Taxonomy of the super-cryptic Hyperolius nasutus group of long reed frogs of Africa (Anura: Hyperoliidae), with descriptions of six new species.

Specimens from across the range of the Hyperolius nasutus species group were sequenced for two mitochondrial genes and one nuclear gene. Advertisement calls were recorded from the same specimens where possible, and morphological characters were compared. Bayesian inference and maximum likelihood produced a tree indicating 16 clades. The clades show little or no overlap in combinations of 16S sequence difference, shared tyr haplotypes, advertisement call parameters, snout profiles and webbing. On the basis of these data we recognise H. acuticeps, H. adspersus, H. benguellensis, H. dartevellei, H. igbettensis, H. nasutus, H. nasicus, H. poweri, H. viridis and describe six new species: Hyperolius friedemanni sp. nov. Mercurio & Rödel, Hyperolius howelli sp. nov. Du Preez & Channing, Hyperolius inyangae sp. nov. Channing, Hyperolious jacobseni sp. nov. Channing, Hyperolius rwandae sp. nov. Dehling, Sinsch, R6del & Channing, and Hyperolius lupiroensis sp. nov. Channing. Hyperolius lamottei is confirmed to be outside the H. nasutus group clade. Hyperolius granulatus, H. oxyrhynchus, H. punctulatus and H. sagitta are assigned as junior synonyms. As our results are based on a small number of specimens, these hypotheses await testing with larger sample sizes and more characters. A species distribution model suggests where outlier populations might be found.

Pilot study of compliance with healthcare facility smoking laws in Georgia.

In 2003 Georgian Parliament restricted smoking in all healthcare facilities to designated smoking areas. Observed compliance has been low. This quantitative study of airborne nicotine and particulate concentrations in nine healthcare facilities in Tbilisi and Region Kakheti in February, 2007 was a pilot to assess the degree of noncompliance with the law and to identify potential strategies for increasing compliance. Passive sampling of nicotine and active sampling of PM(2.5) in selected healthcare facilities. None of the facilities we monitored had designated smoking areas that met the legal requirements. Fifty of the 51 samplers registered concentrations of nicotine above the level of detection. Of these, 52% showed concentrations below 1 microg/m(3) nicotine, 27% showed concentrations between 1 and 5 microg/m(3) and 20% were above 5 microg/m(3). The highest nicotine levels were found in medical staff offices, and in undesignated "informal smoking areas". These data support qualitative observations that the law restricting smoking in Georgian healthcare facilities to designated areas is poorly enforced and does not protect patients and employees from secondhand smoke. These findings suggest that Georgian law should be changed to make all healthcare institutions smoke free environments and that there is a need for tobacco control programs targeted at medical professionals in Georgia.

Novel Microscalpels for Removing Proximal Composite Resin Overhangs on Class II Restorations.

INTRODUCTION: Limited access to interdental spaces complicates removal of excess material when placing class II composite resin restorations. Evidence-based recommendations on interproximal finishing are rare. We present novel microscalpels for this indication. The aim of the study was to test their fracture strength and cutting ability and to compare microscalpels with the use of a scaler, oscillating devices (G5-ProShape, G5-Proxocare), finishing strips and scalpels of sizes 12, 15, and 21 in a standardized in vitro model. METHODS AND MATERIALS: Fracture strength (LOAD) and cutting forces (CUT) of microscalpels were evaluated at different angles (15, 30, 60, and 75 degrees; n=30 each) in a universal testing machine. Devices were compared in vitro using standardized composite overhangs. Marginal quality (QUAL; n=30) and quantity of excess/deficit (QUAN; n=30) were evaluated using scanning electron microscopy (SEM) for each device (explorative data analysis, Student t-test or analysis of variance; post hoc Scheffé). RESULTS: Microscalpels showed the highest LOAD (95.8 [5.0] N) (mean [standard deviation]) and easiest cutting (CUT) (7.6 [1.5]) at 15 degrees. At all angles, LOAD was significantly higher than CUT (p<0.001). Perfect margins were seen most often with scalpel size 12 (QUAL: 37% relative frequency), while most excess (73.4%) was observed with finishing strips. QUAN was lowest with microscalpels (19.3 [4.4] µm) and highest with finishing strips (116.0 [18.8]). Use of scalers led to fractures and crack formation. CONCLUSION: Microscalpels are able to cut composite at a lower force than necessary to fracture the blades at all angles. Small and/or curved scalpels yield the best-quality margins.

