Leptomeningeal Relapse of Embryonal Rhabdomyosarcoma after 15 years.

Aim Rhabdomyosarcoma (RMS) is the most common malignant soft tissue tumour of childhood. We present the case of a late relapse of RMS to the leptomeninges after 15 years. Methods A 20 year old male presented with a 3 week history of headaches and nausea. He previously had RMS of his right ear diagnosed at age 5 years which was treated with concurrent chemoradiotherapy. An MRI Brain and Spine confirmed extensive leptomeningeal disease and CSF analysis confirmed the presence of recurrent embryonal RMS. Results He completed two cycles of cyclophosphamide and topotecan followed by 45Gy/25Fr of craniospinal radiotherapy. Conclusion Late relapses beyond five years can be seen in up to 9% of patients, however very late recurrences (>10 years) are exceedingly rare. Molecular based methods such as gene expression profiling can aid risk stratification and survivorship clinics may become increasingly useful in following patients with high risk features.

Post-conviction polygraph testing of sex offenders.

Post-conviction polygraph testing of sex offenders (typically referred to as PCSOT) is common in the US, increasingly applied in England and Wales, but hardly if ever used elsewhere in the world. This article provides an account of the nature and aims of PCSOT, research into its efficacy, and controversies associated with it.

International review of sexual behaviour assessment labs.

This article provides a comparison and comprehensive analysis of varied approaches to the assessment of sexual interest and behaviours at different international sexual behaviour assessment labs. The assessment protocols are described for four sexual behaviour laboratories: the Royal Ottawa Mental Health Centre's Sexual Behaviours Clinic in Canada; the Medical University of South Carolina's Sexual Behaviours Clinic and Laboratory in the US; the Laboratory of Evolutionary Sexology and Psychopathology in the Czech Republic; and the Laboratory of Forensic Sexology in Russia. An overview of examinee demographics and types of cases assessed is provided for each lab. Assessment protocols, including psychometric measures and objective measures of sexual interest and arousal, such as penile plethysmography or eye-tracking, are also reviewed. The differences across labs may lead to interesting and productive cross-cultural investigations and studies about the efficacy of specific assessment methods.

Stimuli used in the measurement of problematic sexual interests.

Penile plethysmography (PPG) is the primary physiologic assessment method used to gauge sexual responses in adult men. Depending on the country or jurisdiction of assessment, stimuli used to elicit arousal can include videos, still images, and audio materials. It can depict a variety consenting and non-consenting sexual scenarios as well as neutral, non-sexual scenarios. Models in visual stimuli can be clothed, semi-clothed, or nude. Variation in stimuli modality and the type of sexual interest being tested can have a large impact on PPG outcomes. This paper reviews research on types of PPG stimuli, the different sexual interests being assessed, reliability and validity, and the impact of anonymizing models depicted in assessment materials. Innovations in stimuli development in three labs located in Canada, the United States, and the Czech Republic are also discussed. The work done in these three labs and the broader range of research on assessment stimuli are presented to highlight the need for a unified, multi-site, standardized approach to assess problematic sexual interests and their change in response to treatment.

Patterns of emergency ambulance use, 2009-13: a comparison of older people living in Residential Aged Care Facilities and the Community.

OBJECTIVE: to examine demand for emergency ambulances by older people. DESIGN: retrospective cohort study using secondary analysis of routinely collected clinical and administrative data from Ambulance Victoria, and population data from the Australian Bureau of Statistics and the Australian Institute of Health and Welfare. SETTING: Victoria, Australia. PARTICIPANTS: people aged 65 years and over, living in Residential Aged Care Facilities (RACF) and the community, attended by emergency ambulance paramedics, 2009-13. MAIN OUTCOME MEASURES: rates of emergency ambulance attendance. RESULTS: older people living in RACF experienced high rates of emergency ambulance attendance, up to four times those for age- and sex-matched people living in the community. Rates remained constant during the study period equating to a consistent, 1.45% average annual increase in absolute demand. Rates peak among the 80-84-year group where the number of attendances equates to greater than one for every RACF-dwelling person each year. Increased demand was associated with winter months, increasing age and being male. CONCLUSION: these data provide strong evidence of high rates of emergency ambulance use by people aged 65 years and over living in RACF. These results demonstrate a clear relationship between increased rate of ambulance use among this vulnerable group of older Australians and residence, sex, age and season. Overall, absolute demand continues to increase each year adding to strain on health resources. Additional research is needed to elucidate individual characteristics, illness and health system contributors to ambulance use to inform strategies to appropriately reduce demand.

