Incidental maternal findings on fetal MRI.

AIM: To evaluate the type and frequency of maternal findings incidentally identified during fetal magnetic resonance imaging (MRI). MATERIALS AND METHODS: A retrospective single-centre study was undertaken which included all consecutive fetal MRI studies performed between July 2017 and May 2021 at a tertiary institution. Two fellowship-trained radiologists reviewed the studies independently to determine the type and frequency of incidental maternal findings of both no clinical significance (requiring no further follow-up) and of clinical significance (requiring further follow-up, work-up, and/or management). Differences in acquisition were resolved by two-reader consensus. Non-diagnostic MRI examinations or abdominal MRI examinations indicated for maternal complications were excluded from review. RESULTS: A total of 455 consecutive fetal MRI examinations performed in 429 women were included. Mean age was 30 years (SD 5.5 years). At least one incidental maternal finding was identified in 58% (265/455) of studies. Umbilical hernias (35%), maternal hydronephrosis (19%), and maternal hydro-ureter (15%) were the most common. Only two studies (0.5%) showed clinically significant incidental maternal findings (pancreatic pseudocyst and ovarian cyst). CONCLUSIONS: Incidental maternal findings are common on fetal MRI but rarely require further follow-up, work-up, and/or management.

A dynamic baseline for dissolved methane in English groundwater.

Elevated dissolved methane (CH4) concentrations in groundwater are an environmental concern associated with hydraulic fracturing for shale gas. Therefore, determining dissolved CH4 baselines is important for detecting and understanding any potential environmental impacts. Such baselines should change in time and space to reflect ongoing environmental change and should be able to predict the probability that a change in dissolved CH4 concentration has occurred. We considered four dissolved CH4 concentration datasets of English groundwater using a Bayesian approach: two national datasets and two local datasets from shale gas exploration sites. The most sensitive national dataset (the previously published British Geological Survey CH4 baseline) was used as a strong prior for a larger (2153 measurements compared to 439) but less sensitive (detection limit 1000 times higher) Environment Agency dataset. The use of the strong prior over a weak prior improved the precision of the Environment Agency dataset by 75%. The expected mean dissolved CH4 concentration in English groundwater based on the Bayesian approach is 0.24 mg/l, with a 95% credible interval of 0.11 to 0.45 mg/l, and a Weibull distribution of W(0.35 ± 0.01, 0.34 ± 0.16). This result indicates the amount of CH4 degassing from English groundwater to the atmosphere equates to between 0.7 and 3.1 kt CH4/year, with an expected value of 1.65 kt CH4/year and a greenhouse gas warming potential of 40.3 kt CO2eq/year. The two local monitoring datasets from shale gas exploration sites, in combination with the national datasets, show that dissolved CH4 concentrations in English groundwater are generally low, but locations with concentrations greater than or equal to the widely used risk action level of 10.0 mg/l do exist. Statistical analyses of groundwater redox conditions at these locations suggest that it may be possible to identify other locations with dissolved CH4 concentrations ≥10.0 mg/l using redox parameters such as Fe concentration.

Identifying groundwater compartmentalisation for hydraulic fracturing risk assessments.

An environmental concern with hydraulic fracturing (fracking) is that injected fluids or formation fluids could migrate upwards along high-permeability faults and contaminate shallow groundwater resources. However, numerical modelling has suggested that compartmentalisation by low-permeability faults may be a greater risk factor to shallow aquifers than high-permeability faults because lateral groundwater flow is reduced and upward flow through strata may be encouraged. Therefore, it is important that compartmentalisation can be adequately identified prior to fracking. As a case study we used historical groundwater quality data and two-dimensional seismic reflection data from the Bowland Basin, northwest England, to investigate if compartmentalisation could be adequately identified in a prospective shale basin. Five groundwater properties were spatially autocorrelated and interpolation suggests a regional trend from recent (<10 000 years old) meteoric groundwater in the upland Forest of Bowland to more brackish groundwater across the Fylde plain. Principal components analysis suggests two end-member brackish groundwater types. These end-members along with seismic interpretation suggest that a fault may structurally compartmentalise the northwest Bowland Basin. Furthermore, the Woodsfold fault structurally compartmentalises the southern Fylde and the Blackpool area provides evidence for stratigraphic compartmentalisation in the superficial deposits. However, large areas of the Bowland Basin are not sampled and the influence of known faults on groundwater is therefore difficult to assess. Consequently, the adequate identification of compartmentalisation in prospective basins may require supplementing historic data with dedicated basin-wide groundwater monitoring programmes and the acquisition of new seismic reflection data in areas of poor coverage or quality.