Micropapillary morphology is an indicator of poor prognosis in patients with urothelial carcinoma treated with transurethral resection and radiochemotherapy.

Purpose of this study was to evaluate prognostic impact of rare variants of urothelial bladder cancer (BC) after treatment with combined radiochemotherapy (RCT). To this end tumour tissue of 238 patients with urothelial carcinoma (UC) treated with transurethral resection of the bladder (TUR-B) and RCT with curative intent was collected. Histomorphological analysis included re-evaluation and semi-quantitative assessment of rare UC subtypes. Additionally, human epidermal growth factor receptor 2 (HER2) chromogenic in situ hybridisation (CISH) was performed in tumours with a micropapillary component exceeding 30 %. Long-term follow-up was available for 200 patients (range 3-282 months). Variant UC histology was found in 45 of 238 tumours, most frequently micropapillary UC (N = 17) including cases with a small fraction of tumour with micropapillary morphology. The mere presence of micropapillary morphology did not affect prognosis. In tumours with extensive (≥30 %) micropapillary morphology (N = 8) Kaplan-Meier analysis revealed significantly worse cancer specific survival (CSS) (P = 0.002) compared to conventional UC (mean survival times 97 months and 229 months, respectively). Univariate Cox regression analysis of cases with ≥30 % micropapillary morphology revealed a hazard ratio of 4.726 (95 % CI 1.629-13.714) for CSS (P = 0.004). CISH revealed HER2 gene amplification in 3/10 tumours with ≥30 % micropapillary component. In conclusion, for BC treated with TUR-B and RCT, the presence of micropapillary morphology in more than 30 % of the tumour is an adverse prognostic factor. Further studies are needed to evaluate a potential benefit of different, especially multimodal treatment strategies for micropapillary UC and also other subtypes of UC. Her2 represents a promising therapeutic target in a subset of micropapillary UC.

Philip Morris toxicological experiments with fresh sidestream smoke: more toxic than mainstream smoke.

BACKGROUND: Exposure to secondhand smoke causes lung cancer; however, there are little data in the open literature on the in vivo toxicology of fresh sidestream cigarette smoke to guide the debate about smoke-free workplaces and public places. OBJECTIVE: To investigate the unpublished in vivo research on sidestream cigarette smoke done by Philip Morris Tobacco Company during the 1980s at its Institut für Biologische Forschung (INBIFO). METHODS: Analysis of internal tobacco industry documents now available at the University of California San Francisco Legacy Tobacco Documents Library and other websites. RESULTS: Inhaled fresh sidestream cigarette smoke is approximately four times more toxic per gram total particulate matter (TPM) than mainstream cigarette smoke. Sidestream condensate is approximately three times more toxic per gram and two to six times more tumourigenic per gram than mainstream condensate by dermal application. The gas/vapour phase of sidestream smoke is responsible for most of the sensory irritation and respiratory tract epithelium damage. Fresh sidestream smoke inhibits normal weight gain in developing animals. In a 21 day exposure, fresh sidestream smoke can cause damage to the respiratory epithelium at concentrations of 2 microg/l TPM. Damage to the respiratory epithelium increases with longer exposures. The toxicity of whole sidestream smoke is higher than the sum of the toxicities of its major constituents. CONCLUSION: Fresh sidestream smoke at concentrations commonly encountered indoors is well above a 2 microg/m3 reference concentration (the level at which acute effects are unlikely to occur), calculated from the results of the INBIFO studies, that defines acute toxicity to humans. Smoke-free public places and workplaces are the only practical way to protect the public health from the toxins in sidestream smoke.

