Measurement of Direct-Photon Cross Section and Double-Helicity Asymmetry at sqrt[s]=510 GeV in p[over →]+p[over →] Collisions

We present measurements of the cross section and double-helicity asymmetry A_{LL} of direct-photon production in p[over →]+p[over →] collisions at sqrt[s]=510  GeV. The measurements have been performed at midrapidity (|η|<0.25) with the PHENIX detector at the Relativistic Heavy Ion Collider. At relativistic energies, direct photons are dominantly produced from the initial quark-gluon hard scattering and do not interact via the strong force at leading order. Therefore, at sqrt[s]=510  GeV, where leading-order-effects dominate, these measurements provide clean and direct access to the gluon helicity in the polarized proton in the gluon-momentum-fraction range 0.02<x<0.08, with direct sensitivity to the sign of the gluon contribution.

Delayed CSF rhinorrhea presenting as a lethal acute bacterial meningitis 5 years post trauma

Key clinical message

Delayed presentation of cerebrospinal fluid rhinorrhea is rare following head trauma. It is frequently complicated by meningitis if not addressed in time. This report highlights the importance of its timely management, the lack of which can lead to a fatal outcome.

Abstract

A 33-year-old man presented with meningitis in septic shock. He had a history of severe traumatic brain injury 5 years back following which he had a history of intermittent nasal discharge for the past 1 year. On investigation, he was found to have Streptococcus pneumoniae meningitis, and CT scan of his head showed defects in the cribriform plate which established the diagnosis of meningoencephalitis secondary to cerebrospinal fluid rhinorrhea. The patient did not survive despite appropriate antibiotics.

Peripheral Nerve and Plexus Blocks for Hip Surgery in a Nonagenarian with Severe Cardiac Disease

The hemodynamic alterations and stress response associated with anesthesia and surgery are often poorly tolerated by elderly patients. Regional anesthesia techniques are useful in the elderly as they provide excellent perioperative analgesia with minimal hemodynamic perturbations. We report the case of a 90-year-old man with valvular heart disease and severe left ventricular systolic dysfunction, who underwent dynamic hip screw fixation of fractured femur neck under combined pericapsular nerve group block, lumbar plexus block, and para-sacral sciatic nerve block. We are not aware of any previous report of the combination of these blocks used for surgical anesthesia in hip fracture surgery. Keywords: Geriatric; hip fracture; pericapsular nerve group block; regional anesthesia.

Symptomatic Hyponatremia following Bowel Preparation for Colonoscopy: A Case Report

Colonoscopy is considered a gold standard tool for the diagnostic evaluation of colorectal diseases. Bowel preparation, a pre-requisite for colonoscopy, usually involves ingestion of purgatives for the cleansing of the bowel so that visualization is not obscured during the procedure. Commonly used preparations are sodium phosphate-based solutions, sodium picosulphate and polyethylene glycol. The use of such preparations is associated with electrolyte disturbances, commonly hyponatremia. Hyponatremia is usually seen with sodium phosphate based solutions and is rare with polyethylene glycol. Symptomatic hyponatremia, however, is rare following bowel preparation and is attributable to other factors as well, such as the age of patient, non-osmotic release of antidiuretic hormone and the procedure itself. In this report, we discuss a case of severe symptomatic hyponatremia observed in a 71-year-old gentleman who underwent polyethylene glycol based bowel preparation for colonoscopy.

Topical nitroglycerin for management of peripheral extravasation of vasopressors: a case report

Peripheral route for administration of vasopressors is often opted due to resource limitations or as a rescue until central venous access is established. This, however, is not devoid of complications, the most common being extravasation and tissue injury. Phentolamine is the only drug approved for management of vasopressor extravasation; however, successful use of other agents has been reported. Here we report a case of peripheral extravasation of vasopressors, successfully managed with topical nitroglycerin in intensive care unit in Kathmandu. To our knowledge, this is the first report of such kind from Nepal.

