Genetic Screening for Mutants with Altered Seminal Root Numbers in Hexaploid Wheat Using a High-Throughput Root Phenotyping Platform

Roots are the main channel for water and nutrient uptake in plants. Optimization of root architecture provides a viable strategy to improve nutrient and water uptake efficiency and maintain crop productivity under water-limiting and nutrient-poor conditions. We know little, however, about the genetic control of root development in wheat, a crop supplying 20% of global calorie and protein intake. To improve our understanding of the genetic control of seminal root development in wheat, we conducted a high-throughput screen for variation in seminal root number using an exome-sequenced mutant population derived from the hexaploid wheat cultivar Cadenza. The screen identified seven independent mutants with homozygous and stably altered seminal root number phenotypes. One mutant, Cadenza0900, displays a recessive extra seminal root number phenotype, while six mutants (Cadenza0062, Cadenza0369, Cadenza0393, Cadenza0465, Cadenza0818 and Cadenza1273) show lower seminal root number phenotypes most likely originating from defects in the formation and activation of seminal root primordia. Segregation analysis in F2 populations suggest that the phenotype of Cadenza0900 is controlled by multiple loci whereas the Cadenza0062 phenotype fits a 3:1 mutant:wild-type segregation ratio characteristic of dominant single gene action. This work highlights the potential to use the sequenced wheat mutant population as a forward genetic resource to uncover novel variation in agronomic traits, such as seminal root architecture.

The Complex Spine in Children with Spinal Muscular Atrophy: The Transforaminal Approach-A Transformative Technique

BACKGROUND AND PURPOSE

Spinal muscular atrophy, a genetic disease resulting in loss of motor function, presents from in utero to adulthood. Depending on progression and secondary scoliosis, spinal stabilization may be necessary. When planning intrathecal access in these patients, spinal anatomy is the most important factor. Therefore, when planning intrathecal nusinersen injections, we subdivided patients with spinal muscular atrophy into simple-versus-complex spine subgroups. Our purpose was to present our experience with our first 42 transforaminal intrathecal nusinersen injections.

MATERIALS AND METHODS

We reviewed 31 consecutive patients with spinal muscular atrophy types 1-3 who presented for intrathecal nusinersen injections from March 2017 to September 2018. Nine children had complex spines (ie, spinal instrumentation and/or fusion) and required preprocedural imaging for route planning for subarachnoid space access via transforaminal or cervical approaches.

RESULTS

A total of 164 intrathecal nusinersen injections were performed in 31 children 4-226 months of age, with 100% technical success in accessing the subarachnoid space. Nine patients with complex spinal anatomy underwent 45 intrathecal nusinersen injections; 42 of 45 procedures were performed via a transforaminal approach with the remaining 3 via cervical techniques. There were no complications.

CONCLUSIONS

Our initial experience has resulted in a protocol-driven approach based on simple or complex spinal anatomy. Patients with simple spines do not need preprocedural imaging or imaging-guided intrathecal nusinersen injections. In contrast, the complex spine subgroup requires preprocedural imaging for route planning and imaging guidance for therapy, with the primary approach being the transforaminal approach for intrathecal nusinersen injections.

Recovery characteristics of patients receiving either sugammadex or neostigmine and glycopyrrolate for reversal of neuromuscular block: a randomised controlled trial

Sugammadex more rapidly and reliably reverses rocuronium-induced neuromuscular block compared with neostigmine, but it is not known if subsequent patient outcomes, including nausea, vomiting and other aspects of recovery are modified. In this study, we compared the recovery characteristics of sugammadex and neostigmine/glycopyrrolate following reversal of neuromuscular block. This was a single-centre, randomised, blinded, parallel-group clinical trial in women undergoing elective day-surgical laparoscopic gynaecological surgery, with a standardised general anaesthesia regimen that included rocuronium. Neuromuscular block was reversed with either sugammadex 2 mg.kg^-1 or neostigmine 40 μg.kg^-1 and glycopyrrolate 400 μg. The primary outcome was the incidence of nausea and vomiting during the first six postoperative hours. Secondary outcomes included other measures of postoperative recovery such as patient symptoms and recovery scores. Three-hundred and four women were analysed by intention-to-treat (sugammadex n = 151, neostigmine n = 153), which included four major protocol violations. There was no significant difference between sugammadex and neostigmine groups in the incidence of early nausea and vomiting (49.0% vs. 51.0%, respectively; OR 0.92, 95%CI 0.59-1.45; p = 0.731). Double vision (11.5% vs. 20.0%; p = 0.044) and dry mouth (71.6% vs. 85.5%; p = 0.003) were less common after sugammadex. Sedation scores at 2 h were also lower after sugammadex (median (IQR [range]) 0 (0-3 [0-10]) vs. 2 (0-4.[0-10]); p = 0.021). Twenty-four-hour recovery scores were not significantly different between groups. Reversal with sugammadex in this patient population did not reduce postoperative nausea or vomiting compared with neostigmine/glycopyrrolate.

