Nuclear F-actin Cytology in Oral Epithelial Dysplasia and Oral Squamous Cell Carcinoma.

Oral cavity cancer has a low 5-y survival rate, but outcomes improve when the disease is detected early. Cytology is a less invasive method to assess oral potentially malignant disorders relative to the gold-standard scalpel biopsy and histopathology. In this report, we aimed to determine the utility of cytological signatures, including nuclear F-actin cell phenotypes, for classifying the entire spectrum of oral epithelial dysplasia and oral squamous cell carcinoma. We enrolled subjects with oral potentially malignant disorders, subjects with previously diagnosed malignant lesions, and healthy volunteers without lesions and obtained brush cytology specimens and matched scalpel biopsies from 486 subjects. Histopathological assessment of the scalpel biopsy specimens classified lesions into 6 categories. Brush cytology specimens were analyzed by machine learning classifiers trained to identify relevant cytological features. Multimodal diagnostic models were developed using cytology results, lesion characteristics, and risk factors. Squamous cells with nuclear F-actin staining were associated with early disease (i.e., lower proportions in benign lesions than in more severe lesions), whereas small round parabasal-like cells and leukocytes were associated with late disease (i.e., higher proportions in severe dysplasia and carcinoma than in less severe lesions). Lesions with the impression of oral lichen planus were unlikely to be either dysplastic or malignant. Cytological features substantially improved upon lesion appearance and risk factors in predicting squamous cell carcinoma. Diagnostic models accurately discriminated early and late disease with AUCs (95% CI) of 0.82 (0.77 to 0.87) and 0.93 (0.88 to 0.97), respectively. The cytological features identified here have the potential to improve screening and surveillance of the entire spectrum of oral potentially malignant disorders in multiple care settings.

CTA in preoperative planning for DIEP breast reconstruction: what the reconstructive surgeon wants to know. A modified Delphi study.

AIM: To gather expert reconstructive surgical opinion to define and rank the surgically most important anatomy and provide guidance for report content to radiologists when reading a preoperative computed tomography angiography (CTA). MATERIALS AND METHODS: A modified Delphi approach was used, involving a panel of 13 microsurgery experts across North America. Data from three consecutive online surveys were collected and returned to the respondents in the subsequent survey, allowing each respondent to see the range of opinions from other field experts. RESULTS: Response rates were 62%, 77%, and 69% for each of the three survey rounds, respectively. The panel identified that the most important perforator characteristics in selecting the optimal perforator are diameter of the vein, perforator location within the flap, and diameter of the artery, respectively. The stated preference was for perforators located below the umbilicus. If no suitable perforator was located below the umbilicus, the panel would consider perforators up to 2 cm above the umbilicus. The most important considerations for the preoperative radiology planning report are: the size of the perforator vein, perforator location relative to landmarks, and the size of the perforator artery. DISCUSSION: Based on the panel of expert reconstructive microsurgeons, the most surgically important anatomical considerations to be assessed and included in preoperative CTA reports for DIEP flap breast reconstruction were determined. The recommendations for reporting of preoperative DIEP breast reconstructions are presented, which, in consultation with local surgeons, can be used to form a template for reporting.

Adenosine kinase, glutamine synthetase and EAAT2 as gene therapy targets for temporal lobe epilepsy.

Astrocytes are an attractive cell target for gene therapy, but the validation of new therapeutic candidates is needed. We determined whether adeno-associated viral (AAV) vector-mediated overexpression of glutamine synthetase (GS) or excitatory amino-acid transporter 2 (EAAT2), or expression of microRNA targeting adenosine kinase (miR-ADK) in hippocampal astrocytes in the rat brain could modulate susceptibility to kainate-induced seizures and neuronal cell loss. Transgene expression was found predominantly in astrocytes following direct injection of glial-targeting AAV9 vectors by 3 weeks postinjection. ADK expression in miR-ADK vector-injected rats was reduced by 94-96% and was associated with an ~50% reduction in the duration of kainate-induced seizures and greater protection of dentate hilar neurons but not CA3 neurons compared with miR-control vector-injected rats. In contrast, infusion of AAV-GS and EAAT2 vectors did not afford any protection against seizures or neuronal damage as the level of transcriptional activity of the glial fibrillary acidic promoter was too low to drive any significant increase in transgenic GS or EAAT2 relative to the high endogenous levels of these proteins. Our findings support ADK as a prime therapeutic target for gene therapy of temporal lobe epilepsy and suggest that alternative approaches including the use of stronger glial promoters are needed to increase transgenic GS and EAAT2 expression to levels that may be required to affect seizure induction and propagation.