Ankle Surgery in a Patient with Acute Subdural Hematoma Under Combined Lumbar Plexus and Proximal Sciatic Nerve Block - A Case Report

Acute subdural hematoma (aSDH) is commonly encountered in the emergency department in patients with traumatic injuries. If the hematoma is small, non-expanding and asymptomatic, it is managed conservatively. However, other injuries sustained during trauma may warrant surgical intervention, during which anesthetic management becomes challenging. There have been reports of rebleeding in patients with aSDH after undergoing surgery under either general or spinal anesthesia. Here we present a case where ankle surgery for tri-malleolar fracture was successfully performed in a patient with traumatic aSDH under combined lumbar plexus and proximal (para-sacral) sciatic nerve block.

Impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India

OBJECTIVE

To evaluate impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India.

STUDY DESIGN

Before-and-after intervention trial setting: limited resource teaching hospital;

DESIGN

Before and after study.

INTERVENTIONS

A package of simple interventions was evolved. The interventions included: rational admissions and early discharge, entrusting mothers in care-giving, enforcing asepsis routines, aggressive enteral feeding, abandoning unnecessary interventions, protocol-based management, rational antibiotics and training and empowerment of nurses.

STATISTICAL METHODS

The categorical and continuous variables were compared with chi (2) and two-tailed tests, respectively.

RESULTS

Neonatal mortality rate declined significantly during the intervention period as compared to control period (20.3 versus 29.3 per 1000 live births; relative risk 0.69, 95% confidence interval (CI) 0.57 to 0.85). Most significant decline occurred in sepsis-related deaths. The survival of neonates with birth weight 1000 to 1499 improved over two folds (56.7% versus 24.5%, P<0.01). There was a significant decline in antibiotics use (635/878, 72.3% versus 299/897, 23.2%; P=0.00). The duration of stay in neonatal unit was decreased by a mean of 1.5 day (95% CI 0.9 to 2.8 days) after interventions.

CONCLUSIONS

Simple interventions can result in a significant decline in neonatal mortality in hospitals with limited resources. This package is likely to be effective in hospitals with a high proportion of the sepsis deaths.

The effect of metformin on fat distribution and the metabolic syndrome in women with polycystic ovary syndrome--a randomised, double-blind, placebo-controlled trial

OBJECTIVE

To establish whether metformin has a significant action in reducing visceral fat and improving other metabolic parameters in women with polycystic ovary syndrome (PCOS).

DESIGN

Randomised, double-blind, placebo-controlled trial.

SETTING

Reproductive medicine clinic.

POPULATION

Forty women with anovulatory PCOS.

METHODS

Participants were randomised into receiving metformin 500 mg three times a day or placebo for 3 months.

MAIN OUTCOME MEASURES

Fat distribution was measured by computed tomography scan. Secondary outcome measures included serum indices of the metabolic syndrome and evidence of ovulation.

RESULTS

We found no significant differences in any of the measures of fat distribution between the placebo and metformin groups. The metformin group had significantly lower total cholesterol (P= 0.02), low-density lipoprotein cholesterol (P= 0.02) and cholesterol:high-density lipoprotein cholesterol ratio (P= 0.05), but there was no statistically significant treatment effect on androgens, insulin, insulin resistance, triglycerides, ovulation or pregnancy.

CONCLUSIONS

Metformin has no clinically significant effect in reducing visceral fat mass, although it does have a beneficial effect on lipids. This trial lends support to the growing evidence that metformin is not a weight loss drug. Metformin might therefore be used as an adjunct to lifestyle modification in women with PCOS, but not as a substitute for it.

The central issue? Visceral fat mass is a good marker of insulin resistance and metabolic disturbance in women with polycystic ovary syndrome

OBJECTIVE

To establish whether visceral fat mass is the most significant variable correlating with insulin resistance and other metabolic parameters in women with polycystic ovary syndrome (PCOS).

DESIGN

Prospective cross-sectional trial.

SETTING

Reproductive medicine clinic.

POPULATION

Forty women with anovulatory PCOS.

METHODS

Measurements were taken at recruitment, and analysis was performed to define correlations between the outcome measures and the explanatory variables.