Thoughtflow: Standards and Tools for Provenance Capture and Workflow Definition to Support Model-Informed Drug Discovery and Development

Pharmacometric analyses are complex and multifactorial. It is essential to check, track, and document the vast amounts of data and metadata that are generated during these analyses (and the relationships between them) in order to comply with regulations, support quality control, auditing, and reporting. It is, however, challenging, tedious, error-prone, and time-consuming, and diverts pharmacometricians from the more useful business of doing science. Automating this process would save time, reduce transcriptional errors, support the retention and transfer of knowledge, encourage good practice, and help ensure that pharmacometric analyses appropriately impact decisions. The ability to document, communicate, and reconstruct a complete pharmacometric analysis using an open standard would have considerable benefits. In this article, the Innovative Medicines Initiative (IMI) Drug Disease Model Resources (DDMoRe) consortium proposes a set of standards to facilitate the capture, storage, and reporting of knowledge (including assumptions and decisions) in the context of model-informed drug discovery and development (MID3), as well as to support reproducibility: "Thoughtflow." A prototype software implementation is provided.

Pharmacometrics Markup Language (PharmML): Opening New Perspectives for Model Exchange in Drug Development

The lack of a common exchange format for mathematical models in pharmacometrics has been a long-standing problem. Such a format has the potential to increase productivity and analysis quality, simplify the handling of complex workflows, ensure reproducibility of research, and facilitate the reuse of existing model resources. Pharmacometrics Markup Language (PharmML), currently under development by the Drug Disease Model Resources (DDMoRe) consortium, is intended to become an exchange standard in pharmacometrics by providing means to encode models, trial designs, and modeling steps.

Tramadol in pregnancy and lactation

Tramadol produces analgesic effects through both non-opioid and weak opioid activity and is commonly used to treat mild to moderate pain. It has been in use for over 30 years and has a well-established safety profile in the general population. Since tramadol is not licensed for use in pregnancy and lactation, there is limited clinical research on its use in this patient population. A systematic review was undertaken of articles published in English before June 2011, searching Pubmed, Medline, CINAHL, Embase and Cochrane databases using the terms 'tramadol and pregnancy', 'tramadol and breastfeeding', 'tramadol and lactation', and 'tramadol and neonate'.

Improvement of a wind-tunnel sampling system for odour and VOCs

Wind-tunnel systems are widely used for collecting odour emission samples from surface area sources. Consequently, a portable wind-tunnel system was developed at the University of New South Wales that was easy to handle and suitable for sampling from liquid surfaces. Development work was undertaken to ensure even air-flows above the emitting surface and to optimise air velocities to simulate real situations. However, recovery efficiencies for emissions have not previously been studied for wind-tunnel systems. A series of experiments was carried out for determining and improving the recovery rate of the wind-tunnel sampling system by using carbon monoxide as a tracer gas. It was observed by mass balance that carbon monoxide recovery rates were initially only 37% to 48% from a simulated surface area emission source. It was therefore apparent that further development work was required to improve recovery efficiencies. By analysing the aerodynamic character of air movement and CO transportation inside the wind-tunnel, it was determined that the apparent poor recoveries resulted from uneven mixing at the sample collection point. A number of modifications were made for the mixing chamber of the wind-tunnel system. A special sampling chamber extension and a sampling manifold with optimally distributed sampling orifices were developed for the wind-tunnel sampling system. The simulation experiments were repeated with the new sampling system. Over a series of experiments, the recovery efficiency of sampling was improved to 83-100% with an average of 90%, where the CO tracer gas was introduced at a single point and 92-102% with an average of 97%, where the CO tracer gas was introduced along a line transverse to the sweep air. The stability and accuracy of the new system were determined statistically and are reported.