Evaluation of a pharmacist-led, medicines education program for Aboriginal Health Workers.

INTRODUCTION: The health of Indigenous Australians is exceptionally poor compared with that of non-Indigenous Australians. Cardiovascular diseases are the leading cause of death, the death rate being at least 2.7 times higher than the total Australian population. Indigenous Australians also experience underutilisation and reduced quality use of medicines. Aboriginal Health Workers (AHWs) are appropriate members of the healthcare team to provide information about medicines to the Indigenous community. However, despite having an expanding role in medicines management, AHWs have reported they do not have adequate appropriate education to support this role. Community pharmacists in localities with high Indigenous populations are well placed to provide medicines education to AHWs; however, to be successful in this role they need to develop their cultural awareness. The purpose of this study was to evaluate a culturally appropriate, pharmacist-led cardiovascular medicines education program for AHWs. Research questions included: What was the impact of the program on the pharmacists? What were the barriers and facilitators? Was the program useful and acceptable to the AHWs? METHODS: Four educational units were developed in collaboration with AHWs. A purposive sample of community pharmacists from western New South Wales (NSW) attended training involving instruction in the delivery of the program and cultural awareness training. The pharmacists then recruited local AHWs and delivered the program. Evaluation, with respect to the pharmacists, involved a repeated measures, three-phase questionnaire and semi-structured, face-to-face, in-depth interview post-program. Feedback was obtained from the AHWs in the form of a brief survey, and an audit of the attendance at each session was performed. RESULTS: Twelve pharmacists in 10 localities throughout western NSW delivered the program to a total of 47 AHWs. Statistically significant differences in the questionnaire responses, as a result of delivering the education, indicated the pharmacists felt better equipped to deal with Indigenous health issues (p = 0.002, Mann-Whitney U-test); they knew more AHWs in their area (p = 0.005, Mann-Whitney U-test); they felt more confident as educators of AHWs (p = 0.007, Mann-Whitney U-test); and more confident that they had the necessary resources to deliver this education (p = 0.005, Mann-Whitney U-test). The semi-structured interviews revealed that the experience of delivering the education improved pharmacists' confidence as educators and motivated them to develop sustainable relationships with AHWs. A significant barrier lay in the challenges associated with organizing the AHW education sessions, while an important facilitator was prior established relationships with local Aboriginal health services. Evaluation with respect to the AHWs revealed the program reached 80% (n = 47/59) of AHWs within the western NSW region. In total, 46% (n = 27) of AHW participants attended all four educational units and attendance at each educational unit was above 78% (n = 37) throughout. The AHWs reported that they found the program interesting and relevant and were enthusiastic for future collaboration with the pharmacists. CONCLUSIONS: The desire to develop sustainable relationships was seen by all participants as the most positive aspect of the program.

Use of percutaneous gastrojejunostomy feeding tubes in the rehabilitation of stroke patients.

