The impact of environmental factors on the evolution of brain size in carnivorans.

The reasons why some animals have developed larger brains has long been a subject of debate. Yet, it remains unclear which selective pressures may favour the encephalization and how it may act during evolution at different taxonomic scales. Here we studied the patterns and tempo of brain evolution within the order Carnivora and present large-scale comparative analysis of the effect of ecological, environmental, social, and physiological variables on relative brain size in a sample of 174 extant carnivoran species. We found a complex pattern of brain size change between carnivoran families with differences in both the rate and diversity of encephalization. Our findings suggest that during carnivorans' evolution, a trade-off have occurred between the cognitive advantages of acquiring a relatively large brain allowing to adapt to specific environments, and the metabolic costs of the brain which may constitute a disadvantage when facing the need to colonize new environments.

A Simple Modeling-free Method Provides Accurate Estimates of Sensitivity and Specificity of Longitudinal Disease Biomarkers.

OBJECTIVE: To assess the time-dependent accuracy of a continuous longitudinal biomarker used as a test for early diagnosis or prognosis. METHODS: A method for accuracy assessment is proposed taking into account the marker measurement time and the delay between marker measurement and outcome. It dealt with markers having interval-censored measurements and a detection threshold. The threshold crossing times were assessed by a Bayesian method. A numerical study was conducted to test the procedures that were later applied to PCR measurements for prediction of cytomegalovirus disease after renal transplantation. RESULTS: The Bayesian method corrected the bias induced by interval-censored measurements on sensitivity estimates, with corrections from 0.07 to 0.3. In the application to cytomegalovirus disease, the Bayesian method estimated the area under the ROC curve to be over 75% during the first 20 days after graft and within five days between marker measurement and disease onset. However, the accuracy decreased quickly as that delay increased and late after graft. CONCLUSIONS: The proposed Bayesian method is easy to implement for assessing the time-dependent accuracy of a longitudinal biomarker and gives unbiased results under some conditions.

Cesarean section: changing incidence and indications.

There were 19,419 deliveries at Wilford Hall USAF Medical Center from 1970 through 1981. Of these, 1847 (9.5%) were by primary cesarean section and 800 (4%) by repeat operations. The most common indications for cesarean section (dystocia, breech presentation, repeat operation, and fetal distress) remained the same during this period. However, within these four indications and also between the three time periods of 1970 to 1973, 1974 to 1977, and 1978 to 1981, significant trends were apparent. From the periods of 1970 to 1973 through 1974 to 1977, the primary rate increased from 5.6% to 12.8% (P less than .0001). Dystocia (P less than .0001), breech presentation (P less than .0001), and fetal distress (P less than .0001) were responsible for this increase. However, from 1974 to 1977 through 1978 to 1981, the primary rate decreased to 9.6% (P less than .0001). This was related to significantly decreased rates for dystocia (P less than .0001) and fetal distress (P less than .0001). This decrease was temporally related to an initiation of various means to decrease the authors' overall cesarean section rate that approached 20% in 1976.

Second stage fetal heart rate abnormalities and neonatal acidosis.

Of 403 newborns with either fetal heart rate (FHR) bradycardia or tachycardia during the last ten minutes of the second stage of labor, 20% had an umbilical cord pH of less than 7.20 at birth compared with only 4% of newborns who had a normal FHR during the last ten minutes of labor (P less than .0001). Thirty (18%) of 165 neonates with mild bradycardia and 33 (27%) of 121 neonates with moderate to marked bradycardia had cord pH values of less than 7.20 at birth (P less than .0001). Of the 117 neonates with tachycardia during the last ten minutes of the second stage, 17 (15%) had a pH of less than 7.20 (P less than .0001). There was a significant increase in low cord pH values when FHR variability was absent when compared with normal variability (P less than .0001).

Scopolamine nasal spray in motion sickness: a randomised, controlled, and crossover study for the comparison of two scopolamine nasal sprays with oral dimenhydrinate and placebo.

Scopolamine has been used successfully for treatment of motion sickness for almost a century and the nasal administration was first studied 50 years ago. However, there never appeared a nasal dosage form. Finally, after finding a stable and suitable formulation for scopolamine, a study to investigate efficacy, safety, and tolerability was conducted, with a randomised, double-blind, double-dummy, crossover, Latin square design including placebo control and a placebo/placebo control for internal validity at the German Air Force Institute of Aviation Medicine. To assess the efficacy of a new, stable and well-tolerated formulation of scopolamine nasal spray the reproducible induction of whole body vibrations by a rotating chair was chosen and a validated seasickness score (SKS). The reduction of SKS showed that scopolamine nasal spray at a concentration of 0.2% was statistically superior to both placebo and dimenhydrinate (P=0.003 and 0.004, respectively). There were no signs for a nasal or epipharyngeal irritation of the mucous membrane. Scopolamine nasal spray was found to be an effective and safe treatment in motion sickness, with a fast onset of action within 30 min after administration.

