Estimating the prevalence of active Helicobacter pylori infection in a rural community with global positioning system technology-assisted sampling.

We investigated a possible outbreak of H. pylori in a rural Northern Plains community. In a cross-sectional survey, we randomly sampled 244 households from a geocoded emergency medical system database. We used a complex survey design and global positioning system units to locate houses and randomly selected one eligible household member to administer a questionnaire and a 13C-urea breath test for active H. pylori infection (n = 166). In weighted analyses, active H. pylori infection was detected in 55·0% of the sample. Factors associated with infection on multivariate analysis included using a public drinking-water supply [odds ratio (OR) 12·2, 95% confidence interval (CI) 2·9-50·7] and current cigarette smoking (OR 4·1, 95% CI 1·7-9·6). People who lived in houses with more rooms, a possible indicator of decreased crowding in the home, were less likely to have active H. pylori infections (OR 0·7, 95% CI 0·5-0·9 for each additional room).

Added value of a household-level study during an outbreak investigation of Salmonella serotype Saintpaul infections, New Mexico 2008.

In 2008, nationwide investigations of a Salmonella serotype Saintpaul outbreak led first to consumer warnings for Roma and red round tomatoes, then later for jalapeño and serrano peppers. In New Mexico, where there were a large number of cases but no restaurant-based clusters, the NM Department of Health and the Indian Health Service participated with CDC in individual-level and household-level case-control studies of infections in New Mexico and the Navajo Nation. No food item was associated in the individual-level study. In the household-level study, households with an ill member were more likely to have had jalapeño peppers present during the exposure period and to have reported ever having serrano peppers in the household. This report illustrates the complexity of this investigation, the limitations of traditional individual-level case-control studies when vehicles of infection are ingredients or commonly eaten with other foods, and the added value of a household-level study.

Bioactivation of leukotoxins to their toxic diols by epoxide hydrolase.

Leukotoxin is a linoleic acic oxide produced by leukocytes and has been associated with the multiple organ failure and adult respiratory distress syndrome seen in some severe burn patients. Leukotoxin has been reported to be toxic when injected into animals intravenously. Herein, we report that this lipid is not directly cytotoxic in at least two in vitro systems. Using a baculovirus expression system we demonstrate that leukotoxin is only cytotoxic in the presence of epoxide hydrolases. In addition, it is the diol metabolite that proves toxic to pulmonary alveolar epithelial cells, suggesting a critical role for the diol in leukotoxin-associated respiratory disease. In vivo data also support the toxicity of leukotoxin diol. For the first time we demonstrate that soluble epoxide hydrolase can bioactivate epoxides to diols that are apparently cytotoxic. Thus leukotoxin should be regarded as a protoxin corresponding to the more toxic diol. This clearly has implications for designing new clinical interventions.

NASA's Satellite Laser Ranging Systems for the 21st Century.

For over 40 years, NASA's global network of satellite laser ranging (SLR) stations has provided a significant percentage of the global orbital data used to define the International Terrestrial Reference Frame (ITRF). The current NASA legacy network is reaching its end-of-life and a new generation of systems must be ready to take its place. Scientific demands of sub-millimeter precision ranging and the ever-increasing number of tracking targets give aggressive performance requirements to this new generation of systems. Using lessons learned from the legacy systems and the successful development of a prototype station, a new network of SLR stations, called the Space Geodesy Satellite Laser Ranging (SGSLR) systems, is being developed. These will be the state-of-the-art SLR component of NASA's Space Geodesy Project (SGP). Each of SGSLR's nine subsystems has been designed to produce a robust, kilohertz laser ranging system with 24/7 operational capability and with minimal human intervention. SGSLR's data must support the aggressive goals of the Global Geodetic Observing System (GGOS), which are 1 millimeter (mm) position accuracy and 0.1 mm per year stability of the ITRF. This paper will describe the major requirements and accompanying design of the new SGSLR systems, how the systems will be tested, and the expected system performance.

An outbreak of Rocky Mountain Spotted Fever associated with a novel tick vector, Rhipicephalus sanguineus, in Arizona, 2004: preliminary report.

