The Anatomical Society's core anatomy syllabus for undergraduate nursing.

The Anatomical Society has developed a series of learning outcomes in consultation with nursing educators delivering anatomical content to undergraduate (preregistration) nursing students. A Delphi panel methodology was adopted to select experts within the field that would recommend core anatomical content in undergraduate nursing programmes throughout the UK. Using the Anatomical Society's Core Gross Anatomy Syllabus for Medical Students as a foundation, a modified Delphi technique was used to develop discipline-specific outcomes to nursing graduates. The Delphi panel consisted of 48 individuals (n = 48) with a minimum of 3 years' experience teaching anatomy to nursing students, representing a broad spectrum of UK Higher Education Institutions. The output from this study was 64 nursing specific learning outcomes in anatomy that are applicable to all undergraduate (preregistration) programmes in the UK. The new core anatomy syllabus for Undergraduate Nursing offers a basic anatomical framework upon which nurse educators, clinical mentors and nursing students can underpin their clinical practice and knowledge. The learning outcomes presented may be used to develop anatomy teaching within an integrated nursing curriculum.

Imaging of sports injuries in children and adolescents.

Imaging plays an important role in the diagnosis and management of sports injuries of childhood and adolescence. The injuries discussed are typical of those seen in the skeletally immature athlete. Imaging specialists must be able to apply the full range of imaging modalities when evaluating the injured young athlete.

Differentiation of anterior tibial stress fracture from osteoid osteoma.

The authors present a case in which skeletal scintigraphy helped them to differentiate an anterior tibial stress fracture from a possible osteoid osteoma. Important scintigraphic clues to the correct diagnosis included a linear rather than a round to oval configuration to the focus of intense uptake shown by pinhole imaging, absence of focally increased tracer localization on the angiographic and tissue phases, and a symmetrically positioned, less-conspicuous contralateral abnormality.

MRI features of three paediatric intra-articular synovial lesions: a comparative study.

AIM: To determine reliable magnetic resonance imaging (MRI) features differentiating three paediatric intra-articular congenital or neoplastic synovial lesions that contain blood products, from post-traumatic or haemorrhagic inflammatory processes. MATERIALS AND METHODS: This was a retrospective review of MRI findings of 22 paediatric intra-articular congenital or neoplastic synovial lesions, including venous malformation (VM) (n=12), pigmented villonodular synovitis (PVNS; n=8), and synovial sarcoma (SS; n=2). These MRI features were compared with 22 paediatric post-traumatic or inflammatory intra-articular processes containing blood products and producing mass effect. The following imaging features were assessed: presence of a discrete mass, extension, extra-articular oedema, susceptibility, joint effusion, and size. Fisher's exact test was used and results were considered statistically significant when p<0.05. RESULTS: The three intra-articular synovial lesions, compared with controls, were more likely to directly invade osseous structures when a discrete mass was present (13/16, 81.3% versus 1/9, 11.1%; p<0.002) and extend into extra-articular soft tissues (13/21, 61.9% versus 2/17, 11.8%; p<0.003), but were less likely to show extra-articular oedema (3/22, 13.6% versus 13/22, 59.1%; p<0.004), a joint effusion (10/22,45.5% versus 19/22, 86.4%, p<0.01), susceptibility within a joint effusion (0/22, 0% versus 11/22, 40.9%; p=0.00), osseous oedema (3/16, 18.8% versus 7/9, 77.8%; p<0.009), and synovial enhancement (8/21, 38.1% versus 14/16, 87.5%; p<0.003). VMs had characteristic tubular vessels with internal fluid-fluid levels (11/12) that extended into bone (10/12) and extracapsular soft tissues (11/12). CONCLUSION: Our study indicates that, despite the overlapping presence of haemorrhagic products, intra-articular VM, PVNS, and SS show MRI features that permit distinction from acquired post-traumatic and haemorrhagic inflammatory lesions.

Rate of processing and judgment of response speed: comparing the effects of alcohol and practice.