MAIN OUTCOME MEASURES

Visceral and subcutaneous fat by computed tomography scan, insulin resistance, anthropometric measures, markers of the metabolic syndrome and androgens.

RESULTS

Strong linear correlation of visceral fat to insulin resistance (r = 0.68, P < 0.001) was observed. There were also statistically significant correlations with fasting insulin (r = 0.73, P < 0.001), homeostasis model assessment beta-cell function (r = 0.50, P = 0.007), triglycerides (r = 0.45, P = 0.003), high-density lipoprotein cholesterol (r = -0.42, P = 0.007), urate (r = 0.47, P = 0.002), Sex hormone binding globulin (r = -0.39, P = 0.01) and luteinising hormone (r = -0.32, P = 0.02). There were no significant correlations of testosterone with fat distribution or metabolic parameters. Insulin resistance showed closest correlation to visceral fat mass (r = 0.68, P < 0.001), then to waist circumference (r = 0.62, P < 0.001), with the weakest correlation being waist:hip ratio (r = 0.36, P = 0.01). The best regression model for predicting insulin resistance is with visceral fat mass and triglycerides as the explanatory variables (r = 0.72, P < 0.001).

CONCLUSIONS

Visceral fat is the most significant variable correlating with metabolic dysfunction in women with PCOS. Our data support the hypothesis that visceral fat either causes insulin resistance or is a very early effect of it. It also implies that reducing visceral fat should reduce insulin resistance which may account for the observations that exercise and weight loss appear to be more effective interventions than pharmacological treatments. The best anthropometric measure of insulin resistance is waist circumference.

Enzymes of Sphingolipid metabolism in Drosophila melanogaster

Sphingolipids are important structural components of membranes that delimit the boundaries of cellular compartments, cells and organisms. They play an equally important role as second messengers, and transduce signals across or within the compartments they define to initiate physiological changes during development, differentiation and a host of other cellular events. For well over a century Drosophila melanogaster has served as a useful model organism to understand some of the fundamental tenets of development, differentiation and signaling in eukaryotic organisms. Directed approaches to study sphingolipid biology in Drosophila have been initiated only recently. Nevertheless, earlier phenotypic studies conducted on genes of unknown biochemical function have recently been recognized as mutants of enzymes of sphingolipid metabolism. Genome sequencing and annotation have aided the identification of homologs of recently discovered genes. Here we present an overview of studies on enzymes of the de novo sphingolipid biosynthetic pathway, known mutants and their phenotypic characterization in Drosophila.

A time for change and a time for equality--infertility services and the NHS

The provision of infertility services has always provoked controversy. On the one hand, patients' groups and clinicians involved with infertile couples have long campaigned against the 'postcode lottery'. On the other hand, commissioners have been reluctant to commit resources to what they see as a low priority in health care. The issue has been brought back into the news with the government's decision to ask the National Institute of Clinical Excellence to review the inequalities in provision of fertility services. This article sets out the evidence for viewing infertility as an illness that deserves public funding, and argues that assisted conception should be viewed in the same light as other chronic non-life-threatening conditions that are currently funded by the NHS.

Serum-ascites albumin gradient: a predictor of esophageal varices with ascites

Other investigators have found that in adults the Serum-Ascites Albumin Gradient (SAAG) to be 1.1 g/dl or greater in the presence of portal hypertension (PTHN) and less than that in its absence. We sought to determine the correlation between the level of SAAG and the complications of PTHN, manifested by the presence of esophageal varices in children with ascites. Our study included 26 patients with cirrhosis, diagnosed by liver biopsy and 14 patients with nephrotic syndrome (NS) diagnosed by established criteria. The SAAG was measured in all patients. The patients with cirrhosis had upper gastrointestinal (GI) endoscopy for assessment of esophageal varices (EV). We found that 84.6% (22 of 26) patients with cirrhosis had High SAAG (> or = 1.1 g/dl) and 15.4% (4 of 26) had low SAAG (< 1.1 g/dl) (p < 0.001). EV was found in 91% (20 of 22) patients with high SAAG and in 50% (2 of 4) patients with low SAAG (p = 0.013). The SAAG differentiated cirrhosis with EV from those without EV (sensitivity = 91%, specificity = 50%, positive predictive value = 91%, negative predictive value = 50% and efficacy = 85%). The high SAAG is a useful means to predict the presence of EV in children with ascites.