This study describes preliminary results of an investigation of RMSF in Arizona associated with the brown dog tick, Rhipicephalus sanguineus. High numbers of dogs and heavy infestations of ticks created a situation leading to human disease.

Adjuncts to mechanical ventilation in ARDS.

Since its first description, acute respiratory distress syndrome has been characterized by abnormal physiologic and gas exchange properties of the lungs. Many adjunctive therapies have been developed to reduce the stresses of mechanical ventilation on already damaged lungs. We examined the mechanism of action and the latest clinical trial information of several adjunctive therapies including prone positioning, nitric oxide, extracorporeal membrane oxygenation, arterial venous carbon dioxide removal, and liquid ventilation. While all of these therapies have demonstrated short-term improvements in arterial blood gases and in the limitation of lung injury, none have shown an evidence-based survival benefit.

Plasma amino acid concentrations in premature infants: effect of sampling site.

Amino acid concentrations in plasma obtained from infants by heel puncture differ from those in venous plasma primarily because of skin contamination but data from the two sites might agree more closely in premature infants because of their poorly developed sweat glands. To evaluate the importance of sampling site, amino acids were analyzed by a sensitive high-performance liquid chromatographic method in plasma obtained both by heel puncture and venipuncture in 14 premature infants. Histidine, tryptophan, alanine, aspartic acid, glycine, and serine were higher in capillary plasma. Tryptophan and glycine levels in capillary plasma correlated strongly with those in venous plasma. An additional wash with soap and water done in five infants did not eradicate the differences. Thus the lack of agreement between data from the two sites may be due to factors other than contamination.

Extensive brain calcification and progressive dysarthria and dysphagia associated with chronic hypoparathyroidism.

An 81-year-old woman with a 13-year history of hypoparathyroidism developed dysarthria and dysphagia. Cranial computed tomography demonstrated extensive calcification involving the basal ganglia, corona radiata, and deep cerebellar structures. The cerebral small-vessel calcification that occurs in chronic hypoparathyroidism may produce the syndrome of progressive dysarthria and dysphagia.

Steroid receptors in benign mastectomy tissue.

Estrogen and progesterone receptors (ERs and PRs, respectively) were measured in both cancerous and noncancerous components of 104 modified radical mastectomy specimens. In addition, ER and PR levels were determined for 14 benign breast specimens obtained by reduction mammoplasty. The receptor levels were measured by scatchard method. Each of these groups--cancerous, corresponding noncancerous, and mammoplasty specimens--were divided into subgroups according to their receptor levels. Fourteen of the 104 noncancerous specimens were found to be ER positive (ER+). Most cases of ER+ noncancerous tissue (13 of 14 cases) were associated with ER+ tumors. The reverse was not true because only 13 of 64 cases of the ER+ tumors were associated with positive ER in their noncancerous counterparts. Comparable results were obtained for PR. The average ER-PR level of the noncancerous mastectomy tissue was significantly higher than that of the mammoplasty specimens despite the similar histologic findings in both groups.

Mumps outbreak in a highly vaccinated school population. Evidence for large-scale vaccination failure.

OBJECTIVES: To describe an outbreak and to identify risk factors for mumps occurring in a highly vaccinated high school population. (Note: Highly vaccinated means a population in which more than 95% have been vaccinated.) DESIGN AND PARTICIPANTS: Survey and cohort study of 307 (97%) of 318 students. OUTCOME MEASURES: Mumps was defined as an illness with 2 or more days of parotid swelling. Serologic confirmation of infection was obtained in eight cases, seven of which were evaluated for presence of IgM antibody using immunofluorescent antibodies. Vaccination records were verified for 297 (97%) students. RESULTS: Between October 3 and November 23, 1990, clinical mumps developed in 54 students (attack rate, 18%), 53 of whom had been vaccinated. Most cases (40 [77%] of 52) occurred 12 to 20 days after a school-wide pep rally. Immunofluorescent antibody testing of all seven specimens demonstrated IgM antibody to mumps. Risk factors for clinical mumps identified in multivariate analyses included female gender (odds ratio, 3.0; 95% confidence interval, 1.6 to 5.7) and source of vaccination other than the local public health clinic (students vaccinated by private providers [odds ratio, 3.0; 95% confidence interval, 1.3 to 5.2] or in other districts [odds ratio, 2.4; 95% confidence interval, 1.1 to 5.3]). CONCLUSIONS: The overall attack rate is the highest reported to date (and to our knowledge) for a population demonstrating virtually complete mumps vaccine coverage. Even verified documentation of vaccination may not be an accurate indicator of an individual's protection against mumps. Vaccination failure may play an important role in contemporary mumps outbreaks. We found no evidence to indicate that waning immunity (secondary vaccine failure) contributed significantly to this outbreak. A second dose of mumps vaccine, as recommended using measles-mumps-rubella vaccine, could potentially prevent similar outbreaks in secondary school populations in the future.