OBJECTIVE: To determine the characteristics of and complications in the rehabilitation of stroke patients in whom percutaneous gastrojejunostomy (PGJ) feeding tubes have been placed. DESIGN: Retrospective cohort study. SETTING: A rehabilitation unit in a tertiary care hospital. PARTICIPANTS: Stroke patients (n = 563) admitted to a tertiary care hospital over a 10-year period. INTERVENTION: PGJ feeding tubes. MAIN OUTCOME MEASURES: Evidence of aspiration in all videofluoroscopic modified barium swallow (VMBS) studies was noted. For patients with a PGJ feeding tube, the following were recorded: stroke location; results of subsequent VMBS reports; length of time from stroke onset to PGJ feeding tube insertion; total time the PGJ feeding tube remained in situ; discharge disposition; and concurrent feeding status. Follow-up was at 1-year poststroke. Complications during the inpatient stay attributable to the PGJ feeding tube were recorded. RESULTS: Thirty-two of all 563 (5.7%) stroke patients admitted and 28 of the 115 (24.3%) proven aspirators, as shown on VMBS studies, had a PGJ feeding tube inserted. Twenty-one of the 563 (3.7%) stroke patients were discharged to the community with PGJ feeding tubes in place. The tubes were inserted on average 37 days after stroke onset. Seventeen of all 88 (19.3%) brainstem stroke patients and 15 of all 29 (51.7%) brainstem stroke patients with documented aspiration had feeding tubes inserted, whereas only 15 of 475 (3.2%) hemispheric stroke rehabilitation patients received a tube. Eleven of 32 (34.3%) patients with a feeding tube were able to resume oral feedings at discharge; within 1 year of discharge, 24 of 32 (75%) had done so. Although there were no serious complications resulting from tube insertions, minor complications were documented in more than 50% of the cases. The tubes were associated with prolonged institutionalization in only 1 case; most patients were discharged on a home tube-feeding program. CONCLUSIONS: PGJ feeding tubes were placed in approximately 1 of every 20 of our stroke rehabilitation patients. One third of the tubes were removed before the patients were discharged from rehabilitation and 75% were removed within 1 year. Insertion of the tubes was most common in patients with evidence of aspiration and in patients with brainstem strokes. Complications caused by the tube were minor and all patients but 1 who were discharged with feeding tubes were able to manage the home tube-feeding program.

Physical and functional correlations of ankle-foot orthosis use in the rehabilitation of stroke patients.

OBJECTIVE: To examine factors associated with the use of ankle-foot orthoses (AFOs) in stroke patients undergoing rehabilitation. DESIGN: Retrospective cohort study of the frequency of AFO use. SETTING: Inpatient rehabilitation unit. PARTICIPANTS: Consecutive stroke patients (n = 423) admitted to an inpatient rehabilitation unit over a 10-year period. INTERVENTION: Discharge with AFO. MAIN OUTCOME MEASURES: Functional outcome measurement scores of patients who were and who were not prescribed an AFO were examined. The groups were compared by using admission and discharge Chedoke-McMaster Stroke Impairment Inventory (CM; each measure analyzed separately), FIMtrade mark instrument (walking, stairs, overall measures), and Berg Balance Scale scores. RESULTS: Ninety-three of the 423 patients (22%) were discharged with an AFO. Overall, they scored consistently lower than patients who were discharged without an AFO. Statistically significant differences (p <.001) were noted between AFO users and nonusers in admission and discharge scores in the arm, hand, leg, and foot components of the CM and the FIM stairs and walking component scores. Average admission and discharge Berg scores differed between the 2 groups (p =.005, p =.013, respectively). Overall FIM scores were also significantly different both at admission and discharge (p <.001, p =.025, respectively). CONCLUSION: Use of AFOs at discharge was associated with significantly lower admission and discharge CM scores of the arm, hand, leg, and foot; FIM walking and stairs scores; total FIM scores; and Berg Balance Scale scores.

Ultrasound and endocrine evaluation of the ovarian cycle and early pregnancy in the Sumatran rhinoceros, Dicerorhinus sumatrensis.