Cortical responses to object-motion and visually-induced self-motion perception.

We investigated the spatiotemporal cortical dynamics during the perception of object-motion and visually-induced self-motion perception in six normal subjects, using a 143-channel neuromagnetometer. Object-motion specific tasks evoked early transient activity over the right temporooccipital cortex, while self-motion perception, or vection, additionally was followed by sustained bilateral activity in the temporoparietal area. The specific signal distributions suggest to represent the different perceptual modes of object-motion and self-motion sensation.

Adhesive interactions in peri-implantation morphogenesis and placentation.

Antibody perturbation and gene knockout studies show that adhesion receptor modulation plays a critical role in peri-implantation mouse embryo and human cytotrophoblast differentiation. Deletion of beta 1 integrins leads to cell death in the inner cell mass of mouse embryos shortly after implantation in vivo or blastocyst outgrowth in vitro. In F9 embryonal carcinoma cells, deleting beta 1 also affects migration of parietal endoderm even on substrates for which the mutant cells express alternative receptors. Human cytotrophoblasts switch their integrin repertoire as they differentiate and invade the uterine interstitium and vasculature. Interestingly, cytotrophoblasts also transform their cell-cell adhesion molecule phenotype, expressing additional cadherins and immunoglobulin family members as they differentiate. Many of these modulations in adhesion phenotype are initiated early in the pre- and/or peri-implantation periods in human and mouse embryos. Therefore, they constitute important markers of normal progression for evaluating effects of environmental stress and for testing the hypothesis that abnormal switching of adhesion molecules characterizes a significant proportion of conceptuses that fail early in development.

Ultrafast magnetic resonance imaging of the brain.

The purpose of this study was to compare the diagnostic efficacy of single shot fast spin echo sequence (SSh-FSE), and single shot GRASE-sequence (SSh-GRASE) to the conventional T(2)-weighted fast spin echo-sequence (T(2)-FSE) in the imaging of brain disorders. Thirty three patients with high signal intensity lesions on T(2)-weighted images (n = 28), or intracerebral hemorrhage (n = 5), were examined on a 1.0 T MR scanner, with 23 mT/m gradient strength. The scan time for the conventional T(2)-FSE-sequence was 2 min 57 s, the scan time for the single shot-FSE-, and single shot-GRASE-sequences was 11 sec, and 17 sec, respectively. Twenty-one patients remained still during the examination, whereas 12 could not stay still with consecutive marked motion artifacts. Images were reviewed by three radiologists. Lesion conspicuity, image quality, and artifacts were scored on a subjective scale. Signal-to-noise ratios of lesions and normal tissue and contrast-to-noise ratios (CNR) were measured by region of interest (ROI). In the patient group without motion artifacts conspicuity for lesions > or =5 mm did not show a significant difference on conventional T(2)-FSE, single shot-FSE and single shot-GRASE. Detectability of the smaller lesions was significantly inferior on single shot-FSE-, and single shot-GRASE-sequences in artifact free images. For the patient group with motion artifacts SSh-FSE and SSh-GRASE were markedly superior to the conventional T(2)-FSE. Grey-white differentiation was better on conventional T(2)-FSE. Physiologic ferritin as well as pathologic hemosiderin depositions were slightly darker and therefore better visible on SSh-GRASE than on SSh-FSE. Conventional T(2)-FSE showed significantly more artifacts. In conclusion, SSh-FSE and SSh-GRASE imaging can be used for rapid imaging of the brain in those patients who are claustrophobic or in patients with involuntary movements due to extrapyramidal disorders, as well as in children in whom anesthesia is contraindicated or sedation is not possible.

Preoperative fast MRI of brain tumors using three-dimensional segmented echo planar imaging compared to three-dimensional gradient echo technique.