A survey of United States dairy hoof care professionals on costs associated with treatment of foot disorders.

The objective of this study was to collect information regarding hoof care professionals' billing practices and to gather their opinions about foot disorders and the value of their prevention. Responses were gathered from veterinarians (n = 18) and hoof trimmers (n = 116) through both online and paper survey platforms. Because of the limited number of respondents, veterinarian responses were not further analyzed. Of the 6 foot disorders included in the survey, the treatment cost per case was greatest for toe ulcers (mean ± standard deviation; $20.2 ± 8.5), sole ulcers ($19.7 ± 8.6), white line disease ($19.5 ± 8.1), and thin soles ($18.1 ± 8.1), and least for infectious disorders (foot rot and digital dermatitis; $8.0 ± 7.6 and $7.5 ± 9.6, respectively). Of the disorders, digital dermatitis represented most of the foot disorder cases treated by respondents over the past year (43.9 ± 20.4%), whereas toe ulcers and thin soles represented the least (5.3 ± 4.1 and 5.3 ± 5.7%, respectively). Respondents that served mostly large herds (>500 lactating cows) reported a lower prevalence of digital dermatitis (31.6 ± 4.2 vs. 44.4 ± 3.4 and 46.7 ± 3.2% in small and medium herds, respectively) and a higher prevalence of sole ulcers (23.1 ± 3.0 vs. 13.4 ± 2.4 and 13.3 ± 2.3% in small and medium herds, respectively). Region of the United States (Northeast, Midwest, or other) also influenced foot disorder prevalence; respondents from the Northeast reported more sole ulcers than respondents from other regions (22.1 ± 2.3 vs. 12.4 ± 3.3%). When respondents were asked which disorder was associated with the greatest total cost per case to the producer (treatment and labor costs plus the reduction in milk yield, reduced reproductive performance, and so on), hoof trimmers ranked digital dermatitis as having the greatest total cost per case and thin soles as having the least total cost per case. Finally, respondents indicated that the most important benefits of reducing foot disorders were enhanced animal welfare and increased milk production, whereas the least important benefit was reduced veterinary and hoof trimmer fees. Results from this survey can be used to improve the accuracy of foot disorder cost estimates and contribute to better decision-making regarding both foot disorder treatment and prevention.

Characteristics and treatment of internet child pornography offenders.

In the realm of sexual offenses, there has been a decrease in hands-on offenses, but an increase in online offenses against children. The current issue is whether online and offline sexual offenders are alike or differ. This literature review investigates the differences among individuals who have committed child pornography offenses, individuals who have committed contact offenses against children, and individuals who have committed both. This review discusses the various typologies that have been proposed of those who have committed online offenses against children, the diagnostic implications of having committed child pornography offenses, and the current state of treatment and prevention of individuals who have committed online sex offenses against children. The studies examined were found from psychology databases, listserv links, and references of those collected articles. Only articles in English were included in the review. Overall, Internet child pornography offenders (ICPOs) tend to score significantly differently from contact offenders on various psychological measures. These findings may imply that ICPOs have different treatment needs than contact offenders.

Standardization of Penile Plethysmography Testing in Assessment of Problematic Sexual Interests.

Penile plethysmography (PPG) is an objective measure of sexual arousal for men, commonly used to assess sexual arousal to both abnormal (i.e., paraphilic) and normal stimuli. While PPG has become a standard measure in the assessment and treatment of male sex offenders and men with paraphilic interests in both Canada and the United States, there is a lack of standardization of stimulus sets and interpretation of results between sites. The current article critically reviews the current state of the art while highlighting clinical and research efforts that may be undertaken in an attempt to reduce issues arising from lack of standardization across sites. Types and themes of stimulus sets, assessment apparatuses, laboratory preparation, and testing procedures are discussed. The continued development of standardized testing protocol and procedures across multiple international sites continues to be encouraged to promote unified PPG administration and interpretation, thus further enhancing the practical utility of the measurements and decreasing inter-rater discrepancies and error.

Neuroimaging and sexual behavior: identification of regional and functional differences.

