Electric scooters: convenient transport or ED headache?

Electric scooters (e-scooters) provide a potentially attractive means of private transportation in the pandemic era, during which use of public transport is discouraged. E-scooter use has become widespread recently, and we have noticed a concomitant rise in related craniomaxillofacial injuries, often associated with alcohol consumption and lack of protective equipment. We present here the first-published UK data on electric scooter injuries which, in the post-lockdown period, included facial lacerations, mandibular and midface fractures, avulsed teeth, and cervical spine injury. We urge that forthcoming legislation make e-scooters subject to at least the same requirements in lighting, helmet wear, and sobriety as bicycles and that, in this way, their benefits can be enjoyed while reducing associated morbidity and mortality.

Optimal dynamic incentive scheduling for Hawk-Dove evolutionary games.

The Hawk-Dove evolutionary game offers a paradigm of the trade-offs associated with aggressive and passive behaviors. When two (or more) populations of players compete, their success or failure is measured by their frequency in the population, and the system is governed by the replicator dynamics. We develop a time-dependent optimal-adaptive control theory for this dynamical system in which the entries of the payoff matrix are dynamically altered to produce control schedules that minimize and maximize the aggressive population through a finite-time cycle. These schedules provide upper and lower bounds on the outcomes for all possible strategies since they represent two extremizers of the cost function. We then adaptively extend the optimal control schedules over multiple cycles to produce absolute maximizers and minimizers for the system.

Rhabdoid meningioma with cranial nerve involvement: case report of a child.

CASE REPORT: A 13-year-old girl presented with off and on headache for 1 year, hearing loss for 6 months and difficulty in closing eyes for 5 months along with mild cerebellar signs. Histopathologic evaluation of the tumor showed a rhabdoid meningioma (WHO Grade III). DISCUSSION: Rhabdoid meningiomas are uncommon in children, and only 4 cases have been reported so far. None of them presented with cranial nerve involvement. This unusual presentation is reported here. CONCLUSION: Though rare, rhabdoid meningiomas can occur in children. This, to the best of the authors' knowledge, is the first case of rhabdoid meningioma presenting with cranial nerve involvement.

Patient understanding of commonly used oral medicine terminology.

Introduction Communication within the doctor-patient relationship is complex due to a variety of reasons; a patient's understanding may not correspond with the clinician's vocabulary, resulting in misunderstanding, anxiety and ill-informed decision making. We investigated the understanding of terminology commonly used in oral and maxillofacial surgery and oral medicine clinics.Methods We investigated patients' understanding using a questionnaire-based study in the out-patient setting. Age, gender, first language and highest educational level were recorded. The questionnaire included multiple choice questions regarding patients' understanding of words as well as asking patients to define certain terms. Vocabulary included 'ulcer', 'blister', 'cancer', 'malignant' and 'benign'.Results and conclusions Many patients have difficulty in understanding and explaining commonly used terminology. 'Blister' was the most commonly understood term, while 'benign' and 'lesion' were the least well understood. 'Tumour' was mistakenly thought of as synonymous with 'malignancy' by over a third of patients. Understanding was better among those for whom English was their first language. It is essential that all clinicians modify their language appropriately during consultations in order to deliver information in a comprehensive manner, to educate patients on their condition thus enabling informed decision making by patients.

A comparative proteinomic analysis of nipple aspiration fluid from healthy women and women with breast cancer.

This pilot study examines the feasibility of nipple aspiration to distinguish women with breast cancer from healthy women using surface-enhanced laser desorption ionisation time-of-flight mass spectrometry (SELDI-TOF/MS). Nipple aspiration fluid (NAF) was collected from each breast in 21 women newly diagnosed with unilateral breast cancer and 44 healthy women. No differences were found when proteomic profiles of NAF from the cancer-bearing breast and the contralateral non-cancerous breast were compared. In contrast, 9 protein peaks were significantly different between the cancer-bearing breast compared with healthy women and 10 peaks were significantly different between the contralateral healthy breast and healthy women (P<0.05). These data suggest that invasive breast cancer may result in a field change across both breasts and that proteomic profiling of NAF may have more value in breast cancer risk assessment than as a diagnostic or screening tool.