Development of odour assessment criteria in New South Wales and application of the criteria for the assessment of a major public works project

The introduction of the forthcoming Australian and New Zealand standard on odour measurement has led to the review of odour regulation in most Australian states. In New South Wales the regulator has drafted an odour impact assessment policy for point source emissions. The policy is based on the new odour measurement standard and defines regulatory dispersion modelling procedures. The New South Wales odour assessment policy was initially drafted on the basis of a literature review and has since been developed in consultation with various industry and government groups, including sewerage authorities. The policy, while still officially regarded as a draft, has already been used as the basis for the assessment of a number of sewerage projects that have been characterised by point source emissions. The application of modelling-based assessment procedures requires careful judgement concerning the selection of input data and close scrutiny on behalf of the assessor. This paper examines the assumptions underlying the development of the New South Wales draft odour assessment policy and draws important universal lessons from its application for the assessment of a major sewerage project. The introduction of peak to mean factors based on one second nose response times has been controversial and alternative procedures are proposed.

Airway complications following pediatric lung and heart-lung transplantation

Obstruction at the airway anastomosis is a recognized complication of adult heart-lung transplantation (HLT) and lung transplantation (LT). Data for pediatric transplantation have been scarce. We reviewed our experience in pediatric HLT and LT to determine the frequency of airway complications and to document the therapeutic modalities used for their treatment. Fifty-three patients (median age: 13.8 yr; range: 1.3 to 28.2 yr) underwent HLT (n = 25), SLT (n = 3), DLT (n = 25), or repeat DLT (n = 3) and survived for more than 72 h. Major anastomotic airway complications requiring intervention affected one of the 25 HLT (4%) and seven of the 28 LT (SLT + DLT) patients (25%) (p = 0.05). Four patients with granulation tissue occluding the airway were treated with forceps resection, laser ablation, or balloon dilatation. Three patients with fibrotic strictures received silicone stents, laser ablation, or balloon dilatation. Two patients with bronchomalacia or diffuse stricture below the anastomosis underwent metal stent placement. Five of seven patients who were treated for anastomotic complications had satisfactory relief of airway obstruction. As compared with previously studied adults, pediatric heart-lung transplant recipients had the same or a lower frequency, and pediatric lung transplant recipients had a higher frequency of major anastomotic airway complications. A variety of treatment modalities were necessary to achieve adequate relief of airway obstruction.

American Orthopaedic Foot and Ankle Society shoe survey of diabetic patients

A one-page written survey was completed by 402 randomly selected patients with diabetes in five cities during a scheduled visit to their endocrinologist. Patients averaged 61.5 years of age and had been diagnosed with diabetes for 27.3 years. This study suggests that approximately 25% of adults with diabetes are at risk for developing foot ulcers, the precursor to deep infection leading to lower limb amputation. The goal at the inception of this project was to obtain benchmark data on the current level of prophylactic foot care being provided to adult patients with diabetes. The results of this survey suggest that most individuals with diabetes and their physicians are aware of potential diabetic foot morbidity, yet very few take advantage of prophylactic protective footware. Even fewer are presently taking advantage of benefits established through the Medicare Therapeutic Foot Bill. This survey highlights a substantial opportunity for improvement in the long-term care of individuals with diabetes.

Chylothorax and chylopericardium: a complication of a central venous catheter

This article describes a rare and severe complication of central venous catheterization, namely extensive thrombosis within the venous system of the chest resulting in bilateral chylothorax and chylopericardium. The complication resolved with drainage, catheter removal, and low molecular weight heparin therapy.

Partial splenic embolization for treatment of disseminated intravascular coagulation in lymphangiomatosis

A 1-year-old boy presented with pericardial effusion, pulmonary infiltrates, and disseminated intravascular coagulation; lung biopsy indicated pulmonary lymphangiomatosis. He did not respond to medical therapy and was a poor surgical candidate; therefore, he underwent partial splenic embolization. The procedure resulted in a complete disappearance of the DIC and marked improvement in his cardiorespiratory status. He continues to thrive and is transfusion-independent 2 years after the procedure.

Intravenous ondansetron in established postoperative emesis in children. S3A-381 Study Group

BACKGROUND

In pediatric postsurgical patients, postoperative vomiting is a common occurrence that can delay recovery and result in unplanned hospital admissions after outpatient surgery. This randomized, double-blind, placebo-controlled, multicenter study evaluated the efficacy and safety of ondansetron in the control of established postoperative emesis in outpatients aged 2-12 yr.

METHODS

Screened for the study were 2,720 ASA physical status 1-3 children undergoing outpatient surgery during general anesthesia, which included nitrous oxide. Children experiencing two emetic episodes within 2 h of discontinuation of nitrous oxide were given intravenous ondansetron (n = 192; 0.1 mg/kg for children weighing < or = 40 kg; 4 mg for children weighing > 40 kg) or placebo (n = 183).