Both alcohol and practice affect choice reaction time. The present study was conducted to investigate the possibility that impairment from alcohol and improvement with practice could be attributed to changes in the efficiency of control mechanisms (Rabbitt, 1979a), some of which depend upon the ability to judge response speed accurately. Twenty subjects participated in a four-choice reaction time experiment in which they received no alcohol (NA) in Session 1 and either no alcohol (10 subjects) or 0.8 ml alcohol (A) per kilogram of body weight (10 subjects) in Session 2. The task was to respond as fast and as accurately as possible to each stimulus. In addition, subjects were required to press a fifth key after any response that they considered to be both fast and accurate. Subjects had no difficulty in performing this task: (1) there was a significant difference of 122 msec between the mean response time for correct responses indicated as fast and that for correct responses not indicated as fast, and (2) subjects indicated 1 in 4 correct responses but only 1 in 64 errors. Alcohol increased all response times by approximately 40 msec. In contrast, practice decreased response times less for correct responses not indicated as fast than for correct responses indicated as fast. The ability to distinguish between fast and slow responses was thus unaffected by alcohol, but was improved by practice. Responses indicated as "fast" were significantly faster than errors, and appeared to occur without warning (unlike errors, which tended to end a sequence of increasingly fast correct responses). The results suggest that alcohol and practice influence choice reaction time in qualitatively different ways: Alcohol impairs overall response speed but has no effect on the ability to judge response speed, whereas practice improves both.

Developing epiphysis: MR imaging characteristics and histologic correlation in the newborn lamb.

PURPOSE: To correlate magnetic resonance (MR) signal characteristics of developing regions at the ends of bones with the histologic findings. MATERIALS AND METHODS: In 36 newborn lamb epiphyses (including cartilage of the epiphysis and physis, and bone of the secondary ossification center and juxtaphyseal metaphysis), signal intensity and thickness of cartilaginous regions seen on MR images were correlated with architecture and thickness of zones shown in corresponding histologic sections. Possible effects of T2, magnetization transfer, fat or water content, chemical shift, and anisotropy on differences in regional signal intensity were evaluated. RESULTS: MR imaging depicted five regions between the secondary ossification center and the metaphysis corresponding histologically to (a) zone of provisional calcification of the secondary ossification center, (b) physis of the secondary ossification center, (c) epiphyseal cartilage, (d) physis, and (e) zone of provisional calcification. The thickness of regions shown on T1- and T2-weighted images correlated with that of histologic zones (r = .9). T2 signal intensity and relaxation time were greater in physeal than in epiphyseal cartilage (P < .01). No regional differences due to fat or water content, magnetization transfer, chemical shift, or anisotropy were found. CONCLUSION: MR imaging findings differentiate epiphyseal and physeal regions and correlate with histologic findings. T2 is slower in physeal than in epiphyseal cartilage, probably reflecting differences in water binding.

Effect of patient position on sonographically measured renal length in neonates, infants, and children.

OBJECTIVE: Renal length as measured on sonography is fundamental in the evaluation of renal disease in children. Understanding the effect of patient position and imaging plane on measured renal length is important for the appropriate use of the standards for interpretation. The goal of this study was to determine how measurement of renal length on sonograms is affected by changes in patient position and imaging plane. SUBJECTS AND METHODS: One hundred seventy-six neonates, infants, and children who were 2 days to 17 years old underwent sonography froin October 1995 through June 1996. The largest long-axis renal dimension in sagittal, coronal, and prone planes was obtained for each kidney. Data were analyzed separately for each kidney to determine the individual variation of renal length. RESULTS: The correlation between maximum renal length on coronal, sagittal, and prone sonograms was greater than .95 for both right and left kidneys. The coronal plane yielded the largest measured renal length and the prone view, the smallest. The median of the absolute value of the differences between individual renal lengths as measured on sonograms in the different imaging planes was 2-3 mm for both left and right kidneys (mean difference, left kidney = 3.34-3.62 mm; mean difference, right kidney = 3.22-3.68 mm). CONCLUSION: The coronal and sagittal views yield the longest measurements and prone views, the shortest. Therefore, initial measurements should be made in coronal or sagittal planes. Prone views should be reserved for situations in which the suspicion exists that the kidney was foreshortened on other views. Reference standards done in a particular plane should be applicable in most situations regardless of the patient position necessary to obtain optimum length.

Porcine HveC, a member of the highly conserved HveC/nectin 1 family, is a functional alphaherpesvirus receptor.

