Response of green roof performance to multiple hydrologic and design variables: a laboratory investigation.

Multiple factors affect green roof performance and their effects might vary at different stages of operation. This paper aimed to link green roof performance to hydrologic variables (antecedent moisture condition (AMC) and rainfall intensity) and design variables (growing medium (GM) type and depth) under multiple dimensions at the early stage of operation using laboratory experiment data. The results showed that the AMC is the most influential factor of hydrologic performance, whereas the GM type appeared to primarily affect the nutrient levels of the outflow. The significant main effects of other variables and interaction effects between two variables point to challenges in green roof design.

Comparative study of 13 candidate genes applying multi-reference normalization to detect the expression of different fineness in skin tissues of wool sheep.

Fiber diameter is a useful indicator of wool traits and it is the main determinant of wool quality and value. A comparative study was conducted to analyze the abundance and expression of 13 candidate genes using expression profile microarray analysis and to identify novel molecular markers associated with wool traits to provide a molecular basis for improving wool quality in sheep. Genes associated with fineness of skin tissue were identified using a real-time reverse transcriptase-polymerase chain reaction method with 18SrRNA, ß-Actin, and GAPDH used for multi-reference normalization. The results indicated that the expression levels of TXNIP, TFDP1, and FAIM genes in super-fine type wool sheep were higher than those in fine-type wool sheep; the corresponding expression ratios of super-fine to fine wool sheep were 1.45, 1.57, and 2.55, respectively. The expression levels of PIK3CA, ADAM9, and FZD3 genes were lower in super-fine wool sheep compared with fine-type wool sheep; the corresponding expression ratios were 0.61, 0.65, and 0.52, respectively. The other genes tested (RPS6KA, ABCG2, GSTA1, PTPN13, GJB3, PPARD, and LAMB1) were similarly expressed in both types of wool sheep. These results infer that lower expression of PIK3CA, ADAM9, and FZD3 genes was associated with lower fiber diameter, whereas lower expression of TXNIP, TFDP1, and FAIM genes was associated with higher fiber diameter.

River flood prediction using fuzzy neural networks: an investigation on automated network architecture.

Urban floods are one of the most devastating natural disasters globally and improved flood prediction is essential for better flood management. Today, high-resolution real-time datasets for flood-related variables are widely available. These data can be used to create data-driven models for improved real-time flood prediction. However, data-driven models have uncertainty stemming from a number of issues: the selection of input data, the optimisation of model architecture, estimation of model parameters, and model output. Addressing these sources of uncertainty will improve flood prediction. In this research, a fuzzy neural network is proposed to predict peak flow in an urban river. The network uses fuzzy numbers to account for the uncertainty in the output and model parameters. An algorithm that uses possibility theory is used to train the network. An adaptation of the automated neural pathway strength feature selection (ANPSFS) method is used to select the input features. A search and optimisation algorithm is used to select the network architecture. Data for the Bow River in Calgary, Canada are used to train and test the network.

Association of CD4 SNPs with fat percentage of Holstein cattle.

Cluster of differentiation 4 gene (CD4) is well known for its role in immunity, but its effects on production traits remain to be elucidated. The present study was designed to explore single nucleotide polymorphisms (SNPs) in the exons, flanking introns, and promoter of CD4, as well as to analyze their effects on milk production traits (percentage of protein, fat, and lactose; mastitis indicator traits somatic cell count; and somatic cell score). A total of 10 SNPs, including eight in the exon and two in the intron regions, were identified using pooled DNA sequencing. These SNPs were screened in a population of 258 Chinese Holstein using the SNaPshot technique. We analyzed the effects of SNPs, parity, herd, year, and season of calving on the production and mastitis indicator traits. Our analysis revealed two haplotypes and strong linkage disequilibrium (D' > 0.97) among all SNPs. All 10 SNPs were significantly associated with fat percentage (P < 0.01). Cows homozygous for the wild-type genotypes had higher fat percentages than those with the other genotypes. The dominant and additive effects were also significant for fat percentage (P < 0.05). These results suggest that CD4 plays a role in production traits as well as in immune function. The identified SNPs could be used as genetic markers for selection of dairy cows with improved fat percentage. We propose further studies of these SNPs in a larger population as well as further investigations of the function of this gene.