Association of reduced selenium status in the aetiology of recurrent miscarriage

OBJECTIVE

To determine whether recurrent miscarriage is associated with reduced selenium status.

DESIGN

Case-control study.

SETTING

Department of Obstetrics and Gynaecology, Glasgow Royal Infirmary and Glasgow Royal Maternity Hospital.

POPULATION

Twenty nonpregnant women with a history of unexplained recurrent miscarriage, and 47 nonpregnant parous women with a history of at least one successful pregnancy and no more than one miscarriage.

METHODS

A 7 mL blood sample from each woman was collected into lithium heparin 'vacutainer' tubes. Samples were centrifuged at 3000 g for 15 minutes, and plasma was extracted and stored at -20 degrees C. Selenium concentrations were measured using a fluorescence spectrophotometer. The selenium concentrations in the two groups were compared and the differences examined using the Student's t test.

MAIN OUTCOME MEASURES

Plasma selenium concentration (microg/L).

RESULTS

The mean selenium concentration for women with a history of unexplained recurrent miscarriage was 67.7 microg/L (SD 16.4). The selenium level for the women with no history of recurrent miscarriage was 70.3 microg/L (SD 12.7). There was no difference in selenium concentrations between the two groups (P = 0.53).

CONCLUSIONS

In this study there is no association between unexplained recurrent miscarriage and reduced selenium status, implying that reduced selenium status is not a factor in the pathogenesis of recurrent miscarriage. We can find no rationale for a trial of selenium therapy in women with a history of recurrent miscarriage.

Bacterial vaginosis and past chlamydial infection are strongly and independently associated with tubal infertility but do not affect in vitro fertilization success rates

OBJECTIVE

To determine the incidence of active vaginal infection in women undergoing IVF, relate it to the cause of infertility, and investigate a relation with the outcome of fresh ET.

DESIGN

Cross-sectional study.

SETTING

Tertiary care infertility referral center.

PATIENT(S)

Two hundred eighty-six women who underwent 344 oocyte recovery procedures for IVF cycles between March 1997 and January 1998.

INTERVENTION(S)

High vaginal swab specimens and endocervical swab specimens were obtained and ELISA serology was performed for detection of Chlamydia species on samples taken immediately before oocyte recovery. The results were related to the cause of infertility and the outcome parameters.

MAIN OUTCOME MEASURE(S)

Pregnancy rates.

RESULT(S)

Seropositivity for Chlamydia species and the presence of bacterial vaginosis both were strongly and independently associated with tubal disease. There was no difference in pregnancy rates in any of the groups regardless of their serologic status for chlamydial infection or current infection with bacterial vaginosis.

CONCLUSION(S)

This study provides further evidence of the pelvic pathogenicity of bacterial vaginosis. However, it shows that women who have bacterial vaginosis or who have been treated for chlamydial infection in the past achieve pregnancy rates with IVF treatment similar to those of women who have no evidence of such infections.

Broad ligament twin pregnancy following in-vitro fertilization

We report the first case of an ectopic twin pregnancy in the broad ligament following in-vitro fertilization and embryo transfer in a patient with a previous ipsilateral (left) salpingo-oophorectomy. The previous surgery was for endometriosis. We discuss the possible contribution of the embryo transfer technique, limitations of preventive measures and importance of transvaginal ultrasound in establishing the diagnosis.

