Expression of genes controlling steroid metabolism and action in granulosa-lutein cells of women with polycystic ovaries.

INTRODUCTION: Aberrant function of granulosa cells has been implicated in the pathophysiology of PCOS. MATERIALS & METHODS: Granulosa lutein (GL) cells were collected during oocyte retrieval for IVF/ICSI. RT-qPCR was used to compare gene expression between 12 control women, 12 with ovulatory PCO and 12 with anovulatory PCOS. To examine which genes are directly regulated by androgens, GL cells from an additional 12 control women were treated in-vitro with 10 nM dihydrotestosterone (DHT). RESULTS: GL cells from women with PCOS showed reduced expression of CYP11A1 3-fold (p = 0.005), HSD17B1 1.8-fold (p = 0.02) and increased expression of SULT1E1 7-fold (p = 0.0003). Similar results were seen in ovulatory women with PCO. GL cells treated with 10 nM DHT showed a 4-fold (p = 0.03) increase in expression of SULT1E1 and a 5-fold reduction in SRD5A1 (p = 0.03). CONCLUSIONS: These findings support the notion that aberrant regulation of steroid metabolism or action play a part in ovarian dysfunction in PCOS.

The Welsh Blood Service - 70 years of continuous change.

The National Blood Transfusion Service (NBTS) in England and Wales was established as a single entity in 1946 and operated as such for almost half a century. During those 50 years, the blood service in Wales, as in the rest of the UK, saw many technological and operational changes. The automation of donation testing, the introduction of successive layers of microbiological screening, the creation of the Tissue Typing Laboratory (later renamed the Welsh Transplantation and Immunogenetics Laboratory) and the development of information technology brought - over a relatively long period - highly significant improvements to an organisation that had begun life as an Emergency Medical Service. Differing funding and reporting arrangements for the Welsh and English blood services made little difference in practice, but the devolution of government following the 1997 referendum in Wales would have a profound influence. Four years before the Government of Wales Act (1998) was passed through the UK parliament, the National Blood Authority (NBA) assumed executive control of the English blood services but not the blood service in Wales. The Scottish National Blood Transfusion Service and the Northern Ireland Blood Transfusion Service had been created as independent organisations in 1946; thus, the scene was set for diversification between the four independent blood services, each operating in different political environments with different funding streams. The creation of the UK Blood Services Forum and its Joint Professional Advisory Committee in 1999 has, however, ensured consistency in professional matters. The blood transfusion service in Wales, in its new headquarters in Talbot Green, became known as the Welsh Blood Service (WBS), or Gwasanaeth Gwaed Cymru in Welsh, reporting for most of its life to the Velindre NHS Trust, part of NHS Wales. Considerable changes would impact the WBS in the 21st century. Social changes would mean that the role of recruitment and marketing would become ever more important, although the impact of this was lessened somewhat by a decreasing demand for blood following the Better Blood Transfusion initiatives. The Medicines and Healthcare Products Regulatory Agency found new powers and impetus after the so-called EU Blood Directive was transposed into British law, and the inspection regime became significantly more onerous, requiring more resources to be put in this area. A strategic review found that some parts of the service required extensive modernisation, such as the information technology system in use and the deployment of staff on the blood collection teams, and these matters were attended to. The review also prompted the Welsh Government to consider the question of blood supply to and blood collection in North Wales, which had been the remit of the Liverpool Centre since the establishment of the NBTS in 1946. The Welsh Government duly announced the creation of an all-Wales Blood Service, and finally, in May 2016, 70 years after its creation, the WBS took over responsibility for blood collection and blood provision in the whole of Wales.

Postharvest Quarantine Treatments for Diaphorina citri on Infested Curry Leaves.