Association study of single nucleotide polymorphisms in JAK2 and STAT5B genes and their differential mRNA expression with mastitis susceptibility in Chinese Holstein cattle.

The JAK-STAT pathway plays a key role in mediating immune responses. The genetic effects of single nucleotide polymorphisms (SNPs) in JAK2 and STAT5B were investigated for serum cytokines, mastitis indicators and productions traits in a population of 468 Chinese Holstein cattle. Pooled DNA sequencing revealed one SNP (BTA8:g.39645396A>G) in JAK2 and two SNPs (BTA19:g.43673888A>G and BTA19:g.43660093T>C) in STAT5B. A fixed effect model considering the effects of SNPs, parity, herd, season and year of calving was used by way of the general linear model procedure of sas. Genotype frequencies of these SNPs in the population were in Hardy-Weinberg equilibrium (P > 0.05). A novel SNP (g.39645396A>G) in JAK2 was predicted to change the amino acid from lysine to asparagine and was significantly associated with the somatic cell count (SCC) and somatic cell score (SCS), whereas g.43673888A>G in STAT5B was significantly associated with SCC, SCS and interleukin-4 (IL-4) (P < 0.05). The dominant effect of g.39645396A>G in JAK2 was significant for SCS, and its additive effect was significant for SCC, whereas the dominant effect of g.43673888A>G in STAT5B was significant for SCS and IL-4 (P < 0.05). The combination of g.39645396A>G in JAK2 and g.43673888A>G in STAT5B showed a significant effect on SCC, SCS, IL-4 and TNF-α (P < 0.05). As for mRNA expression analysis, the AA genotype g.39645396A>G and GG genotype g.43673888A>G indicated higher mRNA expression level and were significantly different from other genotypes (P < 0.05). The results imply that JAK2 and STAT5B genes could be useful candidate genes, and the identified polymorphisms might potentially be strong genetic markers for selection of dairy cattle against mastitis development.

Antimicrobial resistance and toxin gene profiles of Staphylococcus aureus strains from Holstein milk.

UNLABELLED: Isolation of Staphylococcus aureus (Staph. aureus) from Holstein milk samples with mastitis and nonmastitis was conducted to estimate its prevalence, antimicrobial resistance and toxin genes. A total of 353 milk samples were collected from three Chinese Holstein herds. Fifty-three Staph. aureus isolates collected from 29 Staph. aureus-positive samples were characterized via antimicrobial susceptibility, toxin genes and Pulsed-field Gel Electrophoresis (PFGE) profiles. The prevalence of Staph. aureus was 4·0-9·5% in mastitic and 7·3-11·5% in nonmastitic samples in the analysed herds. Approximately 61·0% of Staph. aureus strains isolated from mastitis cows were resistant to ≥10 antimicrobials compared with 0% of isolates with nonmastitis. The most frequently observed super antigenic toxin gene was pvl (41·5%) followed by seh + pvl (13·2%). We did not find mecA-positive methicillin-resistant Staph. aureus (MRSA) strains, while mecA-negative MRSA strains were identified in the three herds. PFGE results suggested potential transmission of Staph. aureus strains in different farms. These results open new insights into Staph. aureus transmission and antimicrobial resistance of Holstein dairy cows and into developing strategies for udder health improvement of dairy cattle. SIGNIFICANCE AND IMPACT OF THE STUDY: Significantly higher levels of antibiotic resistance of Staphylococcus aureus strains were detected in the lactating Holstein milk with clinical mastitis compared with that without clinical mastitis. PFGE results suggest potential transmission of Staph. aureus strains in different dairy farms. The results imply that the dairy farms need to select effective antibiotics in the treatment of Staph. aureus-infected cows and prevent the transmission of Staph. aureus strains from one herd to another.

Comparison of methods for high quantity and quality genomic DNA extraction from raw cow milk.

