Correlates of atherosclerotic cardiovascular disease risk in older Colorado firefighters.

Background: It has been documented that cardiovascular disease is the leading cause of mortality in on-duty firefighters and little is known about the association between cardiorespiratory fitness and 10-year risk of atherosclerotic cardiovascular disease (ASCVD). Aims: To estimate the probability of 10-year ASCVD risk and its association with per cent body fat (%BF), metabolic syndrome (MetS) and physical fitness in Colorado firefighters. Methods: Ten-year ASCVD risk was calculated using the newly developed pooled cohort equations in firefighters. Logistic regression was conducted to examine the association of 10-year ASCVD risk (<5 versus ≥5%) with estimated maximum volume of oxygen (VO2 max), %BF and MetS. Results: Out of 294 firefighters, 9% had a 10-year ASCVD risk >5%. In the unadjusted models, %BF (odds ratio [OR] = 1.13, P < 0.01), VO2 max (OR = 2.87, P < 0.05) and MetS (OR = 2.66, P < 0.05) were significantly associated with 10-year ASCVD risk. In the adjusted model, only %BF (OR = 1.17, P < 0.01) was significantly associated with 10-year ASCVD risk. Conclusions: Among Colorado firefighters, %BF, but not cardiorespiratory fitness, was independently associated with 10-year ASCVD.

[Percutaneous neuromodulation with pulsating radiofrequency vs cryoablation for the treatment of patients with lumbar facet syndrome]. / Neuromodulación percutánea utilizando radiofrecuencia pulsada versus crioablación en pacientes con síndrome facetario lumbar.

INTRODUCTION: lumbar spine pain affects a high percentage of the population and has a significant socioeconomic impact. Lumbar facet syndrome has a prevalence between 15-31% with lifetime incidence of up to 52% in some series. Due to the use of different types of treatment and different patient selection criteria, the success rate varies in the literature. OBJECTIVE: to compare results of treatment with rhizolysis applying pulsed radiofrequency versus cryoablation in patients diagnosed with lumbar facet syndrome. MATERIAL AND METHODS: from January 2019 to November 2019, eight patients were randomly divided into two groups: group A treated with pulsed radiofrequency and group B treated with cryoablation. Pain was assessed with the visual analogue scale and the Oswestry low back pain disability index at four weeks, in addition to three and six months. RESULTS: follow-up was six months. Immediately the eight patients (100%) reported improvement in symptoms and pain. Of the four patients who were in intense functional limitation, one of them became without functional limitation, and two of them went to minimum functional limitation and one to moderate functional limitation at the first month, statistically significant differences were reported. CONCLUSIONS: both treatments control pain in the short term; there is also an improvement in physical abilities. The morbidity accompanying neurolysis either radiofrequency or cryoablation is very low.

INTRODUCCIÓN: el dolor en columna lumbar afecta a un alto porcentaje de la población y presenta un significativo impacto socioeconómico. El síndrome facetario lumbar tiene una prevalencia entre 15-31% con incidencia a lo largo de la vida de hasta 52% en algunas series. Debido al empleo de distintos tipos de tratamiento y diversos criterios de selección de los pacientes, la tasa de éxito varía en la literatura. OBJETIVO: comparar resultados de tratamiento con rizólisis aplicando radiofrecuencia pulsada versus crioablación en pacientes con diagnóstico de síndrome facetario lumbar. MATERIAL Y MÉTODOS: de Enero de 2019 a Noviembre de 2019, ocho pacientes fueron divididos aleatoriamente en dos grupos: el grupo A tratados con radiofrecuencia pulsada y el grupo B tratados con crioablación. Se evaluó el dolor con la escala visual análoga y el índice de discapacidad de dolor lumbar de Oswestry a las cuatro semanas, además de tres y seis meses. RESULTADOS: el seguimiento fue de seis meses. De forma inmediata los ocho pacientes (100%) refirieron mejoría de los síntomas y del dolor. De los cuatro pacientes que se encontraban en limitación funcional intensa, uno pasó a estar sin limitación funcional, dos de ellos pasaron a limitación funcional mínima y uno a limitación funcional moderada al primer mes; se reportaron diferencias estadísticamente significativas. CONCLUSIONES: ambos tratamientos controlan el dolor en el corto plazo; también hay una mejoría de las capacidades físicas. La morbilidad que acompaña a la neurólisis, ya sea radiofrecuencia o crioablación, es muy baja.