Human herpesvirus entry mediator C (HveC) is an alphaherpesvirus receptor which binds to virion glycoprotein D (gD). We identified porcine HveC and studied its interaction with pseudorabies virus (PrV) and herpes simplex virus type 1 (HSV-1) gD. Porcine and human HveC have 96% amino acid identity and HveC from African green monkey, mouse, hamster, and cow are similarly conserved. Porcine HveC mediates entry of HSV-1, HSV-2, PrV, and bovine herpesvirus type 1. Truncated soluble forms of HSV-1 and PrV gD bind competitively to porcine HveC. Biosensor analysis shows that PrV gD binds with a 10-fold higher affinity than HSV-1 gD. Monoclonal antibodies against human HveC recognize the porcine homologue and can block gD binding and entry of HSV-1 and PrV. Porcine HveC is functionally indistinguishable from human HveC. Our results are consistent with the suggestion that HveC is a pan-alphaherpesvirus receptor that interacts with a conserved structural domain of gD.

Pediatric skeletal scintigraphy: applications of pinhole magnification.

Pinhole magnification scintigraphy is an effective means of evaluating the pediatric skeleton because it provides optimal high-resolution images. This technique is indicated when diagnostic uncertainty persists after high-resolution imaging with parallel hole collimation. Pinhole magnification scintigraphy requires approximately 20 minutes of acquisition time per image and meticulous attention to details such as choice of pinhole insert, collimator positioning, and patient immobilization. However, the technique is superior to planar imaging in demonstrating acute osteomyelitis in bone adjacent to growth centers and epiphyseal involvement that is either primary or the result of local spread of infection. In addition, pinhole imaging has proved highly reliable in the early diagnosis of Legg-Calvé-Perthes disease and is useful in depicting osteonecrosis related to specific causes such as corticosteroid treatment or trauma. Scintigraphic manifestations of femoral head ischemia or infarction and findings indicative of osteomyelitis associated with a hip effusion are well demonstrated with pinhole imaging. This technique also helps characterize osteoid osteomas and may be used intraoperatively to confirm the complete excision of this benign tumor. Finally, pinhole magnification scintigraphy clearly depicts fractures of the femoral neck and allows a high degree of confidence in diagnosing injuries to the small bones of the hands and feet.

Glycoprotein D homologs in herpes simplex virus type 1, pseudorabies virus, and bovine herpes virus type 1 bind directly to human HveC(nectin-1) with different affinities.

Distinct subsets of human receptors for alphaherpesviruses mediate the entry of herpes simplex virus (HSV), pseudorabies virus (PrV), or bovine herpes virus type 1 (BHV-1) into cells. Glycoprotein D (gD) is essential for receptor-mediated entry of all three viruses into cells. However, the gD homologs of these viruses share only 22-33% amino acid identity. Several entry receptors for HSV have been identified. Two of these, HveA (HVEM) and HveC (nectin-1), mediate entry of most HSV-1 and HSV-2 strains and are bound directly by HSV gD. A third receptor, HveB (nectin-2), mediates entry of HSV-2 and only a limited number of HSV-1 strains. HveB and HveC can also serve as entry receptors for PrV, whereas only HveC can serve this function for BHV-1. We show here that gD from PrV and BHV-1 binds directly to the human receptors that mediate PrV and BHV-1 entry. We expressed soluble forms of PrV gD and BHV-1 gD using recombinant baculoviruses and purified each protein. Using ELISA, we detected direct binding of PrV gD to HveB and HveC and direct binding of BHV-1 gD to HveC. Biosensor analysis revealed that PrV gD had a 10-fold higher affinity than HSV-1 gD for human HveC. In contrast, the binding of BHV-1 gD to HveC was weak. PrV gD and HSV-1 gD competed for binding to the V domain of HveC and both inhibited entry of the homologous and heterologous viruses. These data suggest that the two forms of gD bind to a common region on human HveC despite their low amino acid similarity. Based on affinities for human HveC, we predict a porcine HveC homolog may be important for PrV infection in its natural host, whereas a BHV-1 infection in its natural host may be mediated by a receptor other than a bovine HveC homolog.

Vesicoureteral reflux in children: incidence and severity in siblings.