Longitudinal ultrasound and endocrine evaluations were conducted in two adult female Sumatran rhinoceroses (Dicerorhinus sumatrensis) over a period of 12-22 months to learn more about their reproductive physiology. Rectal ultrasonography was conducted to monitor ovarian activity. Blood samples were collected and analysed for progesterone and LH, and faecal samples were analysed for progestin metabolites. One female showed cyclic ovarian activity during the study period, whereas the other female showed no evidence of ovarian activity. The cyclic Sumatran rhinoceros appeared to be an induced ovulator, the first of its kind reported within the Perrisodactyla. Ultrasound examinations of the ovaries revealed the formation of anovulatory haemorrhagic follicles when the animal was not mated. These follicles appeared to undergo varied degrees of luteinization that resulted in irregular faecal progestin profiles. When allowed to mate, the female showed a 21 day reproductive cycle that was reflected in both faecal progestin and serum progesterone profiles. The concentration of serum LH was baseline before mating, increased approximately 30-fold within 1-2 h of intromission and returned to baseline within 22 h. Ovulation occurred within 46 h of copulation. The female conceived three times during the study. Pregnancy was detected using ultrasonography 14-16 days after mating, and the concentration of both serum progesterone and faecal progestins remained high. Early embryogenesis appeared to be similar to that in horses. However, each pregnancy terminated unexpectedly within the first 3 months of gestation. This study demonstrates the important role that basic research and reproductive technology can play in developing a natural breeding programme for an endangered animal in captivity.

Social issues in the rehabilitation of younger stroke patients.

OBJECTIVES: To study social factors and outcomes in stroke rehabilitation patients under the age of 50. STUDY DESIGN: Retrospective chart review examining (1) martial status and employment status on admission and at 3 months post discharge, (2) discharge destination, (3) the presence of absence of children under the age of 16, and (4) psychosocial difficulties as recorded by staff during hospitalization. SUBJECTS AND SETTING: Eighty-three consecutive stroke patients under the age of 50 admitted to a Canadian tertiary-care hospital rehabilitation unit. MAIN OUTCOME MEASURES: Discharge destination and primary caregiver at discharge, and return to work and marital separation 3 months after rehabilitation discharge. RESULTS: Of the 55 patients with spouses, 8 (14.5%) separated within 3 months of hospital discharge. Fifteen of the 83 patients (18.1%) were not able to return to their premorbid place of residence; 4 (4.8%) required institutionalization. Of the 64 patients employed outside the home or studying at the time of their stroke, only 13 (20.3%) were able to return to work within 3 months of their discharge to home. Only 9.4% of those working full-time were able to return to full-time employment. CONCLUSIONS: Rehabilitation of young stroke patients is associated with a variety of social problems, including marital breakup, child care responsibilities, and return to employment, which are uniquely important in this age group.

Midface fractures.

Fractures of the middle portion of the facial skeleton are commonly referred to as midface or LeFort fractures. While significant progress has been made in terms of evaluation and treatment of such fractures, they remain a challenge for the maxillofacial surgeon. In this section, we will review the principles of midface fracture evaluation and repair, emphasizing the importance of understanding biomechanics and controversies that exist in respect to repair sequencing.

Fetal surveillance and monitoring legal issues revisited.

The issue of obstetric litigation and electronic fetal monitoring (EFM) is revisited. The controversy in the medical literature that suggests that we are in an era fraught with both medical and legal dilemmas in the use of EFM is explored. The role of the nurse expert, the standard of care, and case studies are presented that demonstrate the need for obstetric nurses to be competent in EFM, the physiology and pathophysiology of labor, and the standard of care to which they are held accountable. Suggestions are made for risk management in the intrapartum setting.

Frequency of videofluoroscopic modified barium swallow studies and pneumonia in stroke rehabilitation patients: a comparative study.