Studies were conducted to evaluate treatments that reduce survival and attachment of Diaphorina citri nymphs on infested curry leaves (Bergera koenigii). Decontamination of curry leaves infested with D. citri in relation to disinfectant (none or Pro-San), temperature (0, 40, and 50°C), and treatment duration (0, 5, 10, and 20 min) was examined using a split-split plot design. Experiments were performed three times. Treatment duration did not significantly affect D. citri nymph survival or removal (P > 0.2). Temperature and disinfectant each significantly affected D. citri nymph survival and removal (P < 0.031). The interaction of temperature and disinfectant was significant with respect to nymph survival (P < 0.0001) but did not significantly affect removal (P = 0.4589). Tissue damage was significantly affected by temperature (P = 0.0056), duration (P = 0.0023), the interaction of temperature and duration (P = 0.0320), and the interaction of disinfectant, temperature, and duration (P = 0.0410). Of the treatments resulting in 100% D. citri nymph mortality on infested curry leaves, 40°C for 5 min with Pro-San was accompanied with the least proportion of curry leaf tissue damage (0.14 greater than untreated control, P = 0.25). Results from these studies may be useful in formulation of future regulatory policies regarding trade of citrus foliage, especially those used as condiments.

Identification of quantitative trait loci (QTL) for resistance to Fusarium crown rot (Fusarium pseudograminearum) in multiple assay environments in the Pacific Northwestern US.

Fusarium crown rot (FCR), caused by Fusarium pseudograminearum and F. culmorum, reduces wheat (Triticum aestivum L.) yields in the Pacific Northwest (PNW) of the US by as much as 35%. Resistance to FCR has not yet been discovered in currently grown PNW wheat cultivars. Several significant quantitative trait loci (QTL) for FCR resistance have been documented on chromosomes 1A, 1D, 2B, 3B, and 4B in resistant Australian cultivars. Our objective was to identify QTL and tightly linked SSR markers for FCR resistance in the partially resistant Australian spring wheat cultivar Sunco using PNW isolates of F. pseudograminerarum in greenhouse and field based screening nurseries. A second objective was to compare heritabilities of FCR resistance in multiple types of disease assaying environments (seedling, terrace, and field) using multiple disease rating methods. Two recombinant inbred line (RIL) mapping populations were derived from crosses between Sunco and PNW spring wheat cultivars Macon and Otis. The Sunco/Macon population comprised 219 F(6):F(7) lines and the Sunco/Otis population comprised 151 F(5):F(6) lines. Plants were inoculated with a single PNW F. pseudograminearum isolate (006-13) in growth room (seedling), outdoor terrace (adult) and field (adult) assays conducted from 2008 through 2010. Crown and lower stem tissues of seedling and adult plants were rated for disease severity on several different scales, but mainly on a numeric scale from 0 to 10 where 0 = no discoloration and 10 = severe disease. Significant QTL were identified on chromosomes 2B, 3B, 4B, 4D, and 7A with LOD scores ranging from 3 to 22. The most significant and consistent QTL across screening environments was located on chromosome 3BL, inherited from the PNW cultivars Macon and Otis, with maximum LOD scores of 22 and 9 explaining 36 and 23% of the variation, respectively for the Sunco/Macon and Sunco/Otis populations. The SSR markers Xgwm247 and Xgwm299 flank these QTL and are being validated for use in marker-assisted selection for FCR resistance. This is the first report of QTL associated with FCR resistance in the US.

Prevalence of victims of torture in the health screening of quota refugees in New Zealand during 2007-2008 and implications for follow-up care.

New Zealand annually accepts approximately 750 quota refugees from around the world for resettlement in New Zealand. The humanitarian nature of the quota composition consists of those who are determined by the United Nations refugee agency to be in high need of immediate protection, a large proportion of medical and disability cases, and women and children at risk. Quota refugees arrive in group intakes and participate in assessment and orientation for the first 6 weeks at the national Mangere Refugee Resettlement Centre in South Auckland. This paper describes the findings of screening for refugees with a history of torture during 2007-2008. There were 144 refugees or 19.2% of the new arrivals found to have histories of torture during this period. The implications for future research, and follow-up care of people who have survived torture are discussed.