Isolation of sufficient quantities of high quality DNA is a prerequisite for molecular studies. Milk somatic cells can be used; however, inhibitors such as fats and proteins make milk a difficult medium for extracting large amounts of quality DNA. We optimized, evaluated and compared three methods, Modified Nucleospin Blood Kit method, Modified TianGen Kit method and Phenol-Chloroform method for genomic DNA extraction from bovine milk. Individual cows' milk and bulk milk samples were collected from a China agricultural university dairy farm. Genomic DNA extracted from each milk sample by the three methods was evaluated for quantity and purity by spectrophotometry and gel electrophoresis, as well as PCR and sequencing. All the three methods were found suitable for genomic DNA isolation from bovine milk, PCR applications, and sequencing. Comparing the three methods, we found that the Modified Nucleospin Blood Kit method was significantly better than the Phenol-Chloroform method in terms of quantity as well as quality (amount, concentration, 260/280 nm and 260/230 nm absorbance ratio), whereas, the Modified TianGen Kit method was more efficient than the Phenol-Chloroform method and cheaper than the Modified Nucleospine Blood Kit method; it yielded reasonably good quantities of good quality DNA and would be suitable for large-scale genotyping of lactating cows.

Incidence and risk factors for H5 highly pathogenic avian influenza infection in flocks of apparently clinically healthy ducks.

A prospective longitudinal study was conducted on 96 smallholder duck farms in Indonesia over a period of 14 months in 2007 and 2008 to monitor bird- and flock-level incidence rates of H5 highly pathogenic avian influenza (HPAI) infection in duck flocks, and to identify risk factors associated with these flocks becoming H5 seropositive. Flocks that scavenged around neighbouring houses within the village were at increased risk of developing H5 antibodies, as were flocks from which carcases of birds that died during the 2 months between visits were consumed by the family. Duck flock confinement overnight on the farm and sudden deaths of birds between visits were associated with lower risk of the flock developing H5 antibodies. Scavenging around neighbouring houses and non-confinement overnight are likely to be causal risk factors for infection. With this study we have provided insights into farm-level risk factors of HPAI virus introduction into duck flocks. Preventive messages based on these risk factors should be included in HPAI awareness programmes.

The utilization of an absorbable mesh after ostomy reversal does not decrease incisional hernia rates.

BACKGROUND: Postoperative ostomy reversal hernias are common and can create strain on the healthcare system. There is little literature evaluating the utilization of absorbable mesh following ostomy reversal. The effect on subsequent hernia rates at our institution has not been evaluated. We examine if the addition of absorbable mesh decreases the postoperative hernia rate in our patient population. METHODS: We performed a retrospective review of all ileostomy and colostomy reversals. Patients were divided into two groups based on whether an absorbable mesh was used at ostomy closure or not. RESULTS: Hernia recurrence rates were lower in the group that had mesh reinforcement (8.96%) vs the group that did not receive a mesh (14.8%) though this was not statistically significant (p = 0.233). CONCLUSION: Prophylactic use of an absorbable biosynthetic mesh did not alter the rate of incisional hernia rates following ostomy reversal in our cohort of patients.

Exploring the role of microbial biofilm for industrial effluents treatment.

Biofilm formation on biotic or abiotic surfaces is caused by microbial cells of a single or heterogeneous species. Biofilm protects microbes from stressful environmental conditions, toxic action of chemicals, and antimicrobial substances. Quorum sensing (QS) is the generation of autoinducers (AIs) by bacteria in a biofilm to communicate with one other. QS is responsible for the growth of biofilm, synthesis of exopolysaccharides (EPS), and bioremediation of environmental pollutants. EPS is used for wastewater treatment due to its three-dimensional matrix which is composed of proteins, polysaccharides, humic-like substances, and nucleic acids. Autoinducers mediate significantly the degradation of environmental pollutants. Acyl-homoserine lactone (AHL) producing bacteria as well as quorum quenching enzyme or bacteria can effectively improve the performance of wastewater treatment. Biofilms-based reactors due to their economic and ecofriendly nature are used for the treatment of industrial wastewaters. Electrodes coated with electro-active biofilm (EAB) which are obtained from sewage sludge, activated sludge, or industrial and domestic effluents are getting popularity in bioremediation. Microbial fuel cells are involved in wastewater treatment and production of energy from wastewater. Synthetic biological systems such as genome editing by CRISPR-Cas can be used for the advanced bioremediation process through modification of metabolic pathways in quorum sensing within microbial communities. This narrative review discusses the impacts of QS regulatory approaches on biofilm formation, extracellular polymeric substance synthesis, and role of microbial community in bioremediation of pollutants from industrial effluents.