OBJECTIVE: To study the association between the frequency of videofluoroscopic modified barium swallow (VMBS) studies and the incidence of pneumonia in stroke rehabilitation patients. DESIGN: Retrospective comparative study. SUBJECTS AND SETTING: Five hundred sixty-three consecutive stroke patients admitted to one hospital rehabilitation unit in London, Ontario, Canada were compared with 461 consecutive stroke patients admitted to another hospital rehabilitation unit in the same city. INTERVENTIONS: The number of initial and total VMBS studies and the timing from stroke onset to initial VMBS studies. MAIN OUTCOME MEASURE: Incidence of pneumonia. RESULTS: At the first hospital, 146 patients (25.9%) had 232 total VMBS studies performed, whereas at the second hospital 57 patients (12.4%) had 73 total studies (p<.001). For the first 15 days there was no significant difference in the number of initial VMBS studies performed (8.2% vs. 9.2%). There was a marked difference in the number of initial VMBS studies performed after 15 days (17.2% vs. 2.0%, p<.0001). The difference between the hospitals in the number of VMBS studies in patients with brain stem strokes was not statistically significant, but for patients with hemispheric stroke, the difference was statistically significant. Pneumonia developed in 12 patients at the first hospital (2.1%) and 10 patients at the second hospital (2.2%), a difference that was not significant. CONCLUSIONS: The more frequent use of VMBS beyond 15 days after stroke was not associated with a change in the incidence of pneumonia among hemispheric stroke rehabilitation patients, assuming the two units were otherwise similar.

Poststroke seizures in stroke rehabilitation patients.

The incidence, seizure type, location and type of stroke, and anticonvulsant medications, including adverse effects, were studied in a stroke rehabilitation population. Of 563 consecutive stroke patients admitted to the rehabilitation unit, 14 had a history of a seizure and were excluded from the primary study group. Of the remaining 549 stroke rehabilitation patients, 43 (7.8%) suffered a poststroke seizure (PSS). When only hemispheric patients were studied, the incidence of poststroke seizures rose to 43 of 460 (9.3%) as no brainstem stroke patients suffered seizures. The average age of the PSS patients was 55.4 years. The incidence of PSS in all stroke infarction patients was significantly smaller (22 of 450, 4.9%) when compared with hemorrhagic strokes (21 of 99, 21.2%) (P<.001). The incidence of PSS among hemispheric infarcts was 22 of 379 (5.8%) versus 21 of 81 (25.9%) of hemispheric hemorrhagic strokes (P<.001). Twenty-six PSS patients had primarily cortical involvement, 13 had both cortical and subcortical involvement, and only 4 had primarily subcortical involvement. Seizures occurred within the first 24 hours in 23.8% of stroke patients, 52.4% within the first week, in 66.7% within the first month, in 83.3% within the first 6 months, and in 88.1% within the first year. In the 43 patients with PSS, 19 (44.2%) were reportedly focal in nature, 12 (27.2%) were generalized, and 6 (14.0%) were focal with secondary generalization. Three (7.0%) were complex-partial seizures and 3(7.0%) were of an undetermined type. Of the 14 stroke rehabilitation patients excluded from the study group because of a prestroke seizure, 6 (42.9%) suffered a PSS in contrast to the 43 of 549 (7.8%) with no premorbid history of a seizure (P<.001).

Development of embryos produced by intracytoplasmic sperm injection of cat oocytes.