[Application of the Graf method for diagnosis and early detection of hip dysplasia]. / Aplicación del método de Graf para el diagnóstico y tratamiento oportuno de displasia de cadera.

INTRODUCTION: Developmental hip dysplasia (DHD) is the most common disorder affecting pediatric hip; screening all neonates clinically, and using ultrasonography selectively for those babies who are at high risk is a widespread recommendation. our goal is to evaluate the impact that USG diagnosis and early treatment of DHD has had on the child population of our unit. MATERIAL AND METHODS: Retrospective, descriptive and cross-sectional study. Records of those children from one to six months of age, with a diagnosis of DHD, without distinction of sex, subjected to ultrasonographic tracking in the period from January 2018 to December 2019 were reviewed. A follow-up of six months was carried out in all patients, from the moment of diagnosis and the start of treatment with harness, weekly visits for relocation, as well as ultrasonographic revision every four weeks to monitor the treatment. RESULTS: 19 cases were reported from the left side (47.5%), 10 cases from the right side (25%) and 11 bilateral cases (27.5%). The main associated risk factors were: product of the first pregnancy, family history of DHD, pelvic presentation, female sex. The results were favorable with a continuous use of harness of 23 hours observing a satisfactory evolution in 99.2% of the patients. CONCLUSION: With the results obtained we can analyze the considerable success rate of the hip clinic of our hospital with the realization of the ultrasound, we find a lower incidence of patients with pain, limitation of function, as well as satisfactory gait patterns.

INTRODUCCIÓN: La displasia del desarrollo de cadera (DDC) es el trastorno más común que afecta la cadera pediátrica; hacer tamizaje a todos los neonatos en forma clínica y utilizar ultrasonografía en forma selectiva para aquellos bebés que se encuentran con alto riesgo es una recomendación muy difundida. Nuestro objetivo es evaluar el impacto que ha tenido el diagnóstico por ultrasonografía (USG) y tratamiento temprano de la DDC en la población infantil de nuestra unidad. MATERIAL Y MÉTODOS: Estudio retrospectivo, descriptivo y transversal. Se revisaron expedientes de aquellos niños de uno a seis meses de edad, con diagnóstico de DDC, sin distinción de sexo, sometidos a rastreo ultrasonográfico en el período de Enero de 2018 a Diciembre de 2019. Se realizó un seguimiento de seis meses en todos los pacientes, a partir del momento del diagnóstico y del inicio de tratamiento con arnés, visitas semanales para recolocación, así como realización de rastreos ultrasonográficos cada cuatro semanas para monitorización del tratamiento. RESULTADOS: Se reportaron 19 casos del lado izquierdo (47.5%), 10 casos del lado derecho (25%) y 11 casos bilaterales (27.5%). Los principales factores de riesgo asociados fueron: producto de la primera gesta, antecedentes familiares de DDC, presentación pélvica, sexo femenino. Los resultados fueron favorables con un uso continuo de arnés de 23 horas, se observó una evolución satisfactoria en 99.2% de los pacientes. CONCLUSIÓN: Con los resultados obtenidos podemos analizar la tasa de éxito considerable de la clínica de cadera de nuestro hospital con la realización del ultrasonido, encontramos una menor incidencia de pacientes con dolor, limitación de la función, así como patrones de marcha satisfactorios.

[Treatment of severe spinal deformity with 3D printing models]. / Tratamiento de deformidad severa de la columna vertebral con modelos de impresión 3D.