Identification and subcellular localization of human rab5b, a new member of the ras-related superfamily of GTPases.

Members of the mammalian rab family of GTPases are associated with specific subcellular compartments, where these proteins are postulated to function in vesicular transport. By screening a human umbilical vein endothelial cell library with degenerate oligonucleotide probes, we have isolated a 1.6-kb cDNA clone encoding a 215-amino-acid protein belonging to the rab family of GTPases. This newly identified rab protein is 81% identical to human rab5, the canine counterpart of which has been localized to the plasma membrane and early endosomes. In light of this homology, we have named this new member of the GTPase superfamily "rab5b." Northern analysis using the rab5b cDNA as a probe revealed a 3.6-kb mRNA in a variety of cell types, including human umbilical vein endothelial cells, K562 erythroleukemia cells, U937 monoblastic cells, and HeLa cells. A fusion protein between glutathione-S-transferase (GST) and rab5b was expressed in bacteria and purified to homogeneity. The recombinant protein was shown to bind GTP and GDP. As is typical of other recombinant rab proteins, the rab5b-GST fusion protein displayed a low intrinsic rate of GTP hydrolysis (0.005/min). An antiserum to rab5b was prepared and used to determine the apparent molecular size and subcellular distribution of the protein. Western blotting with this antibody revealed a 25-kD protein in COS cells transfected with rab5b and in nontransfected HeLa cells. Indirect immunofluorescence and subcellular fractionation showed that rab5b localizes to the plasma membrane. We speculate that rab5b plays a role in vesicular trafficking at the plasma membrane in various cell types.

Multicenter phase II study of fludarabine phosphate for patients with newly diagnosed lymphoplasmacytoid lymphoma, Waldenström's macroglobulinemia, and mantle-cell lymphoma.

PURPOSE: Fludarabine phosphate (F-AMP) has significant activity in follicular lymphoma and in B-cell chronic lymphatic leukemia, where it has demonstrated high complete response (CR) rates. Lymphoplasmacytoid (LPC) lymphoma, Waldenstrom's macroglobulinemia (WM), and mantle-cell lymphoma (MCL) also present with advanced-stage disease and are incurable with standard alkylator-based chemotherapy. A phase II trial was undertaken to determine the activity of F-AMP in patients newly diagnosed with these diseases. PATIENTS AND METHODS: Between 1992 and 1996, 78 patients (aged 18 to 75 years) received intravenous F-AMP (25 mg/m2/d for 5 days, every 4 weeks) until maximum response, plus two further cycles as consolidation. The primary end point was response rate; secondary end points included time to progression (TTP), duration of response, and overall survival (OS). RESULTS: Forty-four (62%) of 71 assessable patients had a response to F-AMP (LPC lymphoma, 63%; WM, 79%; MCL, 41%); the CR rate was 15%. At a median follow-up of 1.5 years, 19 of 44 responding patients have had progression of lymphoma; the median duration of response was 2.5 years. The median survival has not yet been reached. There was no significant difference in the duration of response or OS between patients with different histologies; TTP was shorter in patients with MCL (P = .015). Myelosuppression was relatively common, and the treatment-related mortality (TRM) was 5%, mostly associated with pancytopenia and infection. CONCLUSION: Single-agent fludarabine phosphate is active in previously untreated LPC lymphoma and WM, with only moderate activity in MCL. However, the CR rate is low, and the TRM is relatively high. Its role in combination chemotherapy remains to be demonstrated.

Laboratory role in the management of hospital acquired infections.

The microbiology laboratory has many important roles. It must collaborate with the infection control team on the investigations of outbreaks. During outbreaks, it must save relevant samples, look for reservoirs and undertake typing techniques, all of which should be timely. New technology should be available to detect, identify and characterize micro-organisms. Molecular biological techniques have enhanced the speed and sensitivity of detection methods and have allowed the laboratory to identify organisms that do not grow or grow slowly in culture. Molecular techniques also enable the microbiologist to identify antibiotic resistance genes and to 'fingerprint' hospital organisms, thereby facilitating studies of nosocomial transmission.

Nanovid microscopy for assessing sperm membrane changes induced by in vitro capacitating and acrosomal reacting procedures.