Rationally designed anti-HER2/neu peptide mimetic disables P185HER2/neu tyrosine kinases in vitro and in vivo.

Monoclonal antibodies specific for the p185HER2/neu growth factor receptor represent a significant advance in receptor-based therapy for p185HER2/neu-expressing human cancers. We have used a structure-based approach to develop a small (1.5 kDa) exocyclic anti-HER2/neu peptide mimic (AHNP) functionally similar to an anti-p185HER2/neu monoclonal antibody, 4D5 (Herceptin). The AHNP mimetic specifically binds to p185HER2/neu with high affinity (KD=300 nM). This results in inhibition of proliferation of p185HER2/neu-overexpressing tumor cells, and inhibition of colony formation in vitro and growth of p185HER2/neu-expressing tumors in athymic mice. In addition, the mimetic sensitizes the tumor cells to apoptosis when used in conjunction with ionizing radiation or chemotherapeutic agents. A comparison of the molar quantities of the Herceptin antibody and the AHNP mimetic required for inhibiting cell growth and anchorage-independent growth showed generally similar activities. The structure-based derivation of the AHNP represents a novel strategy for the design of receptor-specific tumor therapies.

Endothelial adhesion molecules in breast cancer invasion into the vascular and lymphatic systems.

AIMS: It is well recognised that intravasation of tumour cells into the vasculature and/or lymphatics is a key stage in the metastatic process. It is also clear that very little is known about the mechanisms underlying this event. In this review, we will focus on cell surface molecules that may be instrumental in mediating the attachment of tumour cells, and in particular breast carcinoma cells, to the lymphatic and microvascular endothelia and discuss the therapeutic and prognostic value in targeting these receptors in metastatic disease. METHODS: A literature search was carried out from PubMed for indexed articles and reviews. Websites containing information on gene expression profiles were located using standard web browser search functions. For articles containing gene expression data, relevant information was frequently located in supplementary tables or in associated websites. FINDINGS: The search yielded a very large number of indexed published articles and websites. Important major reports and studies were reviewed, screened and tracked for other relevant publications. The most important articles were analysed and discussed. CONCLUSIONS: The lack of knowledge as to the mechanism by which tumour cells intra-vasate into the vasculature and/or lymphatics is perhaps not surprising given the lack of suitable models with which to investigate tumour cell intravasation. However, recent advances in the identification of molecular markers of angiogenic and lymphangiogenic endothelium, the development of techniques to image tumour cells in vivo and a better understanding of the architecture of these vessels is beginning to offer hope that this least well understood event in the metastatic process is becoming more amenable to study.

Clostridium pasteurianum glutamine synthetase mechanism. Evidence for active site tyrosine residues.

Preliminary chemical modification studies indicated the presence of tyrosine, carboxyl, arginine, histidine and the absence of serine and sulfhydryl residues at or near the active site of Clostridium pasteurianum glutamine synthetase. The conditions for tyrosine modification with tetranitromethane were optimized. The inactivation kinetics follow pseudo-first-order kinetics with respect to enzyme and second order with respect to modifier per active site. There was no inactivation at pH 6.5 suggesting the absence of thiol oxidation. The synthetase and transferase reactions followed the same pattern of inactivation on enzyme modification and both were equally protected by glutamate plus ATP. Thus tyrosine residues are present at the active site of the enzyme and are essential for both transferase and synthetase activities.

Dopamine receptors in the ventral tegmental area affect motor, but not motivational or reflexive, components of copulation in male rats.