The purpose of this study was to compare the diagnostic efficacy of a newly developed T(1)-weighted three-dimensional segmented echo planar imaging (3D EPI) sequence versus a conventional T(1)-weighted three dimensional spoiled gradient echo (3D GRE) sequence in the evaluation of brain tumors. Forty-four patients with cerebral tumors and infections were examined on a 1.0 T MR unit with 23 mT/m gradient strength. The total scan time for the T(1) 3D EPI sequence was 2 min 12 s, and for a conventional 3D GRE sequence it was 4 min 59 s. Both sequences were performed after administration of a contrast agent. The images were analyzed by three radiologists. Image assessment criteria included lesion conspicuity, contrast between different types of normal tissue, and image artifacts. In addition, signal-to-noise and contrast-to-noise-ratio (C/N) were calculated. The gray-white differentiation and C/N ratio of 3D EPI were found to be inferior to conventional 3D GRE images, but the difference was not statistically significant. In the qualitative comparison, lesion detection and conspicuity of 3D EPI images and conventional 3D GRE images were similar, but a tow-fold reduction of the scanning time was obtained. With the 3D EPI technique, a 50% scan time reduction could be achieved with acceptable image quality compared to conventional 3D GRE. Thus, the 3D EPI technique could replace conventional 3D GRE in the preoperative imaging of brain.

[Dental magnetic resonance tomography (dental MRI) as a method for imaging maxillo-mandibular tooth retention structures]. / Dentale Magnetresonanztomographie (Dental-MRT) als Verfahren zur Darstellung des maxillo-mandibulären Zahnhalteapparates.

PURPOSE: To establish a new method for dental imaging using magnetic resonance tomography named Dental-MRT and to demonstrate its usefulness in diagnosing dentogen pathologies of the mandible and maxilla. METHODS: Seven healthy volunteers, three patients with pulpitis, two patients with dentigerous cysts, two patients after tooth transplantation, and three patients with atrophic mandibles have been evaluated. Optimized axial T1- and T2-weighted gradient echo and spin echo sequences in 2D and 3D technique have been established to perform studies of the jaws. The acquired images were reconstructed with a standard dental software package on a work-station as panorama and cross-sectional views of the mandible or maxilla. RESULTS: The entire maxillo-mandibular bone, teeth, dental pulp, and the content of the mandibular canal were well depicted. Patients with pulpitis demonstrate bone marrow edema in the periapical region. Dentigerous cysts and their relation to the surrounding structures are clearly shown. After contrast media administration marked enhancement of the dental pulp can be demonstrated. CONCLUSION: Dental-MRT promises to provide a new tool for visualization and detection of dental diseases.

[Occult fractures of the wrist joint: high resolution image magnification roentgen versus MRI]. / Okkulte Handgelenksfrakturen: Feinfokusvergrösserungsröntgen versus MRT.

PURPOSE: To compare the diagnostic value of high definition macroradiography and MRI in patients with the suspicion of occult wrist fractures. MATERIALS AND METHODS: In a prospective study, 23 patients with clinically suspected wrist fractures and normal initial plain radiographs underwent high resolution macroradiography and MR imaging shortly after trauma. Macroradiographs were taken with a microfocus tube using an anode of 0.03-0.3 mm providing a 4x magnification of the wrist, which was obtained in 4 projections. MR images were performed on a 1.0 T MR unit in coronal planes using T1 weighted SE, T2.-weighted 3D GE, and Turbo-STIR sequences. Follow-up radiographs after 6 weeks were used to confirm the diagnosis of a primary occult wrist fracture. RESULTS: Macroradiography depicted 5 wrist fractures: 4 fractures of the scaphoid bone and 1 fracture of the capitate bone. MRI demonstrated 11 fractures (one of them false-positive): 9 fractures of the scaphoid bone and two fractures of the capitate bone. Using macroradiography, the sensitivity for the detection of occult fractures of the wrist was 50% with a specificity of 100%, using MRI the sensitivity was 100% with a specificity of 92%. CONCLUSION: MRI seems to be superior to high resolution macroradiography in the detection of occult scaphoid fractures and thus is recommended in the management of patients with clinically suspected scaphoid fractures not evident on initial plain films.