Signaling via mitogen-activated protein kinase kinase (MEK1) is required for Golgi fragmentation during mitosis

We have developed an assay using permeabilized cells to monitor fragmentation of the Golgi complex that occurs during mitosis. Golgi stacks, in permeabilized interphase normal rat kidney (NRK) cells, upon incubation with mitotic extracts undergo extensive fragmentation, and the fragmented Golgi membranes are dispersed throughout the cytoplasm. We find that the continued presence of p34cdc2, the mitosis initiation kinase, is not necessary for Golgi fragmentation. Instead, fragmentation depends on cytosolic mitogen-activated protein kinase kinase 1 (MEK1 or MAPKK1). However, the known cytoplasmic substrates for MEK1, ERK1, and ERK2 are not required for this process. Interestingly, we find a Golgi-associated ERK, which we propose as the likely target for MEK1 in Golgi fragmentation.

The formation of Golgi stacks from vesiculated Golgi membranes requires two distinct fusion events

We have reconstituted the fusion and assembly of vesiculated Golgi membranes (VGMs) into functionally active stacks of cisternae. A kinetic analysis of this assembly process revealed that highly dispersed VGMs of 60-90 nm diameter first fuse to form larger vesicles of 200-300 nm diameter that are clustered together. These vesicles then fuse to form tubular elements and short cisternae, which finally assemble into stacks of cisternae. We now provide evidence that the sequential stack formation from VGMs reflects two distinct fusion processes: the first event is N-ethyl-maleimide (NEM)-sensitive factor (NSF) dependent, and the second fusion event requires an NSF-like NEM-sensitive ATPase called p97. Interestingly, while the earliest steps in stack formation share some similarities with events catalyzing fusion of transport vesicles to its target membrane, neither GTP gamma S nor Rab-GDI, inhibitors of vesicular protein traffic, inhibit stack formation.

Reconstitution of vesiculated Golgi membranes into stacks of cisternae: requirement of NSF in stack formation

We have developed an in vitro system to study the biochemical events in the fusion of ilimaquinone (IQ) induced vesiculated Golgi membranes (VGMs) into stacks of cisternae. The Golgi complex in intact normal rat kidney cells (NRK) is vesiculated by treatment with IQ. The cells are washed to remove the drug and then permeabilized by a rapid freeze-thaw procedure. VGMs of 60 nm average diameter assemble into stacks of Golgi cisternae by a process that is temperature dependent, requires ATP and a high speed supernatant from cell extract (cytosol), as revealed by immunofluorescence and electron microscopy. The newly assembled stacks are functionally active in vesicular protein transport and contain processing enzymes that carry out Golgi specific modifications of glycoproteins. The fusion of VGMs requires NSF, a protein known to promote fusion of transport vesicles with the target membrane in the exocytic and endocytic pathways. Immunoelectron microscopy using Golgi specific anti-mannosidase II antibody reveals that VGMs undergo sequential changes in their morphology, whereby they first fuse to form larger vesicles of 200-300-nm average diameter which subsequently extend into tubular elements and finally assemble into stacks of cisternae.

Impact of television on children

Television viewing has a great impact on various aspects of child's life. This study was carried out at Sir Padampat Mother & Child Health Institute, Jaipur (Rajasthan). The aim was to study the effects of television viewing on a child's eating habits, general physical health, physical activities, interest in study and school performance. Only 250 children of 3-10 years age groups were studied for a period of nine months (January 1992 to September 1992). Average duration of television exposure to an individual child was 18.5 hours per week in the study. Significant changes were observed in a childs' eating habits, weight, physical activity, sleep pattern, interest in study and general physical health. Increase in weight was observed in 19.6% children suggesting that the television viewing may predispose to childhood obesity. In 30.4% cases decrease in physical activity was found, 18.4% children showed decreased interest in study, while 10% children showed decrease in school performance, and sleep pattern was disturbed in 24% children. Medical problems were found in 11.6% children. Significantly two children had precipitation of fits on television viewing.