HIV vaccine preparedness studies in the non-organization for economic co-operation and development (non-OECD) countries.

HIV vaccine development remains an urgent priority. Vaccine preparedness studies to assess feasibility are an important precursor to HIV vaccine trials. Studies such as these have taken place in many non-Organization for Economic Co-operation and Development (non-OECD) countries using diverse cohorts. This article is a systematic review of retention rates and willingness to participate (WTP) in HIV vaccine trials. Studies took place in Brazil, the Democratic Republic of Congo, Haiti, India, Russia, Thailand, and several sub-Saharan African countries. Studies generally reported recruitment of high-risk individuals. Of 33 studies we identified, retention was assessed in 16 studies, and the 12-month retention ranged from 77 to 85%. Willingness to participate was assessed in 21 studies. Willingness to participate ranged from 23 to 100%, and increased knowledge was associated with an increased WTP. Vaccine preparedness studies have taken place using diverse cohorts in the non-OECD countries. In general, retention rates and WTP have been adequate to conduct HIV vaccine trials. Educational programs to improve knowledge about HIV vaccines may contribute to better follow-up and an increased WTP in these countries.

A simple technique of laparoscopic port closure allowing wound extension.

Reliable and safe access to the abdominal cavity and efficient removal of the resected gallbladder are essential to laparoscopic cholecystectomy. The unpredictable size of the cholecystectomy specimen can sometimes lead to frustration at the time of removal. A simple technique has been developed that allows for tissue extraction and easy fascial closure regardless of the size of the specimen. This is achieved by using a four bite "U-shaped" purse string at the time of Hasson insertion, with cephalad advancement of the proximal two bites. This allows for variable wound extension and secure closure, without the need for additional sutures.

Has nonoperative management of solid visceral injuries adversely affected resident operative experience?

The purpose of this study was to assess the impact of increased use of nonoperative management of blunt injuries to the spleen or liver on surgical residents' operative experience with solid visceral injuries. We conducted a 10-year retrospective study of blunt spleen and liver injuries at a state-designated Level I trauma center and a survey of chief residents' operative experience with splenic and hepatic injuries from blunt trauma during the same time period. From 1990 through 1999, 431 patients were admitted with splenic injuries and 634 patients were admitted with liver injuries; 350 splenic injuries (81%) were due to blunt trauma; 317 liver injuries (50%) were caused by blunt mechanisms. In 1990 100 per cent of patients with splenic injuries and 93 per cent of those with liver injuries underwent surgery for those injuries. These rates were 19 and 28 per cent respectively in 1999. The number of patients with blunt solid visceral injuries increased more than fourfold from 1990 through 1999. The number of operations for splenic and hepatic injuries performed by chief residents did not decline significantly during this time period (5.5 cases per chief resident in 1990; 4.6 cases per chief resident in 1999). The increased numbers of patients with solid visceral injuries were due to two factors: increased proportion of blunt trauma admissions especially from motor vehicle collisions and improved recognition of spleen and liver injuries by expanded use of CT scans. We conclude that nonoperative management of blunt solid visceral injuries does not necessarily lead to a diminution of operations nor jeopardize resident education. However, trauma volumes must be high enough to support adequate operative experience.

An ecological perspective on in-stream temperature: natural heat dynamics and mechanisms of human-caused thermal degradation.