Posterior fossa intraoperative monitoring.

Monitoring of brainstem structures is requested of the neurophysiologist for both intra-axial and extra-axial surgeries of the posterior fossa. A variety of techniques to include upper extremities somatosensory evoked potentials, short latency auditory evoked potentials, spontaneous and evoked electromyographic activity, and recordings from the cochlea and the eighth nerve are available. The indication, implementation, and interpretation of each of these modalities are delineated. The efficacy and utility of these techniques are also discussed.

Value of full-field visual evoked potentials for retrochiasmal lesions.

Some abnormalities in the P100 on monocular stimulation have been said to indicate retrochiasmal abnormalities. This study was undertaken to evaluate the reliability of visual evoked potentials (VEPs) for this purpose. We retrospectively reviewed VEPs that could be interpreted as indicative of a retrochiasmal lesion, based on an amplitude asymmetry of >50% between the P100 recorded on the left and right occipital regions. The abnormality had to be present on both left and right monocular stimulation (uncrossed pattern). Studies were conducted in accordance with the guidelines of the American Electroencephalographic Society. Findings on magnetic resonance (MR) imaging were analyzed. For comparison, we also studied a control group of 30 patients with normal VEPs. During a 16-month period, we identified 15 patients who fulfilled the aforementioned criteria and who had undergone an MR scan of the brain. Eight scans were normal and seven were abnormal. Of the seven abnormal scans, five revealed multiple periventricular white matter lesions in both hemispheres suggestive of multiple sclerosis: one a single punctate white matter lesion in the left frontal corona radiata, and one multiple white matter lesions in the basal ganglia, brainstem, and cerebellum but not in the hemispheres. In the control group with normal VEPs, nine had at least one hemispheric lesion on MR scans. This yielded a positive predictive value of 33%. The negative predictive value was 70%, sensitivity 36%, and specificity 68%. Because of a high rate of false positives, full-field VEPs were not reliable in predicting retrochiasmal lesions.

On the nature of self-monitoring: construct explication with Q-sort ratings.

To explicate M. Snyder's (1987) construct of self-monitoring (SM), a new Q-sort prototype is introduced. Analyses of Q-sorts by both observers and self demonstrated cross-method convergent validity for the revised 18-item Self-Monitoring Scale (SMS-R) and its Public Performing subscale; however, neither scale showed discriminant validity against measures of extraversion. The Other-Directedness items remaining on the SMS-R correlated neither with the other measures of SM nor with extraversion. These findings suggest that the scale revision led to a conceptual shift toward extraverted (and away from other-directed) features of self-presentation. To adequately assess the conceptual domain of SM phenomena, researchers should administer the original 25-item SMS (not the abbreviated 18-item SMS-R) and score Public Performing and Other-Directedness separately to examine their individual and joint effects.

Results of breast biopsies for mammographic findings.

The results of breast biopsies for mammographic findings have been presented, in which 314 biopsies were done on 274 patients. From this number of biopsies, the diagnosis of cancer was established in fifty-seven cases (18 per cent of the biopsies). More than 50 per cent of the lesions were infiltrating duct cell carcinomas. The number of breast biopsies required increased markedly after the national publicity in 1974. As more biopsies were done, the incidence of carcinoma increased, and a significant number of these were found in women less than fifty years old. We believe this justifies the continued judicious use of mammography, even in the younger patient, if clinically indicated.

Tuberculosis of the breast: rare but still extant. Review of the literature and report of an additional case.