A simplified geospatial model to rank LID solutions for urban runoff management.

Studies have shown the usefulness of low impact development (LID) in runoff management in urban areas; however, there is a limited number of systematic decision-making models for ranking LID solutions (i.e., the location and type of LID required). This research proposes a physics-based GIS Multi Criteria Decision Making model (GIS-MCDM), which we refer to as the LID Solution Evaluation and Ranking ApproacH (SERAH). This model integrates the hydrological and socioeconomic-environmental benefits of LID with the subcatchment-level demand of LIDs - this has been traditionally overlooked in previous research. Specifically, SERAH integrates key the contributing criteria, including LID benefits, cost, feasibility, and subcatchment demand to rank LID solutions. To demonstrate the applicability of SERAH, a highly urbanized catchment in Toronto was used as a case-study and three types of LID: rain gardens, infiltration trenches, and porous pavements were considered. The hydrological performance of the ranked solutions was estimated using the stormwater management model, PCSWMM. The resulting LID ranking from SERAH corresponded to the best hydrological performance and LID co-benefits. Runoff volumes were reduced by 8.9-11.3%, and peak runoff values were reduced by 1.3-19.9% compared to the base scenario. The infiltration trench was ranked the highest in 16 of the 19 subcatchments where the cost was identified as a key factor. For the remaining three subcatchments, the rain garden was ranked the highest due to its socioeconomic-environmental benefits outweighing the higher cost. The effect of different rainfall durations, frequencies, and temporal patterns on the performance of the highest-ranked LID solution suggested that LID provide higher performance (runoff volume reduction) in more severe events. SERAH is useful for strategic planning for sustainable infrastructure. Future research is needed to better quantify the socioeconomic and environmental benefits of LID to improve SERAH.

Subsurface transport of carboxymethyl cellulose (CMC)-stabilized nanoscale zero valent iron (nZVI): Numerical and statistical analysis.

Subsurface remediation using nanoscale zero valent iron (nZVI) is a promising in-situ technology that can transform certain groundwater contaminants into non-toxic compounds. However, field scale implementation of nZVI technology has faced major challenges due to poor subsurface mobility, limited longevity and well clogging, all leading to a shorter nZVI travel distance. This distance nZVI travels in the subsurface is an important parameter since it influences the amount of contaminants that can be reached and thereby remediated. There are several factors which may affect nZVI travel distance such as groundwater velocity, injection concentration and rate, lag period (duration when nZVI injection is stopped), solution viscosity, and subsurface heterogeneity. Although various studies have been performed to reveal the effect of different factors on nZVI transport in homogeneous domains, few studies have focused on heterogeneous media, which is more representative of field conditions. In this study, a statistical analysis was performed using a two-dimensional numerical model which simulated carboxymethyl cellulose (CMC) stabilized nZVI transport in randomly distributed soil permeability fields of two aquifers to examine the factors that have the greatest impact on nZVI travel distance. Among all possible factors, field scale solution viscosity and injection rate had a statistically significant effect on nZVI travel distance in both the horizontal and vertical directions, as well as, on the attached mass. Additionally, the lag period between injections had a statistically significant effect on the attached mass, but not the travel distance. These results suggest that having a long injection period followed by a short lag phase during field deployment may result in less nZVI attachment. Lastly, aquifer heterogeneity impacted the nZVI spread while the impact of intrinsic groundwater velocity and injection concentration was found not to be statistically significant. Results from this numerical study can aid in field-scale CMC-nZVI injection by identifying key factors for remediation optimization.

