First record of the genus Touranella Attems, 1937 (Diplopoda, Polydesmida, Paradoxosomatidae) from Laos, with a description of a new species

The paradoxosomatid genus Touranella Attems, 1937 is recorded from Laos for the first time, with a new species, Touranella champasaksp. nov., described here. The taxonomy of the genus is discussed, an identification key is provided, and the current distribution of all species is mapped.

Use of Dual Communication Boards with Students who are Deaf-Blind

The study reported here examined the use of dual communication boards for teaching appropriate communication responses to three high school students who were deaf-blind. It found that the students were able to use these boards with 100 percent accuracy in three communication routines in both school and community environments.

Genital morphology and the mechanics of copulation in the millipede genus Pseudopolydesmus (Diplopoda: Polydesmida: Polydesmidae)

Mate choice, copulation, genital morphology, and sperm storage are not very well understood in millipedes. The use of three-dimensional x-ray computed tomography (μCT) provides new morphological data regarding millipede reproductive systems in both the female and male, including chitinous sclerites and membranes, muscles, glands, oviducts, and sperm conduits. Here we present a complete integrated account of the morphology and function of the female genital organs in the family Polydesmidae (Diplopoda: Polydesmida) using μCT, UV fluorescence imaging, and scanning electron microscopy. These data allow us to consider competing hypotheses regarding millipede vulva formation. We additionally present the morphology of copulatory interface in Pseudopolydesmus Attems, 1898 using images of a mating pair in copula and by simulating the interface of the organs using 3D models from μCT, allowing us to tentatively identify a lock-and-key-like mechanism. Finally, we use μCT to reveal the topology of the seminal canal in the gonopod of male Pseudopolydesmus, a topic that has remained unresolved for nearly 80 years.

Taxonomic synthesis of the eastern North American millipede genus Pseudopolydesmus (Diplopoda: Polydesmida: Polydesmidae), utilizing high-detail ultraviolet fluorescence imaging

The species of the eastern North American millipede genus Pseudopolydesmus are reviewed. Synonyms and comprehensive literature citations are provided for each of the eight recognized species. Diagnostic morphology of the genus, including clarification of male gonopod terminology, is reviewed and defined using scanning electron microscopy and high-quality macrophotographic images, including those in which ultraviolet fluorescence was induced to produce detailed images of morphological structures. Based on the examination of available type material, the following eight species are recognized: (1) Pseudopolydesmus erasus; (2) Pseudopolydesmus canadensis; (3) Pseudopolydesmus collinus; (4) Pseudopolydesmus pinetorum; (5) Pseudopolydesmus minor; (6) Pseudopolydesmus caddo; (7) Pseudopolydesmus paludicolus; and (8) Pseudopolydesmus serratus. The species names Polydesmus neoterus and Polydesmus euthetus are here placed as junior subjective synonyms of Ps. minor (both syn. nov.), and Polydesmus natchitoches is placed as a junior subjective synonym of Ps. pinetorum (syn. nov.).

Enhancing Literacy in Cardiovascular Genetics: A Scientific Statement From the American Heart Association

Advances in genomics are enhancing our understanding of the genetic basis of cardiovascular diseases, both congenital and acquired, and stroke. These advances include finding genes that cause or increase the risk for childhood and adult-onset diseases, finding genes that influence how patients respond to medications, and the development of genetics-guided therapies for diseases. However, the ability of cardiovascular and stroke clinicians to fully understand and apply this knowledge to the care of their patients has lagged. This statement addresses what the specialist caring for patients with cardiovascular diseases and stroke should know about genetics; how they can gain this knowledge; how they can keep up-to-date with advances in genetics, genomics, and pharmacogenetics; and how they can apply this knowledge to improve the care of patients and families with cardiovascular diseases and stroke.