Microinjection of apomorphine into the ventral tegmental area (VTA) of male rats was previously shown to delay the onset of copulation and slow its rate, presumably by stimulating impulse-regulating autoreceptors on cell bodies of the A10 mesocorticolimbic dopamine tract. Such stimulation would be expected to slow the firing rate of these neurons and, thereby, to impair locomotion and/or motivational processes. The present experiments tested whether the delayed onset and slowed rate of copulation were related to deficits in motor performance, sexual motivation, and/or genital reflexes. In X-maze tests the speed of running to all 4 goal boxes was slowed; however, the percentage of trials on which the male chose the female's goal box was not decreased. Examination of videotaped copulation tests revealed that the male showed fewer complete copulatory behaviors (mounts, intromissions, and ejaculations), but more misdirected or incomplete copulatory attempts after apomorphine in the VTA. There were also fewer scores of active, as opposed to inactive, behaviors, and the onset and rate of copulation were slowed. The total number of female directed behaviors was not different in apomorphine tests, compared to vehicle. Finally, tests of ex copula genital reflexes revealed no significant effects of apomorphine in the VTA on erections, penile movements, or seminal emissions. These data suggest a role of the VTA in the motor aspects and/or sensorimotor integration of copulation. Sexual motivation and ex copula genital reflexes appeared to be unaffected by apomorphine in the VTA.

Visual field loss in HIV-positive patients without infectious retinopathy.

PURPOSE: To determine the extent of vision loss in a cross-sectional study of HIV-positive individuals who had no infectious retinopathy. METHODS: Visual field loss was determined by computerized achromatic automated perimetry and short-wavelength automated perimetry in both eyes in 65 HIV-positive individuals without infectious retinopathy and in one randomly selected eye each in 57 age-matched normal controls. Results were analyzed using the global index of mean defect and the Glaucoma Hemifield Test, and significance was determined through analysis of variance, chi-square, and Tukey-Kramer tests. RESULTS: We found that HIV-positive patients, compared with age-matched HIV-negative controls, demonstrated significant (at least P < .01) localized defects as well as an increased mean defect. The HIV-positive patients also had a significantly greater number of defective points, especially on short-wavelength automated perimetry, even while ophthalmoscopic examination and fundus photographs suggested that the retinas were normal. CONCLUSIONS: There is a significant loss of visual function in HIV-positive individuals that is not the result of infectious retinopathies. The finding by short-wavelength perimetry of more severe defects suggests that the vision defects are not caused by attentional or other suprachiasmatic problems because the neurologic difficulty of both achromatic and short-wavelength perimetry is similar. The effects of this vision loss on the daily living and occupational tasks of this population require further study.

Analysis of visual dysfunctions in HIV-positive patients without retinitis.

PURPOSE: To investigate visual dysfunctions in ophthalmoscopically normal human immunodeficiency virus (HIV)-positive patients and to correlate the results to the stage of HIV disease and neuropsychological status. METHODS: Fifty-one randomly selected eyes (26 right, 25 left) of 51 HIV-positive patients with visual acuity measurements of 20/20 or better and no ophthalmoscopically detectable disorders were prospectively examined using achromatic and short-wavelength automated perimetry, color vision testing, and contrast sensitivity testing. CD4+ T-lymphocyte count, presence of systemic infection, hemoglobin, hematocrit, serum beta 2-microglobulin levels, and results of neuropsychological testing were also analyzed. RESULTS: On achromatic automated perimetry, 21.6% (11/51) of patients performed abnormally according to the mean defect and 27.5% (14/51) according to the Glaucoma Hemifield Test; 29.4% (15/51) performed abnormally on short-wave-length automated perimetry according to the mean defect and 23.5% (12/51) according to the Glaucoma Hemifield Test. On contrast sensitivity, 5.9% (3/51) of patients performed abnormally in the 1.5-cycles per degree (cpd) line, 2.0% (2/51) in the 3-cpd line, 23.5% (12/51) in the 6-cpd line, 25.5% (13/51) in the 12-cpd line, and 33.3% (17/51) in the 18-cpd line. On the Farnsworth-Munsell 100-hue test, 29.4% (15/51) of patients performed abnormally. After correction for multiple correlations, two statistically significant correlations were found: sum of log contrast sensitivity with achromatic automated perimetry and sum of log contrast sensitivity with the Farnsworth-Munsell 100-hue test. CONCLUSIONS: A significant percentage of HIV-positive patients with visual acuity of 20/20 or better and no ophthalmologic evidence of retinitis performed abnormally on visual psychophysical tests. The severity of visual dysfunction was not correlated with the stage of HIV infection or the degree of neuropsychological dysfunction.