Development of cat oocytes following intracytoplasmic sperm injection (ICSI) and in vitro fertilization (IVF) was compared in two experiments. Domestic cat donors (used as a model for wild felids) were treated with 150 IU equine chorionic gonadotrophin (eCG) on treatment day 1 or a total of 10-15 IU of follicle-stimulating hormone (FSH) over four days, followed by 100 IU human chorionic gonadotrophin (hCG) on day 5 and follicular aspiration 24-26 h later. A jaguarundi (Herpailurus yaguarondi) female was stimulated twice with FSH (20 IU) or eCG (300 IU) and hCG (250 or 300 IU) before oocyte recovery. After storage at 4 degrees C, domestic cat semen was washed and processed. For ICSI, denuded oocytes were each injected with an immobilised spermatozoon. IVF oocytes were co-incubated with 5 x 10(4) motile spermatozoa/0.5 ml for 4-6 h. Noncleaving oocytes were fixed and stained 24-28 h after injection or insemination. Presumptive zygotes were cultured before transfer on day 5 (experiment I only) or evaluation on day 7 (experiments I and II). In experiment I, fertilization frequency was 67.9% (72/106) and 58.1% (122/210) for IVF and ICSI oocytes, respectively (P > 0.05). Most noncleaving ICSI oocytes (71/88, 80.7%) at 24 h were at metaphase II, of which half (35/71, 49.3%) had an activated spermatozoon (n=4) or premature chromatin condensation (PCC, n=31) of the sperm head. All 69 day 7 IVF embryos developed to morulae (> 16-cells, 46.7%) or blastocysts (53.3%), and 59/63 (93.7%) ICSI embryos reached the morula (50.8%) or blastocyst (42.9%, P > 0.05) stage. Mean cell number in IVF and ICSI embryos was 136 and 116 (P > 0.05); morulae had 77 and 46 (P < 0.05) and blastocysts had 187 and 209 (P > 0.05) cells, respectively. After transfer of 10 or 11 day 5 ICSI morulae to each of four recipients, a total of three kittens were born to two dams at 66 or 67 days. Of 18 fair-to-good quality oocytes recovered from a jaguarundi on two occasions, 10 (55.6%) embryos were produced by ICSI with fresh (n=5) or frozen (n=5) conspecific spermatozoa, but no jaguarundi kittens were born after transfer of these embryos to domestic cat recipients. In experiment II, cleavage frequency following IVF (15/17, 88.2%) and ICSI (31/38, 81.6%) was higher (P < 0.05) than following sham ICSI (13/35, 37.1%). Mean cell number (27 cells) and blastocyst development (0%) on day 7 was lower (P < 0.05) in the sham ICSI group than in the ICSI group (45 cells, 15.6% blastocysts) which, in turn, was lower (P < 0.05) than the IVF group (94 cells, 46.7% blastocysts). We have demonstrated that ICSI can be applied successfully in domestic felids and suggest that the technique will effectively augment other biotechniques being developed for enhancing reproduction in endangered felids.

Black churches as therapeutic systems: a group process perspective.

This article examines Black churches as therapeutic systems that provide psychological and physical support to African American communities. Systems theory and group relations theory are used as conceptual frameworks to discuss Black churches as indigenous community resources. Instrumental to a systems approach is an understanding of Black churches and the religious experiences they support as part of a dynamic process that may vary across churches while maintaining certain basic similarities. It is also important to explore how Black churches may function differently from one another in addressing the needs of their membership and surrounding community. Consequently, a group process perspective is used to examine how roles and functions of the church may vary as they relate to their particular congregation. Examining the role of Black churches as supportive networks provides invaluable information to professional health providers who are interested in working with Black churches as community-based organizations.

Development of a research-based standard for assessment, intervention, and evaluation of pain after neonatal and pediatric cardiac surgery.

This analysis of retrospective and prospective data quantified children (age range 0-18 years, total n = 132) during their stay in a cardiothoracic intensive care unit and examined pain management and sedation practices. Data on both factors that could potentially affect pain and its management, and analgesics/sedatives ordered for and administered to subjects were collected from chart review. In the prospective group, pain intensity was measured twice daily using the Wong-Baker FACES Pain Rating Scale. Repeat cardiac surgical procedure subjects reported significantly more pain than nonrepeat subjects on the first postoperative night. Subjects with sternal incisions reported significantly more pain than subjects with submammary incisions. Not all subjects were premedicated with analgesia for invasive procedures. Significantly greater amounts of analgesia were received by the 0-3 year-old subjects. Large amounts of sedation were used, especially in children under 3 years of age. The results prompted development of a nursing standard to assess and manage pain and sedation in this population.

In vitro and in vivo development of embryos produced by in vitro maturation and in vitro fertilization of cat oocytes.

