the study was to describe the diagnostic performance of a commercially available late-night salivary cortisol (NSC) assay using liquid chromatography tandem mass spectrometry.

METHODS

We retrospectively identified 90 patients who had one or more NSC determinations: 52 patients in whom Cushing syndrome (CS) was excluded or could not be confirmed [group 1 (G1)] and 38 patients in whom CS was confirmed [group 2 (G2)]. Eighteen healthy volunteers served as controls.

RESULTS

Baseline demographics in all groups were similar with regards to age, ethnicity, gender, and body mass index. NSC levels [median (range)] were higher in G2, 381 (64-13,500) ng/dl [10.51 (1.77-372.46) nmol/liter], compared with controls, 19.3 (2.1-416) ng/dl [0.53 (0.06-11.48) nmol/liter], and G1, 26 (4-176) ng/dl [0.72 (0.11-4.86) nmol/liter, P < 0.001]. The highest combined sensitivity (92%) and specificity (92%) was achieved at a cut point of 107 ng/dl (2.95 nmol/liter). Two or more NSCs were done in 32 of 52 G1 and 31 of 38 G2 patients. In G1 eight of 32 (25%) had at least one elevated [>100 ng/dl (2.76 nmol/liter)] NSC including two in whom both NSCs were elevated. In contrast, four of 31 (13%) in G2 had at least one normal NSC including one with four of five normal NSC values. None of the patients with CS had a NSC less than 60 ng/dl (<1.66 nmol/liter). Comparing G1 and G2, obtaining more than one saliva sample did not improve the diagnostic accuracy of NSC measurement (P = 0.64).

CONCLUSION

The liquid chromatography tandem mass spectrometry assay to measure NSC is a simple and reliable test to screen patients suspected to have CS. Clinicians should be aware of appropriate cutoff values for proper interpretation of NSC and use additional tests when necessary.

Vitamin D status and longitudinal lung function decline in the Lung Health Study

Low blood vitamin D levels have been postulated to be a risk factor for worse lung function, based largely on cross-sectional data. We sought to use longitudinal data to test the hypothesis that baseline plasma 25-hydroxyvitamin D (25(OH)D) is lower in subjects with more rapid lung function decline, compared to those with slow lung function decline. We conducted a nested, matched case-control study in the Lung Health Study 3 cohort. Cases and controls were continuous smokers with rapid and slow lung function decline, respectively, over ~6 yrs of follow-up. We compared baseline 25(OH)D levels between cases and controls, matching date of phlebotomy and clinical centre. Among 196 subjects, despite rapid and slow decliners experiencing strikingly and significantly different rates of decline of forced expiratory volume in 1 s (-152 versus -0.3 mL·yr⁻¹; p < 0.001), there was no significant difference in baseline 25(OH)D levels (25.0 versus 25.9 ng·mL⁻¹; p = 0.54). There was a high prevalence of vitamin D insufficiency (35%) and deficiency (31%); only 4% had a normal 25(OH)D level in the winter. Although vitamin D insufficiency and deficiency are common among continuous smokers with established mild-to-moderate chronic obstructive pulmonary disease, baseline 25(OH)D levels are not predictive of subsequent lung function decline.

Primary trisomics of rice: origin, morphology, cytology and use in linkage mapping

Twelve primary trisomics of Oryza sativa L. were isolated from the progenies of spontaneous triploids and were transferred by backcrossing to the genetic background of IR36, a widely grown high yielding rice variety. Eleven trisomics can be identified morphologically from one another and from diploids. However, triplo 11 is difficult to distinguish from diploid sibs.-The extra chromosome of each trisomic was identified cytologically at pachytene stage of meiosis, and the chromosomes were numbered according to their length at this stage. The major distinguishing features of each pachytene chromosome were redescribed.-The female transmission rates varied from 15.5% for triplo 1, the longest chromosome, to 43.9% for triplo 12, the shortest chromosome. Seven of the 12 primary trisomics transmitted the extra chromosome through the male. The low level of chromosomal imbalance tolerated by rice and other evidence are interpreted to indicate that this species is a basic diploid.-Genetic segregation for 22 marker genes in the trisomic progenies was studied. Of a possible 264 combinations, involving 22 genes and 12 trisomics, 120 were examined. Marker genes for each of the 12 chromosomes were identified. The results helped establish associations between linkage groups and cytologically identifiable chromosomes of rice for the first time. Relationships between various systems of numbering chromosomes, trisomics, linkage groups and marker genes are described, and a revised linkage map of rice is presented.

Comparison of sex steroid measurements in men by immunoassay versus mass spectroscopy and relationships with cortical and trabecular volumetric bone mineral density

In men, measurement of serum testosterone and estradiol levels with immunoassays correlated with mass spectroscopic measurements, and correlations of sex steroids with volumetric bone mineral density were similar.

INTRODUCTION

While immunoassays have been used extensively for measurement of serum testosterone (T) and estradiol (E(2)) levels, there is concern about their specificity, particularly at low E(2) levels as present in men.

METHODS

We compared T and E(2) measured by mass spectroscopy to levels measured by immunoassay in men (n = 313, age 22 to 91 years) and related these to volumetric bone mineral density (vBMD) at various skeletal sites.

RESULTS

Serum T and non-SHBG bound (or bioavailable) T levels by immunoassay correlated well with the corresponding mass spectroscopy measurements (R = 0.90 and 0.95, respectively, P < 0.001); the correlations for serum E(2) measured using the two techniques were less robust (R = 0.63 for total E(2) and 0.84 for bioavailable E(2), P < 0.001). Overall relationships between serum bioavailable T and E(2) levels with vBMD at various skeletal sites were similar for the immunoassay and mass spectroscopic measures.