An active-site carboxyl group in liquefying alpha-amylase: specific chemical modification.

Bacillus amyloliquefaciens alpha-amylase activity is pH-dependent and the plot log (Vmax/Km) versus pH implicated a carboxyl group of aspartic acid/glutamic acid at the active site. Chemical modification of alpha-amylase with EDC confirmed this view. Further, analysis of inactivation kinetics showed that modification of a single carboxyl group led to complete loss of the enzymic activity.

The effect of dietary selenium on lead neurotoxicity.

Lead, when administered to male rats for 8 weeks in a dose of 20 mg/kg body weight, resulted in the impairment of the enzymes hexokinase and total ATPase in the cerebral and cerebellar regions of the brain. The changes were, however, more pronounced in the cerebellar region. Along with these, a decrease in acetylcholine esterase (AchE) and monoamine oxidase (MAO) was seen, thus affecting both cholinergic and adrenergic neurotransmitters. When selenium was administered concomitantly with lead, the values of total ATPase and hexokinase activities approached normal values in both brain regions. A significant improvement in acetylcholine esterase activity and MAO was also seen.

Assay of major and minor constituents of opium samples and studies of their origin.

Samples of opium from different countries as well as from various regions of India were studied for their morphine and codeine content by gas-liquid chromatography (GLC) as their silyl ethers in a single step. Non-phenolic alkaloids (thebaine, papaverine and narcotine) were extracted with dichloromethane for GLC after conversion of the meconic acid, morphine and codeine in opium into insoluble salts with lime water. The data on alkaloidal constituents have been utilised in a determination of the origin of seized opium samples in this preliminary study.

The influence of the enhancer dimyristoylphosphatidylglycerol and formulation factors on the nasal absorption of salmon calcitonin.

The objective of this investigation was to study the effect of the phospholipid dimyristoylphosphatidylglycerol (DMPG) on the intranasal absorption of the polypeptide salmon calcitonin (sCT). DMPG was included as an absorption enhancer for salmon calcitonin in a 0.03 M acetate buffer at pH 4 in a nasal spray formulation. The absorption of sCT was studied as a function of NaCl concentration from 0.045 to 0.3 M. Serum calcitonin was determined using a double-antibody radioimmunoassay (RIA). The presence of the phospholipid demonstrated a significant difference in the intranasal bioavailability of salmon calcitonin. The results showed that DMPG enhanced the nasal absorption of sCT by approximately twofold at a salt concentration of 0.045 M. However, higher salt concentrations in the formulation demonstrated a decrease in the absorption-enhancing effect of DMPG. The effect of DMPG on the calcium-lowering effect of sCT was also studied. There was no significant difference in the hypocalcemic activity of sCT in the presence of DMPG. In addition, it was found that increasing the viscosity of those formulations containing DMPG did not further increase the nasal bioavailability of sCT.

Effect of selenium on lead-induced alterations in rat brain.

The effects of lead (Pb) and selenium (Se) interactions on central nervous system (CNS) functions were seen in adult rats by both biochemical and histologic pathological alterations. Pb administration of 20 mg/kg body wt for 8 wk showed degenerative changes only in the cerebral cortex. The changes in the cerebellar regions were not significant. Biochemically a marked decrease in the DNA, RNA, and protein content was seen following lead treatment. These decreases were significant in both the regions of the brain. During the concomitant administration of Pb and Se, the alterations in the transverse section of cerebral cortex showed only marginal changes. The values of DNA and RNA content showed significant improvement in both regions of the brain compared to the Pb treated group.

Compartment syndrome following pelvic surgery in the lithotomy position.

We report the cases of two patients who developed compartment syndrome following pelvic surgery in the lithotomy position. These cases highlight this important and potentially devastating complication.

Purification and preliminary characterization of L-asparaginase from Erwinia aroideae NRRL B-138.