Effect of integrated neuromuscular inhibition technique compared with positional release technique in the management of piriformis syndrome.

CONTEXT: Studies have indicated that the muscle energy technique (MET) and the positional release technique (PRT) are effective in the management of piriformis syndrome (PS); however, evidence is scarce regarding the combination of these techniques in the form of an integrated neuromuscular inhibition technique (INIT) in the management of individuals with PS. Although a previous trial investigated the effect of INIT for PS, that study did not integrate Ruddy's reciprocal antagonist facilitation (RRAF) method into the INIT protocol, nor did the authors diagnose PS according to established criteria. OBJECTIVES: To examine the effects of INIT with integrated RRAF compared with PRT in the management of patients diagnosed with PS. METHODS: This study was designed as a single blind randomized clinical trial in which participants diagnosed with PS were randomly allocated into INIT and PRT groups. Each group attended two treatment sessions per week for 8 weeks. Patients in the INIT group received a protocol in which the patient's tender point or trigger point was palpated in the belly of the piriformis approximately halfway between the inferior lateral angle of the sacrum and the greater trochanter, at which point the therapist applied an intermittent or sustained pressure and maintained the pressure for 20-60 seconds (depending on the participant's response to pain reduction). For INIT patients, that protocol was also followed by RRAF, a method in which a patient introduces a series of tiny/miniature contractions or efforts (20 times per 10 seconds) against a therapist's resistance. Patients in the PRT group were treated by palpating the same trigger point described in the INIT group, followed by application of light pressure at the location of the trigger point, which was maintained the pressure for 2 minutes or until the pain subsided (determined by asking the participant to report a pain score using a visual analog scale at 30 second intervals). For both groups, three repetitions of the INIT or PRT treatment were performed over 10 minutes at each clinical visit. Additionally, each group also received stretching exercises immediately after the INIT or PRT treatment session. Each participant was assessed at baseline, immediately posttreatment, and at 4 months posttreatment for pain, sciatica, functional mobility, quality of life, hip abduction, and internal rotation. A repeated measures analysis of variance (ANOVA) of within-between group interactions was used to analyze the treatment effect. RESULTS: Forty eight participants (age range, 25-47 years; mean age ± standard deviation, 32.81 ± 3.27 years) were randomized into the INIT and PRT groups, with 24 participants in each group. No significant between-group differences (p>0.05) were observed in the baseline demographic and clinical variables of the participants. A repeated-measures ANOVA indicated that there was a significant time effect for all outcomes, with a significant interaction between time and intervention (p<0.001). The Bonferroni post hoc analyses of time and intervention effects indicated that the INIT group improved significantly compared with the PRT group in all outcomes (p<0.05) immediately posttreatment and at the 4 months follow up period. CONCLUSIONS: INIT was more effective than PRT in the management of individuals with PS. It should be noted the significant improvement achieved in both the groups may have also been contributed to by the stretching exercises that were used as adjunct therapies by both groups.

Selection and implementation of single nucleotide polymorphism markers for parentage analysis in crossbred cattle population.

Crossbreeding is an essential way of improving herd performance. However, frequent parentage record errors appear, which results in the lower accuracy of genetic parameter estimation and genetic evaluation. This study aims to build a single nucleotide polymorphism (SNP) panel with sufficient power for parentage testing in the crossbred population of Simmental and Holstein cattle. The direct sequencing technique in PCR products of pooling DNA along with matrix-assisted laser desorption/ionization time-of-flight MS method for genotyping the individuals was applied. A panel comprising 50 highly informative SNPs for parentage analysis was developed in the crossbred population. The average minor allele frequency for SNPs was 0.43, and the cumulative probability of exclusion for single-parent and both-parent inference met 0.99797 and 0.999999, respectively. The maker-set for parentage verification was then used in a group of 81 trios with aid of the likelihood-based parentage-assignment program of Cervus software. Reconfirmation with on-farm records showed that this 50-SNP system could provide sufficient and reliable information for parentage testing with the parental errors for mother-offspring and sire-offspring being 8.6 and 18.5%, respectively. In conclusion, a set of low-cost and efficient SNPs for the paternity testing in the Simmental and Holstein crossbred population are provided.