This study was to verify the usefulness of Nanovid microscopy techniques for evaluating induced modifications in bovine spermatozoal membranes. Frozen thawed bovine sperm were labeled with 20-nm colloidal gold particles bound to concanavalin A (ConA) or heparin ligands. Sperm membrane changes were induced in vitro by capacitating and acrosome-reacting procedures. Capacitation was induced by incubation with 10 micrograms/ml of heparin for 4 hours at 37 degrees C, 5% CO2, and high humidity. Membrane changes associated with the acrosome reaction were induced by addition of lysophosphatidylcholine (100 micrograms/ml) and incubation for 15 minutes at 37 degrees C, 5% CO2, and high humidity. Gray intensity (black = 0; white = 255) of sperm (ONCELL) and background (OFFCELL) were evaluated with computer-enhanced videomicroscopy with either differential interference contrast (DIC) or Nanovid optics. A high gold concentration on a membrane region produced blacker video pictures with Nanovid microscopy. Gray intensity of video pictures of a region with little or no gold would have a gray intensity equal to or greater than that of the background, that is, toward white. Weighted least squares methods were used to analyze ONCELL data using OFFCELL as a covariate. In experiment 1, ONCELL intensities of cells labeled with ConA-gold complex were lower than those labeled with heparin-gold at the same treatment level. In experiment 2, ONCELL intensity decreased as the concentration of heparin-gold increased from 0 to 0.041 microgram/microliter heparin. ONCELL intensity significantly decreased after sperm were treated with the highest heparin-gold level and acrosome reacted.(ABSTRACT TRUNCATED AT 250 WORDS)

Influence of candidates' test selection on pass rates on examinations for certification by the Educational Commission for Foreign Medical Graduates.

BACKGROUND: Parts I and II of the National Board of Medical Examiners (NBME) examination were first offered to graduates of foreign medical schools in 1989 as an alternative to the Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS). This study was designed to determine whether differences in pass rates and scores were related to differences in the populations selecting one or the other examination. METHOD: (1) Combined pass rates on the FMGEMS and NBME in 1989 and 1990 were compared with pass rates in previous years. (2) The proportion of NBME takers in 1989 was compared with the proportion in 1990. (3) Respective pass rates on the FMGEMS and NBME in the first NBME administration in 1989 were compared with pass rates in 1990. (4) The percentage of repeaters taking the FMGEMS was compared with the percentage taking the NBME in 1989 and 1990. (5) The distribution of repeaters by number of previous takes was compared between the FMGEMS and NBME in 1989 and 1990. RESULTS: (1) Combined pass rates were similar to the pass rates of previous years. (2) The proportion of NBME takers declined in 1990. (3) The pass rates for the FMGEMS were higher in both 1989 and 1990, but the difference in pass rates between the two examinations narrowed in 1990. (4) The percentage of repeaters taking the NBME was high in 1989 and declined in 1990. (5) The number of previous takes among repeaters was higher for the NBME than for the FMGEMS in 1989 and became equal in 1990. CONCLUSIONS: Some students probably opted to take the NBME in 1989 in the belief that it might be easier than the FMGEMS, resulting in lower pass rates for the NBME. The NBME pass rates rose in 1990 after the differential pass rates had become public.

Pilot study of the use of the ECFMG clinical competence assessment to provide profiles of clinical competencies of graduates of foreign medical schools for residency directors. Educational Commission for Foreign Medical Graduates.

PURPOSE: To conduct the first of a series of pilot projects of the clinical competence assessment (CCA) of the Educational Commission for Foreign Medical Graduates (ECFMG) in order to provide profiles of clinical competencies of graduates of foreign medical schools for residency directors in the United States and for governments and institutions in other countries. METHOD AND RESULTS: In September 1992 the first pilot project of the ECFMG CCA was conducted for a program director who wanted to evaluate ten first-year residents in a midwestern U.S. program. The CCA consists of integrated clinical encounters with ten standardized patients, 60 laser videodisc pictorials, and analysis of test items of previously completed ECFMG certification examinations. Profiles of the following clinical competencies were provided to the program director: data gathering (history and physical examination), interviewing and interpersonal skills, diagnosis and management skills, interpretation of diagnostic and laboratory procedures, written communication of information to the health care team, and spoken-English proficiency. The profiles were provided as individual scores compared with mean scores of a reference group of 525 first-year residents who took the CCA at four U.S. assessment centers, and as percentile scores with a range of one standard error of measurement. CONCLUSION: The individual performance data in this first pilot project were valuable to the program director, who used them to supplement scores on a written examination during the first residency year. The pilot project has shown the ECFMG CCA to be a useful tool for program directors to evaluate applicants and residents who are graduates of foreign medical schools.

Brain enzyme and clinical alterations induced in rats and mice by nitroaliphatic toxicants.