While external factors (drivers) determine the net heat energy and water delivered to a stream, the internal structure of a stream determines how heat and water will be distributed within and exchanged among a stream's components (channel, alluvial aquifer, and riparian zone/floodplain). Therefore, the interaction between external drivers of stream temperature and the internal structure of integrated stream systems ultimately determines channel water temperature. This paper presents a synoptic, ecologically based discussion of the external drivers of stream temperature, the internal structures and processes that insulate and buffer stream temperatures, and the mechanisms of human influence on stream temperature. It provides a holistic perspective on the diversity of natural dynamics and human activities that influence stream temperature, including discussions of the role of the hyporheic zone. Key management implications include: (1) Protecting or reestablishing in-stream flow is critical for restoring desirable thermal regimes in streams. (2) Modified riparian vegetation, groundwater dynamics, and channel morphology are all important pathways of human influence on channel-water temperature and each pathway should be addressed in management plans. (3) Stream temperature research and monitoring programs will be jeopardized by an inaccurate or incomplete conceptual understanding of complex temporal and spatial stream temperature response patterns to anthropogenic influences. (4) Analyses of land-use history and the historical vs contemporary structure of the stream channel, riparian zone, and alluvial aquifer are important prerequisites for applying mechanistic temperature models to develop management prescriptions to meet in-channel temperature goals.

Anal carcinoma arising from condyloma acuminata.

Condyloma acuminata is a common anorectal condition that frequently requires surgical evaluation and treatment. We have noted an increased incidence of anal carcinoma in patients with condyloma acuminata. The purpose of this study is to review the incidence of malignant transformation of condyloma in our recent experience. We conducted a 5-year retrospective review of patients with condyloma acuminata treated at a university medical center that serves as a major referral center for the state. From May 1994 through May 1999 257 patients were treated for anal condyloma. During the same time period 74 patients were diagnosed with squamous cell carcinoma of the anus; nine of these patients also had condyloma acuminata (12.2% of patients with anal carcinoma). All nine were immunosuppressed by illness and/or medication. The extent of carcinoma at diagnosis ranged from stage 0 (carcinoma in situ) to stage IVb. Overall 3.5 per cent of patients with condyloma acuminata also had squamous cell carcinoma of the anus. One patient with stage IVb disease died shortly after initial evaluation. Two patients with advanced disease required extensive surgical intervention and had complex postoperative courses. Malignant transformation of condyloma acuminata may be increasing in incidence. This disease progression can be insidious and may be fatal. Screening of high-risk patients might be of value, and more aggressive early management of condyloma may prevent the development of malignancy.

Determination of polychlorinated dibenzo-p-dioxin and dibenzofuran congeners in air particulate and marine sediment standard reference materials (SRMs).

Due to the limited number of environmental matrix certified reference materials (CRMs) with assigned values for natural levels of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), an interlaboratory study was undertaken by the National Institute of Standards and Technology (NIST) and Environment Canada to establish reference concentration values for selected PCDD/Fs in two well-characterized NIST Standard Reference Materials (SRMs): SRM 1649a (Urban Dust) and SRM 1944 (New York/New Jersey Waterway Sediment). Results from 14 laboratories were used to provide reference values for the seventeen 2, 3, 7, 8-substituted PCDD/F congeners, the totals for individual tetra- through hepta-substituted PCDD/F homologues, and the total amount of tetra- through hepta-substituted PCDD/Fs. The mass fractions for the individual 2, 3, 7, 8-substituted congeners range from approximately 0.01 microg/kg to 7 microg/kg dry mass.

Laparoscopic Tenckhoff catheter insertion: a prospective study of a new technique.

BACKGROUND: This study describes a new technique of laparoscopic Tenckhoff catheter insertion. METHODS: During a 12-month period, 53 consecutive patients requiring insertion of peritoneal dialysis catheters were studied prospectively. A new technique of laparoscopic insertion was developed. RESULTS: Forty-eight patients out of 49 (98%) had successful insertion. Four patients were excluded with active peritonitis. There was an early complication rate of 8% (4/49) and a late complication rate of 14% (7/49). There was 12% overall failure of catheter with a mean follow up of 6 (1-13) months. CONCLUSION: This new laparoscopic technique maximizes the advantages of laparoscopic surgery and has complication rates which compare favourably with other open and laparoscopic techniques.

Rectus abdominis muscle free flap harvest by laparoscopic sheath-sparing technique.