INTRODUCTION: Scoliosis is a complex deformity that affects all three planes of the axis of the spine. The association between neuromuscular pathology and vertebral alignment was initially described in 1960. Neuromuscular pathology is progressive and results in postural abnormalities. Surgical goals in patients with neuromuscular deformity include anatomical correction for sedation and ambulation, as well as functional improvement. The gold standard of treatment is by posterior approach with transpedicular screws. The "hands-free" technique saves surgical time, decreases radiation by reducing the use of fluoroscopy. The advent of 3D printing technology allows precise study of the anatomical area and detail of the deformity in its three planes. This model can be sterilized for transoperative guidance. A 13-year-old female patient who develops thoracolumbar neuromuscular scoliosis secondary to spastic cerebral palsy (CP), with previous instrumentation T11-L3 of which he develops severe proximal curve. After the segmentation of the three-dimensional model, pedicle violation greater than 2 mm towards bilateral medullary canal was detected in the pedicles of L1 and L2 of previous instrumentation, pedicle dysplasia and the morphological characteristics of the pedicles were observed. Three-dimensional planning and the use of surgical guides represent a tool for surgical planning, especially in severe cases and with pedicle dysplasia. It helps as a surgical guide for the placement of hands-free transpedicular screws with possible reduction of radiation and anesthetic time.

INTRODUCCIÓN: La escoliosis es una deformidad compleja que afecta los tres planos del eje de la columna vertebral. La asociación entre patología neuromuscular y la alineación vertebral fue descrita inicialmente en 1960. La patología neuromuscular es progresiva y resulta en anormalidades posturales. Las metas quirúrgicas en pacientes con deformidad neuromuscular engloban la corrección anatómica para la sedestación y deambulación, así como mejoría funcional. El estándar de oro de tratamiento es por vía posterior con tornillos transpediculares. La técnica de "manos libres" ahorra tiempo quirúrgico, disminuye la radiación al reducir el uso de fluoroscopía. El advenimiento de la tecnología de impresión 3D permite estudio preciso del área anatómica y detalle de la deformidad en sus tres planos. Este modelo puede ser esterilizado para guía transoperatoria. Paciente femenino de 13 años de edad que desarrolla escoliosis neuromuscular toracolumbar secundario a parálisis cerebral infantil (PCI) espástica, con instrumentación previa T11-L3 de la cual desarrolla curva severa proximal. Finalizada la segmentación del modelo tridimensional se detectó violación pedicular mayor a 2 mm hacia canal medular bilateral en los pedículos de L1 y L2 de instrumentación previa, displasia pedicular y se observaron las características morfológicas de los pedículos. La planeación tridimensional y el uso de guías quirúrgicas representan una herramienta para la planeación quirúrgica, sobre todo en casos severos y con displasia pedicular. Ayuda como guía quirúrgica para la colocación de tornillos transpediculares a manos libres con posible reducción de radiación y tiempo anestésico.

[Biomechanical analysis of interespinous ligamentoplasty with polyester fiber after discectomy]. / Análisis biomecánico de la ligamentoplastía interespinosa con fibra de poliéster posterior a discectomía.

INTRODUCTION: There are different pathologies of the lumbar spine that condition a biomechanical and clinical instability for its treatment, various stabilization techniques have been carried out that try to preserve the movement and the transmission of load of the affected segment such as the interspinatus ligamentplasty with Dallos® fiber. OBJECTIVE: To show the biomechanical variations of functional segment of lumbar spine of pigs, before and after performing the discectomy and ligamentoplasty with Dallos® fiber. MATERIAL AND METHODS: The lumbar segment was mounted in a servo-hydraulic multiaxial simulator. Mobility ranges of flexion, extension, lateral flexion and axial rotations were simulated under three conditions: 1. Natural segment, 2. Discectomy segment, and 3. Disectomized segment plus ligamentoplasty with Dallos® fiber. The mobility ranges are made up to a torque of 7.5 N-m The data of the torques and mobility ranges was collected in the simulator program and the results of the biomechanical changes between the three conditions described were plotted. RESULTS: It was shown that lumbar biomechanics is affected after discectomy mainly in flexion and extension. In the left axial bending and rotation movements, an alteration of torque and mobility ranges was found. CONCLUSIONS: The ligamentoplasty recovers part of the stability lost after discectomy preserving part of the disc height without reaching to equalize the movements as in the natural segment. After discectomy the distribution of force suggests that residual instability with ligament plasty may represent facet overload.