L-Asparaginase (L-asparagine amidohydrolase EC 3.5.1.1) from Erwinia aroideae NRRL B-138 has been purified to apparent homogeneity by ammonium sulphate precipitation, chromatography on sulfopropyl-sephadex C-50 and sephadex G-200 with 22% recovery and 567-fold purification. The enzyme obtained from sulfopropyl-sephadex C-50 was unstable and lost activity within a few hours. Addition of glycerol helped in restoring the activity of the enzyme. The enzyme has an apparent molecular mass of approximately 155 kDa and has four subunits of identical molecular mass of approximately 38 kDa. The K(m) for L-asparagine is 2.8 x 10(-3) M. Enzyme shows optimal activity at 45 degrees C and pH 8.2. Energy of activation as determined from Arrhenius plot was 9.1 kcal/mol. Substrate L-asparagine and analogue L-glutamine, D-asparagine and 6 diazo-5-oxo-L-norleucine provide full protection to the enzyme against thermal denaturation.

A comparative evaluation of the tensile strength of silver soldered joints of stainless steel and cobalt chromium orthodontic wires with band material--an in vitro study.

The present study was conducted to compare and evaluate the tensile strength of silver soldered joints of stainless steel and cobalt-chromium orthodontic wires with band material. An attempt was made to observe the effect of joint site preparation by incorporation of tack welding and increasing metal to metal surface contact area by flattening an end of the wire prior to soldering along with the regularly used round wires without tack welding. A total of 180 wire specimens were soldered to 180 band specimens. Fifteen samples according to joint site preparation were included for each of the wire groups i.e. Gloria (S.S.), Remanium (S.S.) and Remaloy (Co-Cr) wires of 0.036" in diameter. The findings of the study were suggestive that all three wires may be used for preparing silver soldered joints irrespective of the quality of the wire. However, when subjecting the wire to joint site preparation, Gloria (S.S.) wire showed less tensile strength as compared to Remanium and Remaloy.

Psoas:lumbar vertebra index: central sarcopenia independently predicts morbidity in elderly trauma patients.

INTRODUCTION: Central sarcopenia as a surrogate for frailty has recently been studied as a predictor of outcome in elderly medical patients, but less is known about how this metric relates to outcomes after trauma. We hypothesized that psoas:lumbar vertebral index (PLVI), a measure of central sarcopenia, is associated with increased morbidity and mortality in elderly trauma patients. METHODS: A query of our institutional trauma registry from 2005 to 2010 was performed. Data was collected prospectively for the Pennsylvania Trauma Outcomes Study (PTOS). INCLUSION CRITERIA: age >55 years, ISS >15, and ICU LOS >48 h. Using admission CT scans, psoas:vertebral index was computed as the ratio between the mean cross-sectional areas of the psoas muscles and the L4 vertebral body at the level of the L4 pedicles. The 50th percentile of the psoas:L4 vertebral index value was determined, and patients were grouped into high (>0.84) and low (≤0.83) categories based on their relation to the cohort median. Primary endpoints were mortality and morbidity (as a combined endpoint for PTOS-defined complications). Univariate logistic regression was used to test the association between patient factors and mortality. Factors found to be associated with mortality at p < 0.1 were entered into a multivariable model. RESULTS: A total of 180 patients met the study criteria. Median age was 74 years (IQR 63-82), median ISS was 24 (IQR 18-29). Patients were 58 % male and 66 % Caucasian. Mean PLVI was 0.86 (SD 0.25) and was higher in male patients than female patients (0.91 ± 0.26 vs. 0.77 ± 0.21, p < 0.001). PLVI was not associated with mortality in univariate or multivariable modeling. After controlling for comorbidities, ISS, and admission SBP, low PLVI was found to be strongly associated with morbidity (OR 4.91, 95 % CI 2.28-10.60). CONCLUSIONS: Psoas:lumbar vertebral index is independently and negatively associated with posttraumatic morbidity but not mortality in elderly, severely injured trauma patients. PLVI can be calculated quickly and easily and may help identify patients at increased risk of complications.