The neuroanatomical correlates of human sexual desire, arousal, and behavior have been characterized in recent years with functional brain imaging techniques such as magnetic resonance imaging (MRI) and positron emission tomography (PET). Here, we briefly review the results of functional neuroimaging studies in humans, whether healthy or suffering from sexual disorders, and the current models of regional and network activation in sexual arousal. Attention is paid, in particular, to findings from both regional and network studies in the past 3 years. We also identify yet unanswered and pressing questions of interest to areas of ongoing investigations for psychiatric, scientific, and forensic disciplines.

Optimization of the gamma reaction history diagnostic for double-shell pusher areal density and reaction history measurements on the National Ignition Facility.

The double-shell inertial confinement fusion campaign, which consists of an aluminum ablator, a foam cushion, a high-Z pusher (tungsten or molybdenum), and liquid deuterium-tritium (DT) fuel, aims for its first DT filled implosions on the National Ignition Facility (NIF) in 2024. The high-Z, high density pusher does not allow x-rays to escape the double-shell capsule. Therefore, nuclear diagnostics such as the Gamma Reaction History (GRH) diagnostic on the NIF are crucial for understanding high-Z implosion performance. To optimize the GRH measurement of fusion reaction history and the pusher's areal density, the MCNP6.3-based forward model of the detector was built. When calculating the neutron-induced inelastic gamma ray production, the interaction of neutrons with the compressed fuel was additionally included. By folding the calculated gamma ray spectrum output and the previously calibrated GRH detector responses, the optimum set of GRH energy thresholds for measuring the pusher areal density is determined to be 2.9 and 6.3 MeV for DT double-shell experiments. In addition, the effect of the down-scattering of neutrons on the gamma ray spectrum, the minimum required yield for measurements, and the attenuation of the gamma rays through the pusher are analyzed.

A fiber-coupled dispersion interferometer for density measurements of pulsed power transmission line electron sheaths on Sandia's Z machine.

A fiber-coupled Dispersion Interferometer (DI) is being developed to measure the electron density of plasmas formed in power flow regions, such as magnetically insulated transmission lines, on Sandia National Laboratories (SNL's) Z machine [D. B. Sinars et al., Phys. Plasmas 27, 070501 (2020)]. The diagnostic operates using a fiber-coupled 1550 nm CW laser with frequency-doubling to 775 nm. The DI is expected to be capable of line-average density measurements between ∼1013 and 1019 cm-2. Initial testing has been performed on a well-characterized RF lab plasma [A. G. Lynn et al., Rev. Sci. Instrum. 80, 103501 (2009)] at the University of New Mexico to quantify the density resolution lower limits of the DI. Initial testing of the DI has demonstrated line-average electron density measurements within 9% of results acquired via a 94 GHz mm wave interferometer for line densities of ∼1 × 1014 cm-2, despite significant differences in probe beam geometries. The instrument will next be utilized for measurements on a ∼1 MA-scale pulsed power driver {MYKONOS [N. Bennett et al., Phys. Rev. Accel. Beams 22, 120401 (2019)] at SNL} before finally being deployed on SNL's Z machine. The close electrode spacing (mm scale) on Z requires probe beam sizes of ∼1 mm, which can only be obtained with visible or near infrared optical systems, as opposed to longer wavelength mm wave systems that would normally be chosen for this range of density.

Design of a 16-channel fiber-optic coupled radiation detection array for radiation asymmetry studies in a 750-kJ dense plasma focus.

A 16-channel fiber optically coupled radiation detection array has been developed for studies of radiation asymmetries and emission histories from the Verus Research 750-kJ Dense Plasma Focus. Each detector in the array consists of a light-tight housing with a plastic scintillator coupled to a fiber optic that is fed into one channel of a multi-anode photomultiplier tube (PMT). The PMT and associated electronics are located in a remote electrically shielded control room. The detector head is configurable for using a Be-9 foil to take advantage of the 9Be(n,α)6He reaction as a fast neutron activation detector or with a bare scintillator alone to record the radiation emission history. Fiber optically coupling the detector head not only provides electrical isolation in the pulsed power environment but also allows the spatial footprint of the detector array to be reduced with concomitant flexibility in positioning each individual detector head. The array allows for spatially resolved neutron yield and radiation waveform measurements for fast z-pinches. The activation detector heads were calibrated for the total neutron yield against silver and indium activation counters for the total neutron yield. Fiber scintillation was found to contribute to the time-resolved detector head signals and was accounted for.