The effect of three anti-oestrogen drugs on cervical mucus quality and in-vitro sperm-cervical mucus interaction in ovulatory women

The anti-oestrogens, clomiphene citrate, tamoxifen and cyclofenil are commonly used in the treatment of female infertility. Their role in the management of anovulation is well established but there is continuing controversy about their relevance to other areas of management. We have studied the effects of each of these drugs on cervical mucus and sperm-cervical mucus interaction among 23 patients with unexplained infertility. Each patient received all three drugs in an alternative month treatment regime and in addition acted as her own control. The starting point in each patient was randomized. Luteinizing hormone (LH) and oestradiol were measured daily from day 10, and follicle scanning was also undertaken. Cervical mucus quality and sperm-cervical mucus interaction were studied on the day of onset of the LH surge. The use of clomiphene and tamoxifen resulted in a significant reduction in cervical mucus score and sperm-cervical mucus interaction as judged by the distance travelled by the vanguard spermatozoa. Cyclofenil had no effect on these parameters.

Prospective study of short and ultrashort regimens of gonadotropin-releasing hormone agonist in an in vitro fertilization program

OBJECTIVE

To assess the usefulness of the ultrashort regimen of gonadotropin-releasing hormone agonist (GnRH-a) in ovulation induction in an in vitro fertilization (IVF) program.

DESIGN

A prospective randomized trial comparing short and ultrashort regimens of GnRH-a.

SETTING

Aberdeen Assisted Reproduction Unit.

PATIENTS

Forty-eight patients having IVF for the first time were randomized between the two protocols.

MAIN OUTCOME MEASURES

Response to ovarian stimulation and occurrence of spontaneous luteinizing hormone (LH) surges.

RESULTS

In ovulation induction, fertilization, and pregnancy rates the ultrashort regimen produces results that were no different to the short regimen but it did not always prevent an LH surge.

CONCLUSION

The ultrashort regimen can be a useful alternative for ovarian stimulation of patients undergoing IVF.

Prospective study of short and long regimens of gonadotropin-releasing hormone agonist in in vitro fertilization program

OBJECTIVE

To assess the usefulness of a short regimen in ovulation induction in an in vitro fertilization (IVF) program.

DESIGN

A prospective randomized trial was set up to compare long and short regimens of gonadotropin-releasing hormone agonist administration for ovulation induction in IVF.

SETTING

Aberdeen Assisted Reproduction Unit.

PATIENTS

Eighty-seven patients undergoing IVF were randomized between the two protocols. Stimulation regimen was the only variable being tested.

MAIN OUTCOME MEASURES

Stimulation response and occurrence of luteinizing hormone (LH) surges.

RESULTS

There was no difference in the stimulation requirements, response to stimulation, number of follicles aspirated, or the number of oocytes obtained. The fertilization rates, number of embryos transferred, and pregnancy rates were also similar in both groups. Like the long regimen, it prevents the occurrence of a premature LH surge.

CONCLUSION

The short regimen is a useful and cheaper alternative in ovarian stimulation of patients undergoing IVF.

Precipitation test--a rapid method for diagnosis of tuberculous meningitis

Precipitation test (modified Lavinson's test) was conducted in 125 cases of meningitis. Of these, 50 cases (proved cases of tuberculous meningitis) who served as positive controls showed positive response for the precipitation test in 96% and in 25 cases of negative control group (cases of meningitis other than TBM), it showed only 4% positivity. The remaining 50 cases of TBM where the cytological and biochemical findings were not in correlation with clinical diagnosis of TBM, showed 92% positivity for early diagnosis of TBM.

Failure to demonstrate altered gastric emptying in irritable bowel syndrome

In irritable bowel syndrome (IBS), abnormalities of motility have been observed in the esophagus and small bowel, as well as in the colon. In order to investigate gastric function, gastric emptying has been measured in 25 patients with strictly defined IBS and compared with 25 age- and sex-matched controls. A standard radioisotope method for measuring gastric emptying has been employed. There was no significant difference between the two groups (T1/2 gastric emptying, IBS subjects 99.3 +/- 9.4 min, control subjects 104.0 +/- 11.9 min, mean +/- SEM), nor was there any major correlation between different symptom patterns and altered gastric emptying times. The results of the present investigation suggest that future studies on abnormalities in IBS should investigate other aspects of gastric motor function.