Muscle pathologies after cervical spine distortion-like exposure--a porcine model.

OBJECTIVE: Histological evaluation of porcine posterior cervical muscles after a forceful translational and extensional head retraction simulating high-speed rear end impact. METHODS: Four anesthetized pigs were exposed to a cervical spine distortion (CSD)-like motion in a lying position. After 2 different survival times of 4 and 6 h (posttrauma), the pigs were euthanized and tissue sampling of posterior cervical muscles was performed. A standard histological staining method involving paraffin-embedded sections was used to analyze the muscles, focusing on injury signs like hemorrhage and inflammatory cell reaction. A pig that was not subjected to impact was used as a control pig and was subjected to the same procedure to exclude any potential artifacts from the autopsy. RESULTS: The differentiation of 8 different posterior neck muscles in the dissection process was successful in more than 50 percent for each muscle of interest. Staining and valid analysis was possible from all extracted samples. Muscle injuries to the deepest posterior neck muscles could be found, especially in the musculus obliquus samples, which showed laminar bleedings in 4 out of 4 samples. In addition, in 4 out of 4 samples we were able to see increased cellular reactions. The splenius muscle also showed bleeding in all 4 samples. All animals showed muscle injury signs in more than three quarters of analyzed neck muscles. Differences between survival times of 4 and 6 h in terms of muscular injury were not of primary interest and could not be found. CONCLUSIONS: By simulating a CSD-like motion we were able to confirm injuries in the posterior cervical muscles under severe loading conditions. Further studies need to be conducted to determine whether these muscle injuries also occur under lower exposure forces.

DBH*444G/A polymorphism of the dopamine-beta-hydroxylase gene is associated with alcoholism but not with severe alcohol withdrawal symptoms.

As the enzyme dopamine-beta-hydroxylase (DbetaH) converts dopamine to norepinephrine and both transmitters seem to be involved in the pathology of alcoholism and severe alcohol withdrawal symptoms, the gene encoding DbetaH (DBH) was applied to explore the genetic background of alcoholism and severe withdrawal symptoms. 102 healthy control subjects and 208 alcoholics, including 97 patients with a history of mild withdrawal symptoms, 57 with a history of alcohol withdrawal seizure (AWS) and 82 with a history of delirium tremens (DT) were genotyped for the DBH*444G/A polymorphism revealing a significantly elevated frequency of genotypes carrying the A-allele (p = 0.02; after Bonferroni adjustment for multiple tests) in alcoholics compared to healthy controls. Frequencies of alleles and genotypes of individuals with mild withdrawal symptoms did not differ significantly from those of patients with DT or AWS.

[Pseudolesions in liver sonography]. / Pseudoläsionen in der Lebersonographie.

Several common hepatic ultrasound pseudolesions are presented that may closely resemble pathological conditions. The majority of these pitfalls is caused by normal anatomic structures, anatomical variants of the liver or the perihepatic regions, and benign alterations of the echotexture of the liver. Exact knowledge and a precise scanning technique by an experienced sonographer are essential to avoid mistaking such findings for true liver disease. In some instances (especially when dealing with anatomical variants) computed tomography is also helpful.

Evaluation of the four-hour Micro-ID technique for direct identification of oxidase-negative, Gram-negative rods from blood cultures.