Tuberculosis of the breast is a rare malady that is usually manifested by a unilateral mass suggestive of carcinoma or sometimes of abscess. Mammography also suggests carcinoma in most instances. However, at operation, the discovery of necrotic tissue or abscess may lead to the suspicion of infectious or inflammatory disease rather than neoplasm. The diagnosis of tuberculosis may be established by the demonstration of acid-fast bacilli in excised tissue, by culture studies, or by guinea pig inoculation; however, the diagnosis is usually not suspected. In the past, mastectomy was the usual treatment. Today, successful treatment combines antituberculous drug therapy with the removal of infected breast tissue. The prognosis for complete cure is excellent. One case of secondary tuberculous mastitis has been reported herein. The patient, an Egyptian woman residing in the United States since 1973, was treated in Egypt for pulmonary tuberculosis at age 17. She presented in 1982 with a breast mass that mimicked carcinoma on physical examination and mammograms, but excisional biopsy and histologic examination revealed a breast abscess that contained caseous material and a solitary acid-fast bacillus. The patient was cured of her disease after appropriate operation and a course of antituberculous drugs. This has been the only documented case of mammary tuberculosis at our institution. Despite its rarity, tuberculosis of the breast should not be forgotten in this age of world travel.

Breast cancer in women under 35 years of age.

A review was undertaken of 226 patients with primary breast carcinoma who were 35 years of age, or younger, from 1960 to 1987. Comparisons to other studies of young and older women were made for clinical, pathologic, and survival characteristics. Young patients with breast cancer share many of the same disease characteristics of tumor type, location, size, and nodal involvement as their older counterparts. Five- and 10-year survival rates were comparable for patients with stage I or stage II disease and negative axillary lymph nodes. However, patients with stage II disease and positive nodes appear to have a decreased survival compared with older patients.

New horizons in the diagnosis and treatment of breast cancer using magnetic resonance imaging.

A new nuclear magnetic resonance imaging (MRI) technique, Rotating Delivery of Excitation Off-resonance (RODEO), has been developed to assist surgeons in the diagnosis and treatment of breast cancer. A nonrandomized, prospective study of 100 patients with a high suspicion of breast cancer was conducted; these patients were examined by RODEO and conventional breast imaging, including mammography. Forty-one breasts were removed by mastectomy; each pathologic specimen was examined by sectional analysis. This study was undertaken to determine the extent that RODEO can aid in detecting breast tumors (including multicentric disease) and in evaluating candidates for conservative breast surgery. RODEO detected 85 pathologically confirmed lesions, 64 of which proved to be malignant. RODEO had a sensitivity of 95%, compared with a sensitivity of 58% for conventional imaging. More study is needed to determine distinguishing MRI characteristics that are suspicious for malignancy. RODEO may be used clinically to assess multicentricity and response to chemotherapy.

Effects of culture conditions on susceptibility of alveolar epithelial cell monolayers to NO2.

The effects of nitrogen dioxide (NO2) exposure on primary cultured monolayers of rat type II pneumocytes were investigated as a function of the isolation and culture conditions. Monolayers were cultured in Eagle's minimum essential medium (MEM) and in MEM supplemented with Ham's F-12; in some experiments, the initial cell suspension was also replated after 3 h. Both supplementation of the basal medium and replating increased the sensitivity of the monolayers to NO2, as measured by reduction in dome formation of plastic dishes 24 h post-exposure. These findings suggest that comparisons of in vitro toxicologic observations may be complicated by the effects of specific experimental conditions.

Transient appearance of periodic EEG discharges in senile dementia.

We describe an elderly patient with probable Alzheimer's disease whose EEG and clinical status improved rapidly coincident with normalization of temperature. This finding suggests that her transient illness, of fever, pneumonia and confusional state, triggered the production of this periodic EEG pattern. With the increased prevalence of dementia in our aging population, we predict that the appearance of a multifocal periodic triphasic sharp wave pattern in the EEG of chronically demented patients (with superimposed infection) will become more common. Only when this pattern persists over time and the patient is not systemically ill, is this pattern a reliable discriminator for CJD. Serial EEGs in this setting (after treatment of the systemic illness) might reveal the transient nature of the periodic EEG change, thus avoiding the erroneous conclusion that the patient's dementia is a manifestation of CJD.