INTRODUCCIÓN: Existen diferentes patologías de la columna lumbar que condicionan una inestabilidad biomecánica y clínica para su tratamiento, se han efectuado diversas técnicas de estabilización que tratan de preservar el movimiento y la transmisión de carga del segmento afecto como la ligamentoplastía interespinosa con fibra Dallos®. OBJETIVO: Mostrar las variaciones biomecánicas de segmento funcional de columna lumbar de porcino, antes y después de realizar la discetomía y ligamentoplastía con fibra Dallos®. MATERIAL Y MÉTODOS: El segmento lumbar se montó en un simulador multiaxial servo-hidráulico. Se simularon rangos de movilidad de flexión, extensión, flexiones laterales y rotaciones axiales en tres condiciones: 1) segmento natural; 2) segmento discectomizado; y 3) segmento disectomizado más ligamentoplastía con fibra Dallos®. Los rangos de movilidad se realizan hasta un torque de 7.5 N-m. La data de los torques y rangos de movilidad se recolectó en el programa del simulador y se graficaron los resultados de los cambios biomecánicos entre las tres condiciones descritas. RESULTADOS: Se demostró que la biomecánica lumbar es afectada después de la discectomía principalmente en la flexión y la extensión. En los movimientos de flexión y rotación axial izquierdas, se comprobó una alteración del torque y los rangos de movilidad. CONCLUSIONES: La ligamentoplastía recupera parte de la estabilidad perdida postdiscectomía, preservando parte de la altura discal sin llegar a igualar los movimientos como en el segmento natural. Posterior a la discectomía, la distribución de la fuerza sugiere que la inestabilidad residual con ligamento plastía puede representar sobrecarga facetaria.

[Stevens-Johnson syndrome plus intrahepatic cholestasis caused by clindamycin or chlorpheniramine]. / Síndrome de Stevens Johnson más colestasis intrahepática inducido por clindamicina o clorfeniramina.

A 48-year-old woman was hospitalized with the diagnosis of hepatitis. She presented with symptoms of jaundice, headache, elevated bilirubin, and elevated hepatic enzymes. She related a recent episode of a bronchial infection that was treated during the previous eight days with paracetamol (500mg, 2 doses only), chlorpheniramine, betamethasone and clindamycin. After an initial clinical and laboratorial improvement, she began to complain of pruritus of the palms and soles. Thereafter, vesicles evolving to blisters developed and a deterioration of her general health ensued. Serologies for hepatitis A, B, and C viruses were negative. Intrahepatic cholestasis and Stevens Johnson Syndrome (SJS) were the final diagnosis. The association of the Stevens Johnson Syndrome and intrahepatic cholestasis simultaneously, related to adverse drug reactions, is very rare. The drugs reportedly involved are mainly antibiotics, such as ampicillin, vancomycin, amoxicillin/clavulinic acid and erythromycin. Other drugs involved are non-steroidal anti-inflamatory drugs, such as mefenamic acid, ibuprofen, and sulindac. The reactions can be minor or severe and can even cause death, an outcome that has been reported in patients of all races and ethnic groups, but appears to be more rare in patients of Latin origin. We present a discussion of this case and review the main characteristics of the Stevens Johnson Syndrome.

Could clinical audit improve the diagnosis of pulmonary tuberculosis in Cuba, Peru and Bolivia?