Previous reports of endoscopic rectus abdominis muscle harvest have described techniques that are hampered by the need for anterior rectus sheath division or mechanical devices to maintain the optical cavity. The authors report the first successful clinical case of a laparoscopic sheath-sparing rectus abdominis muscle harvest for free tissue transfer. It offers considerable advantages over the traditional open method and, with the help of an experienced laparoscopic surgeon, it should add little to operative time.

The use of temporary laparoscopic loop ileostomy in lumbosacral burns.

The technique of laparoscopic formation of loop ileostomies has been previously described for use in a variety of conditions. We present this as an option for faecal diversion in severe burns involving the back and buttock region and describe its use in two cases. Faecal diversion allows for easier wound care and nursing. Intra-abdominal assessment of these very sick patients can also be performed simultaneously. The technique is relatively simple, readily available and associated with minimal morbidity. Furthermore, this technique minimises interference with the abdominal wall as a donor site for skin grafts.

Acute laparoscopic cholecystectomy. A case controlled study.

BACKGROUND: Acute laparoscopic cholecystectomy (ALC) has been performed successfully at a number of institutions. Interval laparoscopic cholecystectomy (ILC) is preferred by many surgeons because of its convenience and a perceived increased risk with acute surgery. METHODS: A case control study was undertaken. The case group was a consecutive series of patients who underwent ALC between October 1996 and October 1997. The control group underwent ILC between March 1996 and March 1997 after at least one previous acute admission for gallstone disease. RESULTS: There were 81 patients in the case group and 100 in the control group. The groups were similar in terms of age, sex, and clinical diagnosis. Operative times (70 min vs 78 min, p = 0.60), major complications (4.9% vs 2%, p = 0.41), minor complications (4.9% vs 7%, p = 0.76), and conversion rates (7. 4% vs 7%) were similar in both groups. There were no bile duct injuries in either group. The median total hospital stay was 5 days in the case group and 8 days in the control group (p < 0.0001). CONCLUSIONS: Acute laparoscopic cholecystectomy can be performed safely at the first hospital admission, thus reducing hospital stay and minimizing inconvenience to patients.

Trauma patients with positive cultures have higher levels of circulating macrophage migration inhibitory factor (MIF).

Macrophage migration inhibitory factor (MIF) is a pituitary "stress" hormone that plays a critical role in the host immune response. The aims of the study were to determine whether MIF was detectable in the circulation of trauma patients, to assess whether MIF levels were associated with injury severity, days post injury, infection, and to examine concentrations of other pro-inflammatory cytokines in circulation. We collected plasma samples from 35 trauma (multiple injury) patients and 18 healthy controls. Concentrations of MIF, TNF-alpha, IL-1beta, and IL-6 were measured by ELISA. Average MIF concentration in plasma of trauma patients was 14 fold higher than that of healthy controls (19,439+/-2,615 pg/ml in trauma vs 1,337+/-286 pg/ml in control; p=0.0002). There was no correlation between MIF values and injury severity score or days post injury. Average level of IL-6 in trauma patients was 587+/-85 pg/ml but was not correlated with MIF concentration. TNF-alpha and IL-1beta were not detectable in trauma patients or healthy controls. Higher MIF levels were associated with positive cultures (blood, urine, sputum, wound). These data suggest that MIF may be a possible indicator of infection in trauma patients.

Violence in America: a public health crisis--domestic violence.

Domestic violence is a major public health problem. It is important that physicians are aware of the extent and pervasiveness of this disease. It is important to identify potential victims of domestic violence when they are encountered in the hospital or office environment. A few, short, carefully asked questions can serve an important surveillance and diagnostic function. Once domestic violence is identified, a well thought out, sensitive, safe plan of action should be discussed with the victim. In this way, not only will the current event be well managed, but also the potential for mitigating further domestic violence events will be initiated. Through this document, EAST hopes to add its voice to that of other physician groups to serve as a catalyst for broad education on the subject of domestic violence as well as activating victim advocacy among physicians and others who come into contact with this problem in their patients.