A prospective observational study of the association between cabin and outside air temperature, and patient temperature gradient during helicopter transport in New South Wales

The prevalence of hypothermia in patients following helicopter transport varies widely. Low outside air temperature has been identified as a risk factor. Modern helicopters are insulated and have heating; therefore outside temperature may be unimportant if cabin heat is maintained. We sought to describe the association between outside air, cabin and patient temperature, and having the cabin temperature in the thermoneutral zone (18-36°C) in our helicopter-transported patients. We conducted a prospective observational study over one year. Patient temperature was measured on loading and engines off. Cabin and outside air temperature were recorded for the same time periods for each patient, as well as in-flight. Previously identified risk factors were recorded. Complete data was obtained for 133 patients. Patients' temperature increased by a median of 0.15°C (P=0.013). There was no association between outside air temperature or cabin temperature and patient temperature gradient. The best predictor of patient temperature on landing was patient temperature on loading (R2=0.86) and was not improved significantly when other risk factors were added (P=0.63). Thirty-five percent of patients were hypothermic on loading, including those transferred from district hospitals. No patient loaded normothermic became hypothermic when the cabin temperature was in the thermoneutral zone (P=0.04). A large proportion of patients in our sample were hypothermic at the referring hospital. The best predictor of patient temperature on landing is patient temperature on loading. This has implications for studies that fail to account for pre-flight temperature.

Abstract P1-10-27: Self-reported symptoms and interference issues in breast cancer patients

BACKGROUND: Breast cancer and its treatments produce multiple symptoms that significantly impact patient quality of life (QOL). Distress and impaired function are the most commonly referred symptoms [Cleeland CS, 2007]. Routine cancer care assessment of patient-reported outcomes (PROs), including symptoms, function, and QOL, has been shown to improve symptom management, identification of psychosocial problems, and patient-provider communication. The Symptom Inventory Tool (SIT) is an assessment tool that captures the patients' perceived symptom burden for real-time clinical intervention, taken at the point of no intervention (baseline) and every 21 days or greater. The SIT is comprised of 27 questions utilizing the M.D. Anderson Symptom Inventory tool (MDASI) [Cleeland CS, Cancer 2013], and validated assessment instrument with 8 questions added and a free text box by Cancer Treatment Centers of America (CTCA). CTCA is a national network of five hospitals that specialize in cancer treatment and integrative oncology.

PATIENTS & METHODS: Patients reported symptoms intensity using 19-item MD Anderson Symptom Inventory (MDASI) and 8 additional questions created by CTCA (constipation, swelling, mouth soreness, bleeding, sexual interest, family, hope & QOL). Symptoms were rated "at the worst" on an 11-point numeric scale ranging from 0 ('no present") to 10 ("as bad as you can imagine") in the previous 24 hours. SIT became an integral part of patient care at CTCA beginning in 2012.

RESULTS: From July 2012 to February 2015, a total of 3,740 outpatients with breast cancer were evaluated at CTCA.

A total of 13,852 assessments were analyzed. The assessments consisted of 3,513 completed at baseline, 2,237 completed at the 2nd follow up (FU), and 8,014 completed at 3rd FU or greater. Median age was 50 (range, 17-88), 60% of patients were ER+. Race: White (68%), Black (29%), and other (3%). Disease extension: locoregional (86%) and metastatic (13.6%). The average time since cancer was diagnosed were 35 months, and 50.7% of the patients received prior systemic therapy: chemotherapy (55%), hormone-therapy (41%), and immunotherapy (4%). Mean, standard deviation and inter quartile ranges at baseline assessment are depicted in.

Table 1.Patient Reported SymptomBaseline assessment statisticsPercentage of patients with severe symptoms at baseline and reporting a clinically significant change (2 points) at 2nd SIT assessment Mean +/- STDInterquartile range (IQR)Significant decreaseNo changeDistress3.0 +/- 3.0[0.5]695 (31.3%)594 (26.8%)414 (18.7%)Sadness2.5 +/- 2.9[0.4]622 (28%)718 (32.3%)358 (16.1%)Disturbed Sleep3.3 +/- 3.2[0.6]550 (24.8%)517 (23.3%)642 (28.9%)Mood2.6 +/- 2.7[0.4]549 (24.7%)678 (30.5%)447 (20.1%)Pain2.7 +/- 3.0[0.5]523 (23.9%)675 (30.8%)519 (23.7%)*IQR is a measure of variability, based on dividing a data set into quartiles. Quartiles divide a rank-ordered data set into four equal parts

CONCLUSIONS: The SIT was successful in identifying symptoms burden and interference with life issues in breast cancer patients. Distress, sadness, disturbed sleep, mood and pain were the most common reported symptoms. Early identification of patient burden symptoms allowed immediate intervention and improvement in approximately a quarter of patients.

Citation Format: Alvarez RH, Hartman S, Bosch B, Kendrick D, Cohen L, Fridman J, Ottersen D, Walcott K, Ware S, Castro I, Thomas J, Niu J, Ahn E, Denny D, Markman M. Self-reported symptoms and interference issues in breast cancer patients. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-27.