OBJECTIVES: To assess the effectiveness of clinical audit in improving the quality of diagnostic care provided to patients suspected of tuberculosis; and to understand the contextual factors which impede or facilitate its success. METHODS: Twenty-six health centres in Cuba, Peru and Bolivia were recruited. Clinical audit was introduced to improve the diagnostic care for patients attending with suspected TB. Standards were based on the WHO and TB programme guidelines relating to the appropriate use of microscopy, culture and radiological investigations. At least two audit cycles were completed over 2 years. Improvement was determined by comparing the performance between two six-month periods pre- and post-intervention. Qualitative methods were used to ascertain facilitating and limiting contextual factors influencing change among healthcare professionals' clinical behaviour after the introduction of clinical audit. RESULTS: We found a significant improvement in 11 of 13 criteria in Cuba, in 2 of 6 criteria in Bolivia and in 2 of 5 criteria in Peru. Twelve out of 24 of the audit criteria in all three countries reached the agreed standards. Barriers to quality improvement included conflicting objectives for clinicians and TB programmes, poor coordination within the health system and patients' attitudes towards illness. CONCLUSIONS: Clinical audit may drive improvements in the quality of clinical care in resource-poor settings. It is likely to be more effective if integrated within and supported by the local TB programmes. We recommend developing and evaluating an integrated model of quality improvement including clinical audit.

Magnetization reversal in orthorhombic Sr-doped LaFe0.5Cr0.5O3-δ.

In this paper we studied the reversal magnetization of La1-x Sr x Fe0.5Cr0.5O3-δ (x = 0, 0.1 and 0.2) samples produced by combustion synthesis. The structural analysis was carried out by x-ray diffraction with Rietveld analysis. These analyses revealed that all samples have an orthorhombic structure with space group Pbnm (62) and that the Sr-doping induces a decrease of the lattice parameter. The x-ray photoelectron spectroscopy analysis indicates that the Sr-doping favor the change of the valence states of the Fe3+ to Fe4+. The magnetization as a function of the temperature reveals an unusual magnetic behavior with a reversal of magnetization. The increase of the Sr content induces a decrease of the temperature where occurs an inversion of the magnetization and do the value of the magnetization at 5 K more negative. This effect is attributed to the increase of the concentration of Fe4+ with increasing of the Sr content. The Fe and Cr with a valence of 4+ act as paramagnetic impurities in the antiferromagnetic lattice and are responsible for the changes in the magnetic behavior.

[Tuberculosis in 0-14 year-olds in Cuba (1994-2003)]. / Tuberculosis en niños de 0-14 años: Cuba, 1994-2003.

INTRODUCTION: Tuberculosis in infants and children is a sign of continuous transmission. The present article describes the distribution and the trend in incidence rates of new tuberculosis cases in 0-15-year-olds in Cuba. METHODS: Incidence rates and their trend were estimated by provinces and age groups for the 1994-2003 period. Distribution and overall variation percentages, annual average rates, and rates and percentages according to classification were determined. RESULTS: The incidence rate decreased from 0.76 x 10(5) in 1994 to 0.31 in 2003 (59.2% of the overall reduction and 6.6% of the annual average reduction). The highest rate (1.06 x 10(5)) was found in 1995 (26 cases). In almost all provinces, the incidence trend decreased, except in the City of Havana, Sancti Spíritus, Santiago de Cuba, and the Isle of Youth. Childhood tuberculosis was mainly pulmonary (69.6%). Among the affected population, the highest percentages were found in the groups aged 10-14 years (35.6%) and 1-4 years (35.2%). CONCLUSIONS: Tuberculosis is infrequent and is extremely uncommon in infants. Notification is low throughout the country and the overall trend shows a steady decrease.

[Diet quality, overweight and obesity in university students]. / Calidad de la dieta, sobrepeso y obesidad en estudiantes universitarios.