A 4-h Micro-ID technique for direct identification of oxidase-negative gram-negative rods from positive blood cultures was compared to subculture and species identification of single colonies by API 20E and Micro-ID, using standardized inocula. A total of 127 patients (220 positive cultures) were studied. Isolates included 96 Escherichia coli, 46 Klebsiella pneumoniae, 7 Klebsiella oxytoca, 8 Enterobacter aerogenes, 17 Enterobacter cloacae, 19 Serratia marcescens, 2 Serratia liquefaciens, 8 Proteus mirabilis, 1 Salmonella species, 1 Morganella morganii, 6 Haemophilus influenzae, 2 Haemophilus parainfluenzae, 3 Bacteroides fragilis, 3 Acinetobacter calcoaceticus biotype anitratus, and 1 Pseudomonas maltophilia. In 90% of the cultures, identification by Micro-ID was identical to that obtained after subculture; if the 15 non-enterobacterial isolates were excluded, the corresponding figure was 96.6%. Enterobacteria identified incorrectly by direct Micro-ID were three S. marcescens (two identified as S. liquefaciens, one as Hafnia alvei), two S. liquefaciens (both identified as E. cloacae), and two K. pneumoniae (one identified as Klebsiella ozaenae, the other as Serratia rubidaea). None of the 15 non-enterobacterial cultures were correctly identified by Micro-ID (non-identifiable, or classified as Providencia/Yersinia/Klebsiella species). Although biochemical discrepancies between direct and final Micro-ID tests occurred in 41% of the enterobacterial cultures, this did not seriously interfere with identification. Direct species identification of Enterobacteriaceae from blood cultures by direct Micro-ID is accurate and easily performed and identified organisms within 4 h compared to at least 24 h by most other methods; the direct Micro-ID technique would be rendered even more valuable by the additional capability of identifying non-enterobacterial gram-negative isolates.

Muir-Torre syndrome: a case for surveillance of the ampulla of Vater.

A 64-year-old man with Muir-Torre syndrome (MTS), a condition characterized by the association of multiple sebaceous tumours and kerato-acanthomas with internal malignancies, developed a carcinoma of the ampulla of Vater. This is the 2nd reported ampullary carcinoma in 205 reported cases of MTS, suggesting a higher prevalence in MTS patients than in the general population. As an ampullary carcinoma is potentially amenable to surgical resection, particularly when detected early, patients with MTS should undergo regular endoscopic surveillance of the ampulla of Vater.

Recurrent suppurative thyroiditis due to pyriform sinus fistula: a case report.

Acute suppurative thyroiditis is a rare disease, particularly in childhood. We present a case with recurrent acute suppurative thyroiditis due to a pyriform sinus fistula originating from the fourth branchial pouch. The typical symptoms of a pyriform sinus fistula are recurrent left-sided pain and swelling of the neck with signs of acute bacterial inflammation. Diagnosis should be made by high resolution ultrasound, barium meal studies and endoscopic examination. During acute exacerbations treatment with antibiotics is indicated, but permanent cure can only be attained by complete fistulectomy.

Atypical appearance of elastofibroma dorsi on MRI: case reports and review of the literature.

Three patients with histologically proven elastofibroma dorsi underwent MRI, using T1-weighted, T2-weighted, STIR (short inversion time inversion recovery), and contrast-enhanced SE sequences. All lesions typically displayed low signal intensity masses interspersed with areas of high signal intensity on T1- and T2-weighted SE images. Contrary to prior reports, two patients showed marked enhancement of the mass after administration of Gd-DTPA. Although the characteristic signal intensity on conventional T1- and T2-weighted images may lead to the early diagnosis of this rare tumor, radiologists should be aware that marked contrast enhancement may be representative in elastofibroma dorsi.

[MR-pool: the "Vienna blend". An interactive computer-assisted teaching system for MRI]. / MR-Pool: die "Wiener Mischung". Ein interaktives computerunterstütztes Lehrsystem für MRI.

Advances in the field of computer technology have facilitated the development of computer-assisted instruction. In this paper we present an interactive computer-based MR teaching system for education in radiology. Our program contains 120 teaching files. Various MR sequences can be displayed and compared to conventional X-ray images, CT, angiography and scintigraphy. Using a text field, additional clinical and diagnostic hints are offered. This teaching file can be easily upgraded and distributed on CD-ROM. Furthermore, we compare computer-assisted teaching in general to other conventional instruction media.