Shared Segment Analysis and Next-Generation Sequencing Implicates the Retinoic Acid Signaling Pathway in Total Anomalous Pulmonary Venous Return (TAPVR)

Most isolated congenital heart defects are thought to be sporadic and are often ascribed to multifactorial mechanisms with poorly understood genetics. Total Anomalous Pulmonary Venous Return (TAPVR) occurs in 1 in 15,000 live-born infants and occurs either in isolation or as part of a syndrome involving aberrant left-right development. Previously, we reported causative links between TAVPR and the PDGFRA gene. TAPVR has also been linked to the ANKRD1/CARP genes. However, these genes only explain a small fraction of the heritability of the condition. By examination of phased single nucleotide polymorphism genotype data from 5 distantly related TAPVR patients we identified a single 25 cM shared, Identical by Descent genomic segment on the short arm of chromosome 12 shared by 3 of the patients and their obligate-carrier parents. Whole genome sequence (WGS) analysis identified a non-synonymous variant within the shared segment in the retinol binding protein 5 (RBP5) gene. The RBP5 variant is predicted to be deleterious and is overrepresented in the TAPVR population. Gene expression and functional analysis of the zebrafish orthologue, rbp7, supports the notion that RBP5 is a TAPVR susceptibility gene. Additional sequence analysis also uncovered deleterious variants in genes associated with retinoic acid signaling, including NODAL and retinol dehydrogenase 10. These data indicate that genetic variation in the retinoic acid signaling pathway confers, in part, susceptibility to TAPVR.

Ductus arteriosus aneurysm with massive thrombosis of pulmonary artery and fetal hydrops

Ductus arteriosus aneurysm (DAA) is a rare cardiovascular lesion usually diagnosed within the first 2 months of life, or less frequently in the 3rd trimester, by antenatal sonography. The true in utero incidence of DAA is unknown, as most affected fetuses are asymptomatic at birth. Potential complications include thromboembolism, rupture, and death. We report a unique lethal case of a large DAA detected by mid-2nd trimester fetal echocardiography, complicated by stricture and massive occlusive thrombosis extending into the pulmonary artery branches. Stricture and thrombosis of the DAA led to interruption of fetal circulation, cardiac failure, and fetal hydrops, ultimately resulting in fetal demise.

Structure of the fibrinogen gamma-chain integrin binding and factor XIIIa cross-linking sites obtained through carrier protein driven crystallization

The human fibrinogen gamma-chain C-terminal segment functions as the platelet integrin binding site as well as the Factor XIIIa cross-linking substrate and thus plays an important role in blood clot formation and stabilization. The three-dimensional structure of this segment has been determined using carrier protein driven crystallization. The C-terminal segment, gamma-(398-411), was attached to a linker sequence at the C-terminus of glutathione S-transferase and the structure of this fusion protein determined at 1.8 A resolution. Functional studies of the chimeric protein demonstrate that the fibrinogen sequence in the presence of the carrier protein retains its specific functions as ligand for platelet integrin alpha(IIb)beta3 (gpIIb/IIIa) and as a cross-linking substrate for Factor XIIIa. The structure obtained for the fibrinogen gamma-chain segment is not affected by crystal packing and can provide the missing links to the recently reported model of cross-linked fibrin.

Differences between asthma exacerbations and poor asthma control

BACKGROUND

Increased variation in peak expiratory flow (PEF) is characteristic of poorly controlled asthma, and measurement of diurnal variability of PEF has been recommended for assessment of asthma severity, including during exacerbations. We aimed to test whether asthma exacerbations had the same PEF characteristics as poor asthma control.

METHODS

Electronic PEF records from 43 patients with initially poorly controlled asthma were examined for all exacerbations that occurred after PEF reached a plateau with inhaled corticosteroid treatment. Diurnal variability of PEF was compared during exacerbations, run-in (poor asthma control), and the period of stable asthma before each exacerbation.

FINDINGS

Diurnal variability was 21.3% during poor asthma control and improved to 5.3% (stable asthma) with inhaled corticosteroid treatment. 40 exacerbations occurred in 26 patients over 2-16 months; 38 (95%) of exacerbations were associated with symptoms of clinical respiratory infection. During exacerbations, consecutive PEF values fell linearly over several days then improved linearly. However, diurnal variability during exacerbations (7.7%) was not significantly higher than during stable asthma (5.4%, p=0.1). PEF data were consistent with impaired response to inhaled beta2-agonist during exacerbations but not during poorly controlled asthma.