RESULTS

The proportion of children with no emetic episodes and no use of rescue medication was significantly greater (P < 0.001) in the ondansetron group compared with placebo for both 2- and 24-h periods after study drug administration (78% of the ondansetron group and 34% of the placebo group for 2 h; 53% of the ondansetron group and 17% of the placebo group for 24 h). Among patients with at least one emetic episode or with rescue medication use, the median time to onset of emesis or rescue was 127 min in the ondansetron group compared with 58 min in the placebo group (P < 0.001). The median time from study drug administration until discharge was significantly shorter (P < 0.01) in the ondansetron group (153 min, range 44-593 min) compared with the placebo group (173 min, range 82-622 min). The incidence of potentially drug-related adverse events was similar in the ondansetron (3% of patients) and the placebo (4% of patients) groups.

CONCLUSION

A single dose of ondansetron (0.1 mg/kg up to 4 mg) is effective and well tolerated in the prevention of further episodes of postoperative emesis in children after outpatient surgery. Administration of ondansetron also may result in a shorter time to discharge.

Osteoid osteoma: percutaneous excision using a CT-guided coaxial technique

OBJECTIVE

We describe a coaxial technique for percutaneous, CT-guided removal of osteoid osteoma in children.

SUBJECTS AND METHODS

The study included eight children aged 3 years to 15 years 9 months who had signs and symptoms of osteoid osteoma. The diagnoses were confirmed by CT scans. Seven of nine lesions were removed manually with a coaxial technique and a trephine. Power tools were added to the technique in the other two cases. Removal of the nidus was confirmed by postprocedural CT scans and by histologic examination.

RESULTS

All CT-guided excisions were technically successful, and only one minor complication occurred. One recurrence at 13 months was successfully treated percutaneously.

CONCLUSION

CT-guided coaxial removal of osteoid osteoma is a safe and effective treatment. Increasing experience and the use of power tools in selected cases helps to shorten the procedure.

Intervention in the critically ill patient

In summary, interventional techniques are well-established and offer safe and effective alternatives for management of patients in the intensive care unit or other setting. It is likely that the radiologist will become more involved in the management of ill children and adults. It is hoped that this will reduce the need for opened surgical procedures, reduce the complexity of surgery, and provide treatment options for complications.

Investigations into the fat pads of the sole of the foot: anatomy and histology

Anatomical, histological, and histochemical studies were performed on normal and abnormal fat pads of the sole of cadaver feet. The fat pads were found to contain a significant nerve and blood supply separate from that to the surrounding musculature and skin. Pacinian corpuscles and free nerve endings within the fat were identified. Histological analysis indicated a meshwork of fibroelastic septae arranged in a closed-cell configuration. The mechanical consequences of this organization are discussed in the context of the weightbearing role of the fat pads of the feet. Alterations seen in dysvascular or senescent feet are consistent with the hypothesis that the septal anatomy of the fat pads is central to their cushioning function.

Aging of diabetic and nondiabetic skin fibroblasts in vitro: life span and sequential growth curves

Skin fibroblasts from age-matched normal and juvenile diabetic (IDDM) subjects were studied throughout their life span in vitro. The number of mean population doublings (MPD) attained at senescence was determined. Sequential 5-day growth curves were constructed. Normal cells were compared to cells from diabetics with recent onset of disease, 1-5 years, 6-10 years, and greater than 10 years of insulin therapy. A trend of decreasing MPD in vitro with increasing duration of diabetes in vivo was found. The growth potential of all cells (sequential growth curves) decreased with increasing time in vitro. The confluent density (Day 5) of diabetic (10 years' duration) cells was significantly lower than that for normal cells at Stage 2 of growth (passage 6-10). The in vitro aging of cells from diabetics (recent onset) was essentially the same as that of normal cells.

Research and practice in the treatment of insulin-dependent diabetes: a survey of 53 pediatric diabetologists

New techniques are available for the treatment of children with insulin-dependent diabetes mellitus. These include more intensive methods of insulin delivery by multiple daily injections or continuous subcutaneous infusion by portable pumps combined with patient self-monitoring of blood glucose. Long-term diabetic control can be evaluated by measurement of glycosylated hemoglobin, HbA1 or HbA1c. Pediatric practitioners may be in doubt as to the extent to which these techniques should be incorporated into their own practices. In order to provide some guidance in this quandary, the treatment practices as of June 1982, of 53 physicians with a special interest in the treatment of diabetic children were surveyed by questionnaire. The respondents estimated that they cared for 12,350 diabetic patients less than 19 years of age. Among their patients, 72% received twice-daily injections of insulin, 3% received three or more injections daily, and only 195 patients (2.7% of the total) were treated with insulin pumps. Among patients older than 10 years of age, 50% performed self-monitoring of blood glucose four times daily on one or more days per week and 32% of these patients did so daily. Two thirds of the patients utilized glucose oxidase-impregnated strips for blood glucose estimation and the remainder used reflectance meters. Essentially all respondents utilized glycosylated hemoglobin to evaluate quality of control. The mean number of determinations was 3.8 per year. Reasons for introducing pump therapy or discontinuing its use, glycemic targets for pump patients, and experience with utilization of the pump are described.(ABSTRACT TRUNCATED AT 250 WORDS)