OBJECTIVE: To assess diet quality and to examine the association between diet quality and overweight and obesity in a group of university students. SUBJECTS: Our simple consisted of 749 volunteer students of the State University of the Basque Country (68% females and 32% males). Mean age was 21.52 +/- 2.50 years old. METHODS: Dietary intake data were obtained from food frequency questionnaire. This questionnaire was validated using a 24 hour recall technique. From these data the diet quality index score was calculated. The total diet quality index score ranges from 0 to 50. Body mass index was used as criteria to identify overweight and obesity. Demographic data (age, sex), smoking status and alcohol use were also registered. The statistical analyses were performed with SPSS vs 13.0. Significance level P < 0.05. RESULTS: Prevalence of overweight and obesity for the total sample was 17.5% (25% in males and 13.9% in females). The mean diet quality index was 31.93 +/- 5.62. The diet quality index score was higher in women and among individuals who have a consumption of alcohol lower than 3 times per week. The mean diet quality index was significantly lower among obese and overweight subjects compared to the normal weight individuals in total sample and in men. CONCLUSIONS: Our results suggest that diet quality is associated with overweight and obesity in this population, and that this association varied across sex groups and groups according to alcohol consumption. Since the diet quality index is based on the Dietary Guidelines, the use of these guidelines as a way to improve health should be emphasized.

Characteristics of a presynaptic plasma membrane Ca2(+)-ATPase activity from electric organ.

Ca2(+)-ATPase activity was measured in electric organ synaptosomal homogenates and their derived presynaptic plasma membranes using a low ionic strength medium, low in Ca2+ and Mg2+, and devoid of K+. The enzyme activity showed a high apparent affinity for Ca2+ (KCa:0.5 microM) and was: (1) 5-fold stimulated by 120 nM calmodulin, (2) highly sensitive to LaCl3 inhibition, and (3) not affected by 20 mM NaN3 or 0.1 mM ouabain. The addition of Mg2+ promoted the disappearance of Ca2(+)-ATPase activity. Incubation of synaptosomal homogenates in the above-mentioned assay medium with [gamma -32P]ATP resulted in the appearance of a 140 kDa band as revealed by SDS-gel electrophoresis. Labeling of this band with 32P was inhibited by 1 mM EGTA or 10 mM NH2OH, indicating that the isotope incorporation required the presence of Ca2+ and the formation of an acyl-phosphate derivative. The results indicate that the Ca2(+)-ATPase activity from synaptosomal homogenates had characteristics corresponding to those of the enzyme that catalyzes an outward transport of Ca2+ in nerve terminals. Preincubation of synaptosomes in Ca2+ plus K+, a depolarizing procedure, induced a large and rapid decrease in the Ca2(+)-ATPase activity, possibly mediated via Ca2+ entry through voltage-gated Ca2+ channels. Furthermore, the muscarinic cholinergic agonist oxotremorine (at 15 microM concentration) did not significantly affect either the enzyme activity or the intensity of the Ca2(+)-dependent 32P incorporation into the 140 kDa band, suggesting that the enzyme is not coupled to muscarinic binding sites.

Transepithelial fate of bilirubin in the isolated rat kidney.

The renal handling of bilirubin in the rat was studied using an isolated kidney preparation by means of the determination of total pigment concentration decay in the perfusion medium and its renal clearance. Unconjugated bilirubin was incorporated in the perfusate at a concentration of about 4 microg/ml. In order to establish the potential role of secretion in renal handling of the pigment, experiments were also performed incorporating in the perfusate different doses of nicotinic acid (NA) (0.1 and 1.0 mM final concentration), which is considered an alternative substrate for the organic anion transport system, or probenecid (Prob) (0.1 and 1.0 mM final concentration), the classical inhibitor of organic anion transport process. The magnitude of pigment uptake from the perfusion medium, estimated by a first order exponential decay constant, was decreased in a dose-dependent way by NA (40 and 76% decrease for 0.1 and 1.0 mM of NA, respectively) and Prob (57 and 88% decrease for 0.1 and 1.0 mM of Prob, respectively). NA and Prob also induced a diminution in the ratio of pigment renal clearance to glomerular filtration rate (24 and 48% decrease for 0.1 and 1.0 mM of NA and 52 and 55% decrease for 0.1 and 1.0 mM of Prob). Based on these findings, it can be proposed that tubular secretion through the proximal cells contributes significantly to renal pigment depuration. In order to establish the possible contribution of cellular metabolism to the secretory process, a different set of experiments was conducted. The content of bilirubin mono and diconjugates (BMC and BDC) were determined in urine, in arterial and venous samples and in renal cortex. Studies performed using either an open or a closed circulating system, revealed that after conjugation in the renal cell, pigment derivatives can be secreted into both the tubule and the venous compartments. Total bilirubin concentration as well as the relative content of BMC and BDC in urine increased over time, representing the sum of both conjugates about 50% of the total pigment excreted by the end of experiments. Consequently, our results support the existence of a tubular transepithelial transport of bilirubin, playing the metabolism of the pigment an important role in this process.