INTERPRETATION

Asthmatics remain vulnerable to exacerbations during clinical respiratory infections, even after asthma is brought under control. Calculation of diurnal variability may fail to detect important changes in lung function. PEF variation is strikingly different during exacerbations compared with poor asthma control, suggesting differences in beta2-adrenoceptor function between these conditions.

Cutaneous vascular response to calcitonin gene-related peptide in psoriasis and normal subjects

To determine whether cutaneous blood vessels in subjects with psoriasis possess a generalized inherently abnormal response to neuropeptides, the effect of three doses of intradermally injected calcitonin gene-related peptide (CGRP) on skin blood flow in normal subjects (n = 10), and on clinically normal skin (greater than 5 cm from psoriatic lesions) in subjects with psoriasis (n = 9) was measured using a laser Doppler technique. Calcitonin gene-related peptide caused a dose-dependent increase in local blood flow in both psoriatic and normal subjects, which was not statistically different between the two groups. This study has shown that the cutaneous vasculature at sites distant from lesions of psoriasis (> 5 cm) is not inherently different from normal skin in its response to CGRP.

Initiating requests during community-based vocational training by students with mental retardation and sensory impairments

Students with mental retardation and deafness or deaf-blindness often need some type of communication system to communicate effectively with communication partners during community-based vocational training. However, students may need specific training to learn how to initiate requests for items or assistance, a skill identified as critical for job success. Students were taught to initiate requests using dual communication boards and gestures. Data were recorded on student performance using a multiple-baseline probe design in which data were collected during baseline, intervention, and generalization phases. Students were able to initiate requests with 80% to 100% accuracy with the communication system at vocational sites. Training students to initiate requests may need to be targeted when students are first learning a job, as this is when most naturally occurring opportunities exist.

Finger sudorometry and assessment of the sudomotor drive

Sudorometry of the finger was carried out using the ventilated capsule method, the aim being to use the level of relative humidity within the sudorometer as an indirect measure of the sudomotor drive. Subjects inserted a finger through a diaphragm of a finger-shaped, temperature-controlled chamber which also contained the humidity sensor. Manoeuvres known to alter the sudomotor drive produced changes in chamber humidity. The relative humidity within the sudorometer became constant after local anaesthesia of the digital nerves and after upper limb sympathectomy, suggesting that fluctuations in the sudorometer output were dependent upon an intact autonomic nervous system. In an environment in which temperature was controlled and arousal effects from the process of measurement were minimised, chamber humidity always increased during a Stroop test, providing a rapid means of indirectly assessing sudomotor drive mechanisms.

Prevalence study of substance abuse in a midwestern city

Illicit substance abuse among pregnant women has been documented in many large metropolitan areas. However, there has been limited documentation in smaller, more traditional cities of America. The urine of 105 viable newborns delivered within a 30-day period was tested for illicit drugs in a blind study. Positive results were obtained in 9.5% of the subjects. The following demographic data were compiled about the subjects: (a) type of identified substance; (b) age of mother; (c) timing of mother's entry into prenatal care; (d) maternal complications; (e) newborn complications; (f) newborn gestational age; and (g) mother's economic status.

Anaplastic seminoma

Fourteen patients with anaplastic seminoma were analyzed retrospectively. At the time of presentation anaplastic seminoma has similar prognosis stage for stage as the classic seminoma. However, the distinctive histologic findings and the high rates of local invasion and of elevations of serum beta-subunit human chorionic gonadotropin serve to distinguish anaplastic seminoma from the classic seminoma. These features, suggesting a possibly greater metastatic potential for anaplastic seminoma, warrant its continued identification as a distinct pathologic subtype.

Acute liver disease associated with sodium valproate

Five patients, four of them children, had acute liver disease after treatment with sodium valproate. Three died. The liver disease began 3-6 months after the start of treatment and was often associated with other side-effects of sodium valproate such as thrombocytopenia and hair loss.

Postoperative hypoglycaemia in small children

Six of 57 children under 4 years old became hypoglycaemic during postoperative recovery from various surgical procedures. Fluids either by mouth or intravenously did not always prevent this. Children at risk could not be predicted on the basis of age or weight-for-age. Small children should be fed as soon as practicable after operations, preferably with milk.