Organic aciduria in neonatal multiple carboxylase deficiency

A Samoan patient and a Saudi-Arabian patient were found to have abnormalities in the pattern of organic acid metabolites characteristic of 3-methylcrotonylglycinuria, propionic acidaemia and lactic acidosis. Both patients died early in life. The metabolic pattern is diagnostic of multiple carboxylase deficiency and an enzymatic diagnosis was made in a subsequent affected sibling of the first patient. Deficiency of the three carboxylases suggests a primary defect in the metabolism of biotin which is required for their activity. The importance of the recognition of the clinical picture is highlighted by the fact that this lethal disease is readily treated with biotin. These patients have prominent skin lesions which can serve as alerting signs for the diagnosis.

Physicians measure up. A study of 13 surgical procedures

The Colorado Foundation for Medical Care Professional Standards Review Organization performed a six-month study in the latter half of 1978 to determine if the following surgical procedures were performed in accordance with the appropriate indications: primary appendectomy, cataract surgery, cholecystectomy, coronary arteriography, uterine dilation and curettage, surgical repair of hiatal hernia, abdominal hysterectomy, vaginal hysterectomy, lumbar disk excision, meniscectomy, tonsillectomy, adenoidectomy, and tonsillectomy and adenoidectomy. Data were collected concurrently by nurse reviewers on 4,850 hospitalized Medicare and Medicaid patients in Colorado hospitals. Cases that did not meet explicit indications were referred to physician reviewers for final determination. The 4,728 cases (97%) either met indications for these procedures or were justified by physician review. The conclusion from the study was that Colorado physicians are performing these procedures appropriately.

Multicenter comparison of naproxen and indomethacin in rheumatoid arthritis

In a double-blind, crossover study, naproxen, 250 mg twice a day, naproxen, 500 mg taken at bedtime, and indomethacin, 25 mg four times a day, were compared in 132 patients with rheumatoid arthritis; six centers participated in the study. Objective indices of arthritis activity, such as number of clinically active joints, walking time, and duration of morning stiffness, were nearly identical for the three treatment regimens. Of particular interest was the observation that efficacy of a single daily dose of naproxen was comparable to that of the twice-daily dosage. Naproxen was better tolerated than indomethacin, as shown by a statistically significant difference in the incidence of CNS complaints.

Subpopulations of peripheral lymphocytes in juvenile diabetes

Subpopulations of peripheral lymphocytes were studied in 26 children with insulin-treated juvenile diabetes and in 27 control children of comparable age. T-lymphocytes were quantitated by spontaneous rosette-formation with sheep erythrocytes and B-lymphocytes by indirect immunofluorescence with the use of monovalent, fluorescein-labeled rabbit antiserum specific to the heavy chains of human IgG IgM, or IgA. No significant quantitative difference in subpopulations of the peripheral lymphocytes, T-cells, and B-cells with IgG, IgA, or IgM markers found between children with juvenile diabetes and the control group, although the B-lymphocytes with IgG or IgA markers tended to be higher and those with IgM markers lower in the diabetic than in the control group.

Isolation of P22 specialized transducing phage followong F'-episome fusion

A P22 specialized transducing phage has been constructed which carries the structural gene for aspartate transcarbamylase (ATCase). This gene (pyrB) was first brought close to the P22 attachment site by fusing an F' pyrB(+) episome to an F' prolac episome which carries a P22 prophage attachment site. A prophage was added to these fused F' episomes and the lysogen was UV-induced. The specialized transducing phage was isolated from the resulting lysate. The phage also carries argI, the structure gene for ornithine transcarbamylase.

The role of the liaison psychiatrist in a hemodialysis program: a case study

The role of a liaison psychiatric consultant and the practical usefulness of psychiatric expertise in an ongoing hemodialysis program is illustrated by means of an individual patient study. Initially, the psychiatrist concentrated on establishing a diagnosis and defining the etiological significance of a variety of factors that were influencing the patient's behavior. Consequently, changes in the patient's medical program were suggested in an attempt to modify the patient's psychiatric status. The psychiatrist also needed to help the dialysis unit staff understand the patient and make a decision on feasibility of a kidney transplant.