Cumulus-oocyte complexes of domestic cats were classified by morphology of ooplasm (A = good, B = fair, C = poor) and cultured for 24 h in TCM 199 with gonadotrophins (eCG, FSH, hCG or FSH/hCG). More of type A oocytes (52%) underwent in vitro maturation (IVM) than of type B (41%) or type C (17%). The gonadotrophin source did not affect frequency of IVM of type A (50-53%) or type B (38-44%) oocytes, but IVM of type C oocytes in hCG or FSH/hCG (27%/19%) was about double that in eCG or FSH alone (13%/10%). After IVF, frequency of cleavage for type A (54%), B (41%) and C (26%) oocytes was similar to the IVM frequency of the equivalent type. After 7 days, development to the morula (M) stage in vitro was similar among types (47-58%); however, higher percentages of type A and B oocytes developed to blastocysts (Bl), 31% and 29%, respectively, than of type C (15%). After transfer of day 5 (n = 70) or 6 (n = 32) M and Bl to day 4 or 5 recipients in trial 1 (n = 4) and 2 (n = 3), respectively, the three recipients in trial 2 gave birth to four live kittens. Development in vitro to M of IVM/IVF embryos frozen in propanediol plus sucrose during early cleavage was similar (64-69%) to that of cohort controls (64%), but Bl formation was reduced (13-17% versus 32%). Damage to the zona pellucida after plunging into liquid nitrogen at -30 degrees C was higher (11%) than that of the embryos cooled at 10 degrees C min-1 from -30 degrees C to -150 degrees C before storage (2%).

Birth of a western lowland gorilla (Gorilla gorilla gorilla) following in vitro fertilization and embryo transfer.

A 21-year-old multiparous female exhibiting 31-41 day menstrual cycles was given hFSH (225 IU/day, Metrodin 75, from cycle day 3 through 9 (menses = day 1) and hCG (10,000 IU, Profasi, on day 10 to stimulate follicular development. At 35 h after hCG, under isoflurane (AErrane) anesthesia, follicles were aspirated by controlled suction under transvaginal ultrasound guidance. Metaphase II oocytes (n = 11) were placed in modified human tubal fluid (mHTF, 100 microliters) medium under oil at 37 degrees C in humidified 5% CO2. Frozen semen, collected by voluntary ejaculation, was thawed (70 degrees C H2O bath, 6 sec), diluted slowly, centrifuged, and resuspended in mHTF, and 160,000 motile spermatozoa/ml were added at 6 h after oocyte recovery. At 21 h postinsemination (p.i.) eight oocytes were at the two-cell stage, five were cryopreserved, and three were cultured to the six- to eight-cell stage in mHTF with granulosa cells before transcervical uterine transfer at 47 h p.i. using a Teflon catheter. Micronized progesterone (400 mg/d) was orally administered for 10 weeks posttransfer (p.t.). Ultrasound examination revealed a single fetus at 15 weeks p.t., and unassisted delivery of a live 1.37 kg female infant occurred at 29 weeks. Am. J. Primatol. 41:247-260, 1997.

Gain changes in the accommodative convergence cross-link.

The output of the accommodative vergence cross-link, the AC/A ratio, was measured before and after subjects viewed through a telestereoscope which increased their interocular separation (pd) approximately fourfold. The initial paradigm was designed to force an increase in the AC/A ratio in that subjects alternately fixated targets set at differing distances. In this paradigm, the varying vergence demands could not be met by a constant increase in phasic or tonic vergence responses. In a second paradigm, only one target was viewed at a fixed position from the eye. Now the constant vergence demand could be met by a set increase in phasic and/or tonic vergence. A significant increase in the AC/A ratio was found in the two-target study but not in the single-target study. Increases in the accommodative vergence gain did show considerable individual differences. Tonic vergence changes were interpolated from the data. This parameter increased significantly in both cases but more so when two targets were alternately fixated. This finding is consistent with current near triad models which predict that accommodative convergence input acts along with disparity vergence input to increase tonic levels of convergence. When AC/A ratios were calculated using clinical measures of the phoria at 6 and 0.4 m, increases were found in the two-target study and to a lesser degree in the single-target study. This clinical method of AC/A measure appears to have been confounded by changes in tonic vergence.