Reconstitution of acetylcholine receptor function in lipid vesicles of defined composition.

The effect of specific lipids on the functional properties of the acetylcholine receptor were examined in reconstituted membranes prepared from purified Torpedo californica acetylcholine receptor and various defined lipids. Cholesterol and negatively charged lipids greatly enhanced the ion influx response of the vesicles as measured by the effect of a receptor agonist on cation translocation across the vesicles. Part of the lipid-dependent effects could be attributed to alterations in the average size of the vesicles. All lipid mixtures used permitted complete incorporation of receptor and retention of ligand binding properties. Quantitative differences in ion flux properties suggest a modulating role for specific lipids in acetylcholine receptor function.

Spreadsheet application for radiology resident match rank list.

RATIONALE AND OBJECTIVE: Enormous resources are spent on the selection process for radiology residency, yet agreement on criteria, process, and outcome remains elusive. The aim was to develop, implement, and evaluate a spreadsheet application that streamlined the creation of a match list for resident selection. MATERIALS AND METHODS: The Department of Radiology's traditional procedure of screening, interviewing, and rating candidates was left intact because the selection committee could not reach consensus regarding possible improvements in the process or outcome measures. We developed a spreadsheet application that used the ratings of candidate desirability for our program from our preexisting process to create a tentative match list by adding a system of ordinal ranking and weighting. After 4 years of use, the fairness and usefulness of this application were evaluated by members of the selection committee by means of a survey. RESULTS: The spreadsheet application was used to create tentative match lists for 4 years. The system eliminated ties among candidates on the preliminary match list and met the expectations of a majority of the selection committee members for fairness, objectivity, efficiency, and results. CONCLUSION: A spreadsheet application can streamline the process of resident selection without having to resolve underlying conflicts about selection criteria and outcome measures.

Application of the case method in medical student radiology education.

RATIONALE AND OBJECTIVES: Our goal is to design, implement, and evaluate a rich educational activity to engage medical students in learning the importance of providing clinical histories when ordering radiological examinations. We adapted the format of the case method commonly used in business schools. MATERIALS AND METHODS: In the setting of a 1-week required radiology course offered during the third year of medical school, we created an unknown case assignment consisting of two chest radiographs and a concise history for three- to four-person study teams. Unknown to students, each team received the same images, but different patient histories. After turning in their written analyses, students had a classroom opportunity to discuss their conclusions. A written evaluation of the entire experience using both Likert items and unstructured response items was conducted at the end of each session. RESULTS: The evaluation was conducted during a 17-month period, and 141 evaluations were received from students. The response rate was 100%. Most teams met several times and worked on the assignment for 2 or 3 hours. Students agreed that the learning experience was worthwhile (95%), content was appropriate (93%), and the activity should be continued for subsequent classes (94%). Unstructured responses indicated that students learned the importance of clinical histories in the interpretation of radiological studies. CONCLUSION: An educational activity based on the case method was well received by students and met its educational objectives. Activities of this type have potential for widespread application in radiology education.

Frequency of germ-line BRCA1 mutations among Spanish families from a Mediterranean area.

We have carried out a study of breast cancer in Spanish families in which the entire coding region of the BRCA1 gene have been analyzed. To identify BRCA1 mutations, PTT and CSGE methods were used followed by direct sequencing. We investigated 51 breast cancer women with a family history. Among these we have identified 7 frameshifts mutations (15%), 185delAG (4 times), 1623del5 and 3450del4 (2 times), and 3 missense mutations, Ser1613Gly, Met1652Ile and Ala1708Glu, which are likely polymorphisms. These findings show that BRCA1 is implicated in a fraction of Spanish familial breast cancer similar to other countries. There was association between bilateral breast cancer and BRCA1 mutations. The CSGE technique has been demonstrated to be a highly reliable method for mutation screening because of its sensitivity and high throughput.