PURPOSE: We attempted to determine the incidence of vesicoureteral reflux in asymptomatic siblings of children with reflux at different ages and assess the incidence of renal damage in asymptomatic siblings with reflux. MATERIALS AND METHODS: We reviewed radionuclide cystograms of 482 consecutively referred siblings of children with vesicoureteral reflux, including 295 girls and 187 boys 2 weeks to 12.8 years old (mean age 2.8 years). Ultrasonograms and renal cortical scintigrams of children with reflux were evaluated. All siblings were considered asymptomatic by the referring physicians. RESULTS: The overall incidence of vesicoureteral reflux was 36.5%, and the incidence in girls and boys was 39.3 and 32.1%, respectively. Children 24 months old or younger had the highest incidence (45.7%) and the highest risk of bilateral reflux. From ages 25 to 72 months the incidence of reflux was 33.1% and in siblings older than 72 months it was 7%. Reflux of urine to the level of the renal pelvis was detected in 28.6% of all referred siblings. Renal damage was observed on sonography or scintigraphy in 4.7% of the siblings with reflux. CONCLUSIONS: The high incidence of vesicoureteral reflux through age 72 months indicates that it is important to screen siblings of children with reflux at an early age to prevent renal damage, which can occur in the absence of symptomatic urinary tract infection.

Natural history of vesicoureteral reflux in girls after age 5 years.

PURPOSE: Expectations concerning the likelihood that vesicoureteral reflux will resolve during a given interval are predominantly based on experience with children younger than 5 years. We assess the natural course of vesicoureteral reflux in girls older than 5 years. MATERIALS AND METHODS: We reviewed the diagnostic and followup cystograms, medical records and renal imaging studies of 200 girls with vesicoureteral reflux, of whom 97 were diagnosed before age 60 months and 103 were diagnosed at or after age 60 months. Vesicoureteral reflux was considered to have resolved when a followup radionuclide cystogram demonstrated no reflux. RESULTS: Vesicoureteral reflux demonstrated at or after age 60 months by a radionuclide or radiographic examination (index study) resolved in 43% of cases during a mean followup interval of 41 months. The yearly percent chance of resolution approached or exceeded 20% through age 11 years. For girls with moderate vesicoureteral reflux on the index study unilateral moderate vesicoureteral reflux was associated with a higher overall percent chance of resolution and a shorter time from index study to resolution. Evidence of new or progressive parenchymal injury was not indicated in any of 92 girls who underwent serial renal ultrasonograms. CONCLUSIONS: Vesicoureteral reflux resolution continues after age 5 years at a rate similar to that in younger children. Continued medical management in the anticipation of spontaneous resolution is safe and appropriate for most patients.

Localization of the gD-binding region of the human herpes simplex virus receptor, HveA.

During virus entry, herpes simplex virus (HSV) glycoprotein D (gD) binds to one of several human cellular receptors. One of these, herpesvirus entry mediator A (HveA), is a member of the tumor necrosis factor receptor (TNFR) superfamily, and its ectodomain contains four characteristic cysteine-rich pseudorepeat (CRP) elements. We previously showed that gD binds the ectodomain of HveA expressed as a truncated, soluble protein [HveA(200t)]. To localize the gD-binding domain of HveA, we expressed three additional soluble forms of HveA consisting of the first CRP [HveA(76t)], the second CRP [HveA(77-120t)], or the first and second CRPs [HveA(120t)]. Biosensor and enzyme-linked immunosorbent assay studies showed that gD bound to HveA(120t) and HveA(200t) with the same affinity. However, gD did not bind to HveA(76t) or HveA(77-120t). Furthermore, HveA(200t) and HveA(120t), but not HveA(76t) or HveA(77-120t), blocked herpes simplex virus (HSV) entry into CHO cells expressing HveA. We also generated six monoclonal antibodies (MAbs) against HveA(200t). MAbs CW1, -2, and -4 bound linear epitopes within the second CRP, while CW7 and -8 bound linear epitopes within the third or fourth CRPs. None of these MAbs blocked the binding of gD to HveA. In contrast, MAb CW3 recognized a discontinuous epitope within the first CRP of HveA, blocked the binding of gD to HveA, and exhibited a limited ability to block virus entry into cells expressing HveA, suggesting that the first domain of HveA contains at least a portion of the gD binding site. The inability of gD to bind HveA(76t) suggests that additional amino acid residues of the gD binding site may reside within the second CRP.