Assessment of family needs of children with cerebral palsy in Northern-Nigeria: A cross-sectional study.

PURPOSE: This study aimed to identify the needs and priorities of parents of children with cerebral palsy (CP) in order to improve care by increasing family participation in rehabilitation programmes. METHODS: This cross-sectional questionnaire-based study was conducted between January to March 2019. Convenience sampling was used to recruit 43 family members (18 years and above) of children with CP who came to the physiotherapy departments for rehabilitation services for their children. Fisher's exact test was used to analyse the association between socio-demographic characteristics and each of the need items. RESULTS: Five different items were identified to be the family needs that were most frequently met: a) 'need for active involvement in the child's treatment and therapies' (n= 40; 93.0%), b) 'need for the provision of standard medical care (n= 39; 90.7%), c) 'need for questions to be answered honestly' (n= 38; 88.4%), d) 'need for healthcare professionals to respect the child's wishes' (n= 36; 83.7%), e) 'need for mothers to discuss their feelings (depression, stress etc.) with someone who has similar experience' (n= 36; 83.7%). Conversely, three items were the most unmet family needs: a) 'need to have professionals to consult whenever the child needs help' (n= 39; 90.7%), b) 'need to be informed about the child's prognosis' (n= 41; 95.3%), and c) 'need to have financial support to provide the child with adequate care' (n= 43; 100%). CONCLUSION: All participants overwhelmingly reported that their financial needs were their highest priority. The multiple needs of families of children with disabilities must be assessed and considered in rehabilitation services when treating children with CP.

Firearm Acoustic Detection in Hartford, Connecticut: Outcomes of a Trauma Center - Law Enforcement Collaboration.

Introduction Firearm homicide is a leading cause of violence-related death in the United States.Unfortunately, more than 80% of illegal firearm discharges are never reported to police by traditional means.ShotSpotterTM (Newark, California) is an acoustic firearm event detection system that can localize gunfire, prompting police, and subsequent emergency medical services (EMS) presence. Previously reported healthcare effects of acoustic detection are speculative in nature. We sought to investigate Hartford, Connecticut's experience with ShotSpotter​​​​​​​TM given its smaller size and broad coverage.  Methods The three trauma centers in Hartford (two for adults and one for pediatric) collaborated with the Hartford Police to review outcomes of victims with acoustically detected gunshots and compare them to those who went undetected. We performed a retrospective review of patients who presented with gunshot wounds (GSW) over a 30-month period, from January 1, 2016 to June 30, 2018. Victim location and acoustic detection were reconciled by the police department and hospital staff independently. Patients were individually matched for location, prehospital response, treatment durations, and hospital outcomes. Results Of 387 GSW, 157 (40.6%) presented via EMS and were included in the sample. Of these, 89 correlated to a detection event (56.7%) and 68 had no correlating event (43.3%). These two groups had no difference in prehospital treatment times, scene and transport duration, and injury severity. Further, the need for surgery or transfusion, lengths of stay, and disposition, including mortality, did not differ. Conclusions Despite limited previous reports demonstrating conferred benefits to acoustic detection of gunshots, Hartford's experience showed no benefit. The potential for such systems to act as early warning systems is evident but may depend on a city's resources, geography, and technology.

Application of chemo thermal coupled sonic homogenization of marine macroalgal biomass for energy efficient volatile fatty acid recovery.