CONCLUSIONS

Although E(2) levels with immunoassay correlate less well with the mass spectroscopic measurements than do the T measurements in men, our findings indicate that the fundamental relationships observed previously between vBMD and the sex steroids by immunoassay are also present with the mass spectroscopic measurements.

Processing of rayon waste effluent for the recovery of zinc and separation of calcium using thiophosphinic extractant

Zinc is used in various metallurgical, chemical and textile industries. In textile industries, waste effluent containing zinc is generated during the manufacture of rayon yarn. Due to the strict environmental regulations and the presence of toxic metallic and other constituents, the discharge of effluents in sewage is restricted. In view of above a process has been developed for the recovery of zinc from rayon waste effluent following solvent extraction technique using thiophosphinic extractants Cyanex 272 and 302. Before recycling of zinc sulphate solution in spinning bath, solution must be free from calcium, which is deleterious to the process as gypsum precipitates and forms scale. The extractant Cyanex 302 has been found selective for the recovery of 99.99% of zinc in the form of [R(2)Zn](org) from the effluent above equilibrium pH 3.4 maintaining the O/A ratio of 1/30 leaving all the calcium in the raffinate. The zinc from the loaded Cyanex 302 can be stripped with 10% sulphuric acid at even O/A ratio of 10. The stripped solution thus obtained could be recycled in the spinning bath of the rayon plant and raffinate could be disposed safely without affecting environment.

Landmark research in legumes

Legumes are members of the family Fabaceae or Leguminosae and include economically important grain legumes, oilseed crops, forage crops, shrubs, and tropical or subtropical trees. Legumes are a rich source of quality protein for humans and animals. They also enrich the soil by producing their own nitrogen in symbiosis with nitrogen-fixing bacteria. International centers and national institutes collect, maintain, distribute, and produce high-yielding legumes (grain-pulses, oilseeds, forages, nutraceuticals, medicinal shrubs, and trees). Legume breeders are confined within the primary gene pools (GP-1) in their varietal improvement programs and have not exploited secondary gene pools (GP-2), tertiary gene pools (GP-3), or quaternary gene pools (GP-4). Legumes are also an excellent source of timber, medicine, nutraceuticals, tannins, gums, insecticides, resins, varnish, paints, dyes, and eco-friendly by-products such as soy diesel. Three forage crops, Medicago truncatula , Lotus japonicus , and Trifolium pratense , are model legumes for phylogenetic studies and genome sequencing. This paper concludes that a “protein revolution” is needed to meet the protein demands of the world.

Atorvastatin inhibits calcification and enhances nitric oxide synthase production in the hypercholesterolaemic aortic valve

OBJECTIVE

To study in a rabbit model the expression of endothelial nitric oxide synthase (eNOS) in association with the development of calcification of the aortic valve, and to assess the effects of atorvastatin on eNOS expression, nitrite concentration, and aortic valve calcification.

METHODS

Rabbits (n = 48) were treated for three months: 16, forming a control group, were fed a normal diet; 16 were fed a 0.5% (wt/wt) high cholesterol diet; and 16 were fed a 0.5% (wt/wt) cholesterol diet plus atorvastatin (2.5 mg/kg/day). The aortic valves were examined with eNOS immunostains and western blotting. Cholesterol and high sensitivity C reactive protein (hsCRP) concentrations were determined by standard assays. Serum nitrite concentrations were measured with a nitric oxide analyser. eNOS was localised by electron microscopy and immunogold labelling. Calcification in the aortic valve was evaluated by micro-computed tomography (CT).

RESULTS

Cholesterol, hsCRP, and aortic valve calcification were increased in the cholesterol fed compared with control animals. Atorvastatin inhibited calcification in the aortic valve as assessed by micro-CT. eNOS protein concentrations were unchanged in the control and cholesterol groups but increased in the atorvastatin treated group. Serum nitrite concentrations were decreased in the hypercholesterolaemic animals and increased in the group treated with atorvastatin.

CONCLUSION

These data provide evidence that chronic experimental hypercholesterolaemia produces bone mineralisation in the aortic valve, which is inhibited by atorvastatin.

Comparison of cough of 2 and 3 weeks to improve detection of smear-positive tuberculosis cases among out-patients in India

SETTING

Governmental health facilities in six districts of India.

OBJECTIVE

To estimate the prevalence of cough and to compare the detection of smear-positive tuberculosis (TB) among out-patients with cough of > or =2 or > or =3 weeks.

DESIGN

Trained health workers questioned each out-patient for presence of cough. Those with cough > or =2 weeks underwent sputum microscopy.

RESULTS

Of 55561 out-patients interviewed, 2210 (4%) had cough > or =2 weeks, of whom 267 had sputum-positive TB, compared to 182/1370 with cough > or =3 weeks. The 31% who did not spontaneously complain of cough were less likely to be sputum-positive than those who did (45/680 [7%] vs. 222/1530 [15%], P < 0.001), but they accounted for 45/267 smear-positive cases. Using cough > or =2 weeks as the screening criterion, the estimated number of smears performed per day at each primary and secondary health care facility was respectively 8 and 19, compared to 5 and 12 using cough > or =3 weeks.

CONCLUSION

The detection of smear-positive TB cases can be substantially improved by actively eliciting history of cough from all out-patients, and by changing the screening criterion for performing sputum microscopy among out-patients from cough > or =3 weeks to > or =2 weeks. Before implementing this change nationally, its programmatic feasibility should be assessed.