Potential role of mesenchymal stem cells (MSCs) in the breast tumour microenvironment: stimulation of epithelial to mesenchymal transition (EMT).

Bone marrow-derived mesenchymal stem cells (MSCs) are known to specifically migrate to and engraft at tumour sites. Understanding interactions between cancer cells and MSCs has become fundamental to determining whether MSC-tumour interactions should be harnessed for delivery of therapeutic agents or considered a target for intervention. Breast Cancer Cell lines (MDA-MB-231, T47D & SK-Br3) were cultured alone or on a monolayer of MSCs, and retrieved using epithelial specific magnetic beads. Alterations in expression of 90 genes associated with breast tumourigenicity were analysed using low-density array. Expression of markers of epithelial-mesenchymal transition (EMT) and array results were validated using RQ-PCR. Co-cultured cells were analysed for changes in protein expression, growth pattern and morphology. Gene expression and proliferation assays were also performed on indirect co-cultures. Following direct co-culture with MSCs, breast cancer cells expressed elevated levels of oncogenes (NCOA4, FOS), proto-oncogenes (FYN, JUN), genes associated with invasion (MMP11), angiogenesis (VEGF) and anti-apoptosis (IGF1R, BCL2). However, universal downregulation of genes associated with proliferation was observed (Ki67, MYBL2), and reflected in reduced ATP production in response to MSC-secreted factors. Significant upregulation of EMT specific markers (N-cadherin, Vimentin, Twist and Snail) was also observed following co-culture with MSCs, with a reciprocal downregulation in E-cadherin protein expression. These changes were predominantly cell contact mediated and appeared to be MSC specific. Breast cancer cell morphology and growth pattern also altered in response to MSCs. MSCs may promote breast cancer metastasis through facilitation of EMT.

Differences in corpus callosum volume and diffusivity between temporal and frontal lobe epilepsy.

We analyzed volume and diffusivity measures of the corpus callosum (CC) in patients with temporal (TLE) and frontal (FLE) lobe epilepsy in comparison with healthy subjects. On high-resolution T1-weighted scans of 18 controls and 44 patients the volumes (cm(3)) of Witelson regions (WRs) and the entire CC were measured. The apparent diffusion coefficients (ADCs, 10(-5)mm(2)s(-1)) for the entire CC and three areas of interest were measured from co-registered ADC maps. The CC of patients with TLE and FLE, corrected for total brain volume, was smaller than that of controls. Patients' ADC values were higher than those of controls. Findings were significant for WR1, WR2, and WR6, the CC regions connecting the frontal and temporal lobes. Patients with FLE had smaller WR1 and higher ADC values; in patients with TLE, the findings were similar for WR6. Atrophy and increased diffusivity in subregions of the CC connecting homotopic contralateral cortical regions indicate anatomical abnormalities extending beyond the epileptogenic zone in FLE and TLE.

Potential organ donor audit in Ireland.

As increasing demand for organs is a challenge for transplant services worldwide it is essential to audit the process of organ donation. To address this, a national audit of potential organ donors was undertaken across hospitals with Intensive Care Units (N = 36). Questionnaires were returned on all patients (n = 2073) who died in these units from 1/9/07-31/8/08; 200 (10%) of these patients were considered for Brain Stem Testing (BST), 158 patients (79%) were diagnosed Brain Stem Dead (BSD) and 138 patients (87%) became potential donors. Consent for donation was given by 92 (69%) next of kin and 90 potential donors (65%) became organ donors. There was no evidence of a large number of potential organ donors being missed. Recommendations included completion of BSTs on all appropriate patients, development of support on BST, referral of all BSD patients to the Organ Procurement Service; enhanced co-ordination within hospitals and sustained information/education campaigns.

Neuroleptic Malignant Syndrome Secondary to Quetiapine in Critical Care: A Case Report.

Quetiapine, an atypical antipsychotic, is widely used to treat delirium in intensive care units (ICUs). Studies demonstrate its efficacy and favorable safety profile. We report a case of an elderly patient who developed clinical and biochemical evidence of neuroleptic malignant syndrome (NMS) 5 days after quetiapine was commenced. Signs of NMS resolved after discontinuation of quetiapine and administration of dantrolene. Quetiapine-induced NMS has occurred with long-term use in the elderly in the outpatient setting. However, NMS has not previously been reported after treatment of ICU delirium. NMS is an important complication to consider before prescribing quetiapine in the ICU.