Desensitization of central cholinergic mechanisms and neuroadaptation to nicotine.

This review focuses on neuroadaptation to nicotine. The first part of the paper delineates some possible general mechanisms subserving neuroadaptation to commonly abused drugs. The postulated role of the mesocorticolimbic neuroanatomical pathway and drug-receptor desensitization mechanisms in the establishment of tolerance to, dependence on, and withdrawal from psychoactive drugs are discussed. The second part of the review deals with the pharmacological effects of nicotine at both pre- and postsynaptic locations within the central nervous system, and the still-perplexing upregulation of brain nicotine-binding sites seen after chronic nicotine administration. A special emphasis has been put on desensitization of presynaptic cholinergic mechanisms, and postsynaptic neuronal nicotinic-receptor function and its modulation by endogenous substances. A comparison with the inactivation process occurring at peripheral nicotinic receptors is also included. Finally, a hypothesis on the possible connections between desensitization of central cholinergic mechanisms and neuroadaptation to nicotine is advanced. A brief comment on the necessity of fully understanding the effects of nicotine on the developing nervous system closes this work.

Marginal zone B-cell lymphoma of the salivary gland arising in chronic sclerosing sialadenitis (Küttner tumor).

We report a case of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type of the salivary gland arising in a background of chronic sclerosing sialadenitis. Chronic sclerosing sialadenitis is a common fibrosing chronic inflammatory lesion of the submandibular gland, which is thought to be the result of sialolithiasis, and is not associated with a systemic autoimmune disease. Salivary MALT lymphomas are typically associated with lymphoepithelial sialadenitis (LESA) in a patient with or without Sjögren's syndrome. Our case of salivary MALT lymphoma was neither preceded by Sjögren's syndrome nor accompanied by LESA. This case suggests that chronic inflammatory processes other than Sjögren's syndrome may provide a substrate for the development of MALT lymphoma.

Silicon micromachining to tissue engineer branched vascular channels for liver fabrication.

To date, many approaches to engineering new tissue have emerged and they have all relied on vascularization from the host to provide permanent engraftment and mass transfer of oxygen and nutrients. Although this approach has been useful in many tissues, it has not been as successful in thick, complex tissues, particularly those comprising the large vital organs such as the liver, kidney, and heart. In this study, we report preliminary results using micromachining technologies on silicon and Pyrex surfaces to generate complete vascular systems that may be integrated with engineered tissue before implantation. Using standard photolithography techniques, trench patterns reminiscent of branched architecture of vascular and capillary networks were etched onto silicon and Pyrex surfaces to serve as templates. Hepatocytes and endothelial cells were cultured and subsequently lifted as single-cell monolayers from these two-dimensional molds. Both cell types were viable and proliferative on these surfaces. In addition, hepatocytes maintained albumin production. The lifted monolayers were then folded into compact three-dimensional tissues. Thus, with the use microfabrication technology in tissue engineering, it now seems feasible to consider lifting endothelial cells as branched vascular networks from two-dimensional templates that may ultimately be combined with layers of parenchymal tissue, such as hepatocytes, to form three-dimensional conformations of living vascularized tissue for implantation.

The effects of amantadine on liposomally reconstituted nicotinic acetylcholine receptor.

The effects of amantadine on liposomally reconstituted nicotinic acetylcholine receptor function were studied. At 1 x 10(?4)M, the drug blocked 85% of the carbamylcholine-induced cation influx into liposomes, but left 90% of the ?bungarotoxin binding intact. In addition, amantadine was shown to be a non-competitive inhibitor of membrane bound acetylcholinesterase. These experiments are relevant to the mechanism of action of amantadine at the motor end plate, where it produces electrophysiological changes compatible with an inhibition of cholinergic agonist mediated ion flux.