The present study aimed to employ energy efficient chemo thermal coupled sonic homogenization (CTSH) to obtain VFA from marine macroalgal hydrolysate, (Ulva fasciata). At first, chemo thermal homogenization (CTH) was applied on macroalgal biomass by adjusting the temperature, pH and treatment time from 60 to 90 â„ƒ, 4-7 and 0-60 min, respectively. A higher organic matter solubilisation of 11.81% was obtained at an optimum pH of 6 at a temperature of 80 â„ƒ with 40 min of homogenization time. The results of CTSH implied that a higher organic matter solubilization of 26.4% was achieved by combined CTSH (sonic power & treatment time - 140 W & 14 min treatment time). CTSH considerably doubles the liquefaction in comparison with CTH. Based on OMS grouping, achieving 25% was sufficient for VFA production (2172.09 mg/L) and considered as economically feasible with net cost of 97.17 USD/ton of macroalgae.

Ependymal enhancement on magnetic resonance imaging for the identification of high-grade gliomas.

BACKGROUND: High-grade gliomas have high infiltrative potential and spread along white matter and blood vessels. Enhancement of ependymal lining on magnetic resonance imaging (MRI) is considered as a marker of parenchymal spread of disease. In this study, we aimed to assess the sensitivity, specificity, and positive and negative predictive values of ependymal enhancement (EE) for identification of high-grade glial tumors. METHODS: We reviewed preoperative MRI scans of 94 consecutive patients surgically treated for space occupying lesions of the brain for EE. Assessment for EE was blind to the final histopathological diagnosis of the patient. An enhancement of more than 2 mm was considered positive. Pathologies of these patients were reviewed and matched to the radiological findings. Percentage and proportion of EE in glial and non-glial pathology groups was then calculated and a sensitivity and specificity analysis was performed. RESULTS: The population included 94 cases (64 males and 30 females) with population mean age 45 ± 15.5 years. Sensitivity of EE in differentiating glioma from total number of cases was 82.61% specificity 35.42% (P value = 0.048). EE had a sensitivity of 67.39% and specificity of 64.58% (P value = 0.002) in identifying high-grade glioma within the glioma group with a positive predictive value of 64.58% (95% CI: 49.46% to 77.83%), negative predictive value of 67.39% (95% CI: 51.98% to 80.46%). CONCLUSION: EE has moderate sensitivity and specificity for high-grade gliomas. However, larger sample studies are required for further validation of this observations.

Intrathecal and intraventricular antibiotics for postoperative Gram-negative meningitis and ventriculitis.

BACKGROUND: Postoperative meningitis is a growing cause of concern, especially with the evolution of multidrug-resistant organism. The authors evaluate the use of intraventricular/intrathecal (IVT/IT) antibiotics for postoperative gram-negative meningitis in patients whom intravenous antibiotics were ineffective. METHODS: Medical records were retrospectively reviewed and neurosurgery patients with gram-negative postoperative infection meningitis/ventriculitis were enrolled in the study. Their demographics, hospital course, and outcomes were recorded in a pro forma and analyzed using Statistical Package for the Social Sciences, version 19. RESULTS: The review identified 21 patients with postneurosurgical gram-negative meningitis/ventriculitis who were treated with IVT or IT antibiotics. The most common organism was Acinetobacter species (n = 14; 66%). Amikacin was used in 7 patients, polymyxin B in 9 patients, and colistin in 5 patients. A combination of antibiotics was used in one patient. Cerebrospinal fluid sterility was achieved in all patients with no incidence of relapse. There was a single death, though that was not related to the infectious process as the patient had a massive pulmonary embolism. CONCLUSION: The findings of this study suggest that IVT and IT antibiotic therapy is a useful option in patients who are nonresponsive to standard intravenous therapy with little or no side effects.

Bowen's disease of the nipple-a new method of treatment.

Squamous cell carcinoma in situ (Bowen's disease) is a common skin condition but has only rarely been described on the nipple. All reported cases have been treated with wide local excision and observation. A new treatment for Bowen's disease is photodynamic therapy. This has been reported as being able to treat Bowen's disease in other sites effectively with an acceptable local recurrence rate. We describe two patients presenting with itching and scaling of the nipple which were histologically proven Bowen's disease, one of these patients was treated successfully with a combination of photodynamic therapy and cryotherapy: this is the first time such a lesion has been treated in this way.