Higher sociability leads to lower reproductive success in female kangaroos.

In social mammals, social integration is generally assumed to improve females' reproductive success. Most species demonstrating this relationship exhibit complex forms of social bonds and interactions. However, female eastern grey kangaroos (Macropus giganteus) exhibit differentiated social relationships, yet do not appear to cooperate directly. It is unclear what the fitness consequences of such sociability could be in species that do not exhibit obvious forms of cooperation. Using 4 years of life history, spatial and social data from a wild population of approximately 200 individually recognizable female eastern grey kangaroos, we tested whether higher levels of sociability are associated with greater reproductive success. Contrary to expectations, we found that the size of a female's social network, her numbers of preferential associations with other females and her group sizes all negatively influenced her reproductive success. These factors influenced the survival of dependent young that had left the pouch rather than those that were still in the pouch. We also show that primiparous females (first-time breeders) were less likely to have surviving young. Our findings suggest that social bonds are not always beneficial for reproductive success in group-living species, and that female kangaroos may experience trade-offs between successfully rearing young and maintaining affiliative relationships.

The validity and reliability of the exposure index as a metric for estimating the radiation dose to the patient.

INTRODUCTION: With the introduction of digital radiography, the feedback between image quality and over-exposure has been partly lost which in some cases has led to a steady increase in dose. Over the years the introduction of exposure index (EI) has been used to resolve this phenomenon referred to as 'dose creep'. Even though EI is often vendor specific it is always a related of the radiation exposure to the detector. Due to the nature of this relationship EI can also be used as a patient dose indicator, however this is not widely investigated in literature. METHODS: A total of 420 dose-area-product (DAP) and EI measurements were taken whilst varying kVp, mAs and body habitus on two different anthropomorphic phantoms (pelvis and chest). Using linear regression, the correlation between EI and DAP were examined. Additionally, two separate region of interest (ROI) placements/per phantom where examined in order to research any effect on EI. RESULTS: When dividing the data into subsets, a strong correlation between EI and DAP was shown with all R-squared values > 0.987. Comparison between the ROI placements showed a significant difference between EIs for both placements. CONCLUSION: This research shows a clear relationship between EI and radiation dose which is dependent on a wide variety of factors such as ROI placement, body habitus. In addition, pathology and manufacturer specific EI's are likely to be of influence as well. IMPLICATIONS FOR PRACTICE: The combination of DAP and EI might be used as a patient dose indicator. However, the influencing factors as mentioned in the conclusion should be considered and examined before implementation.

Monocyte chemotactic protein-1 secreted by primary breast tumors stimulates migration of mesenchymal stem cells.

PURPOSE: Major barriers to effective adenovirus-based gene therapy include induction of an immune response and tumor-specific targeting of vectors. The use of mesenchymal stem cells (MSC) as systemic delivery vehicles for therapeutic genes has been proposed as a result of their combined ability to home in on the tumor site and evade the host immune response. This study is aimed at investigating factors mediating homing of human MSCs to breast cancer primary cultures and cell lines in vitro and in vivo. EXPERIMENTAL DESIGN: Fluorescently labeled MSCs were given to mice bearing breast cancer xenografts, and tumor tissue was harvested to detect MSC engraftment. MSC migration in response to primary breast tumors in vitro was quantified, and chemokines secreted by tumor cells were identified. The role of monocyte chemotactic protein-1 (MCP-1) in cell migration was investigated using antibodies and standards of the chemokine. Serum MCP-1 was measured in 125 breast cancer patients and 86 healthy controls. RESULTS: Engrafted MSCs were detected in metastatic breast tumors in mice after systemic administration. There was a significant increase in MSC migration in response to primary breast tumor cells in vitro (6-fold to 11-fold increase). Tumor explants secreted a variety of chemokines including GROalpha, MCP-1, and stromal cell-derived factor-1alpha. An MCP-1 antibody caused a significant decrease (37-42%) in MSC migration to tumors. Serum MCP-1 levels were significantly higher in postmenopausal breast cancer patients than age-matched controls (P < 0.05). CONCLUSIONS: These results highlight a role for tumor-secreted MCP-1 in stimulating MSC migration and support the potential of these cells as tumor-targeted delivery vehicles for therapeutic agents.