The effects of a single subcutaneous (s.c.) injection of the nitroaliphatic toxicants 3-nitropropanol (NPOH) and 3-nitropropionic acid (NPA) dissolved in physiological saline solution were studied in mice and rats, respectively. Clinical signs observed in both NPOH-treated mice and NPA-treated rats included depression, abnormal motor activity, and recumbency. Succinate dehydrogenase (SDH) activity, demonstrated histochemically in frozen brain sections, was markedly reduced in intoxicated mice and rats. The SDH activity of mitochondrial preparations from brains of intoxicated mice and rats was diminished to 18-24% of control values, although the activity of another mitochondrial flavoprotein enzyme, alpha-glycerophosphate dehydrogenase (alpha-GPDH), was not altered.

Potential protein kinase C inhibitors. 8,9,10,11 alpha-tetrahydro-7 alpha H-7,11-methano-12, 12-dimethylcycloocta[de]naphthyl-9-amines.

The synthesis of the 9 alpha- and 9 beta-epimers of 8, 9, 10, 11 alpha-tetrahydro-7 alpha H-7, 11-methano-12, 12-dimethylcycloocta [de] naphthyl-9-amine is described.

Bovine spermatozoal head size variation and evaluation of a separation technique based on this size.

The objectives of this study were to determine the variation of head areas of normal spermatozoa attributable to breed, individual bull and ejaculate and to verify separation of X and Y chromosome-bearing spermatozoa and separation effectiveness. Spermatozoa were evaluated using video enhanced contrast microscopy combined with video intensified fluorescent microscopy and the polymerase chain reaction (PCR). In Experiment 1, spermatozoal head areas were measured from 2 ejaculates collected from bulls of 3 beef and 2 dairy breeds. No differences in head areas were found between breeds or between bulls within breeds; variation was observed among ejaculates from individual bulls across breeds. In Experiment 2, spermatozoa from 5 ejaculates were separated on individual SEPDEVICEs (Patented). Head area, fluorescent intensity and PCR of spermatozoa retained in the SEPDEVICEs suggested a separation based on size in 1 of 5 samples. Ejaculate variation in head areas affected separation efficiency.

Genetic counseling for the deaf.

Genetic counseling is a process that emphasizes accurate diagnosis of hereditary conditions and communication of information to families. Genetic counseling involves systematic collection of family and medical history, a physical examination by a certified clinical geneticist, sharing of information with the family, and follow-up and support services. The issues that arise in genetic counseling can differ for every family and are often dependent on the degree of deafness present in the family, age of onset, and linguistic and cultural orientation. It is important for the genetic counselor to consider these factors in the provision of genetic services. With the increasing application of molecular genetics to the diagnosis and management of hereditary deafness and the increasing participation of families with deafness in research studies, the involvement of genetic counselors to provide information and education to consumers as well as medical professionals and researchers is becoming even more critical. The success of genetic counseling for the provision of information to families and the delineation of types of hereditary deafness through clinical and laboratory research is dependent on appropriate referrals by medical professionals, including otolaryngologists. A working relationship between otolaryngologists and clinical geneticists for the referral and evaluation of patients with hereditary deafness or deafness of "unknown" etiology is important.

A proposed model for a collaborative approach to dental hygiene research.

As dental hygiene responds to the increased need for quality oral health services, dental hygienists seek quality research findings on which to base their practice decisions. However, the amount of research published by dental hygienists, and addressing dental hygiene interventions, remains limited. There are few dental hygienists in Canada working in positions that have time dedicated to research activities. To increase the amount of dental hygiene research, innovative approaches such as collaborative research must be considered. This paper considers measures that facilitate the conduct of collaborative research, and discusses challenges to the process that should be considered during the design. An example of a group investigation is presented, involving dental hygiene educators who collaborated on a research project implemented within their respective educational institutions. A model for a collaborative approach to future research initiatives is proposed. Lessons learned are shared and recommendations are put forward. It is suggested that innovative collaborations such as this may help to increase the body of knowledge for dental hygiene in Canada.

Implications of planning for regional libraries: our underlying philosophy.

The National Library of Medicine Extramural Program in administering the Medical Library Assistance Act of 1965 has developed the following specific program objectives: provide financial assistance for improving biomedical libraries; encourage and assist the establishment and functioning of a responsive national biomedical information network by strengthening present biomedical libraries and their interlibrary relationships; and assure that the biomedical library network is linked to related science information systems. The ultimate goal is to develop the role of the library as a full learning resource center for education, research, and service. The regional library program aims to augment present capability of existing medical libraries so that information can be made available more extensively and more rapidly. Comprehensive and thorough advanced planning is a basic element in the development of regional medical libraries.