[Prostate cancer: anatomo-pathological correlation and MRI]. / Cancer prostatique: corrélation anatomo-pathologique et IRM.

In our study, 50 patients had a prostatic carcinoma stade B. Before the radical prostatectomy we have realised a MRImaging of the prostate. After a precise histopathologic correlation we tried to appreciate the MRI performance for the detection of neoplasic nodes in the peripheral zone and for the loco-regional staging of the carcinoma. In detection of the pathologic nodes, MRImaging is more sensitive from the apex (22.5%) to the base of the prostate (91%), but it is at the same time specificless (apex: 90%, base: 40%). The accurate diagnostic for loco-regional staging in our study is 70%. Extracapsular extension is often underestimated because of the very small size of the invasion. On the other hand the specificity of MRI in seminal vesicles extension is satisfactory (87.5%).

[Breast micro-opacities of lead origin mimicking microcalcifications]. / Micro-opacités mammaires d'origine saturnine mimant des microcalcifications.

After a surgical excision of focal mammary "microcalcification" we noticed that in fact they represented fine lead deposits (mean diameter: 100 microns) resulting from an attempted suicide (22 long rifle) 10 years previously. The leaded nature of these foreign microbodies was demonstrated by a micro-analysis by energy dispersion on histological slides.

'I am absolutely shattered': the impact of chronic low back pain on Australian Aboriginal people.

BACKGROUND: Aboriginal people in Australia have been uniquely identified as less susceptible to chronic low back pain (CLBP) disability when compared to non-Aboriginal populations, reportedly due to cultural beliefs about pain. A qualitative, culturally secure research approach was used to explore this assumption. METHODS: In-depth interviews were undertaken with 32 Aboriginal men and women with CLBP in regional and remote areas of Western Australia. Interviews were conducted collaboratively with male and female Aboriginal co-investigators, and with the support of local Aboriginal community organizations. A primary focus was to investigate the impact of CLBP from the perspective of Aboriginal people living with the condition. RESULTS: The experience of CLBP was found to be multidimensional, impacting on activities of daily life, employment, sport and family participation, emotional and cultural well-being. CONCLUSIONS: Contrary to previous assumptions, CLBP is profoundly disabling for some Aboriginal people and a priority health concern. Issues of gender, cultural obligations and the emotional consequences of CLBP are important consideration for health care. These findings, and the contextual approach used to gain an in-depth understanding of CLBP, may be relevant to populations elsewhere.

Faithfulness to partners: a means to prevent HIV infection, a source of HIV infection risks, or both? A qualitative study of women's experiences in Abidjan, Côte d'Ivoire.

A cross-sectional study was carried out at a programme to prevent mother-to-child transmission of HIV (MTCT) at a public antenatal clinic in Abidjan, Côte d'Ivoire. The objectives were to obtain information from women concerning their reactions to HIV test results received through the programme, their experiences with faithfulness to partners as a means of primary HIV prevention for themselves and their infants, their relationships with partners, their own and their partners' experiences with HIV testing, and their knowledge of their partners' HIV serostatus. The participants were a purposive sample of 87 women who had received HIV-1-positive test results and 30 women who had received HIV-1-negative test results through the clinic's programme. Eighty-five per cent of the HIV-positive women were surprised by their test result; 52% of those who tested HIV-negative anticipated that result. Nearly two-thirds of those who were surprised to be HIV-positive and a similar proportion of those who expected to be HIV-negative explained their reactions by referring to faithfulness to their partners. Only five of the 117 women interviewed expressed a belief that their partners were faithful to them; and only two, and none of those who received an HIV-positive test result, reported using condoms with partners. No more than one-fourth of either the HIV-positive or the HIV-negative groups of women had been previously tested for HIV; less than one-fourth of the women in each group reported having partners who had been tested for HIV, or knew their partners' serostatus. Relationship characteristics of some HIV-positive women may have increased their vulnerability to HIV infection. Although being faithful to partners can be effective for the primary prevention of HIV infection, the manner in which it was practiced by many of the women in our study may have further increased their risk of infection. Organisations that choose to fund HIV prevention programmes that promote faithfulness to partners, and the programmes that stress faithfulness, must ensure that women are informed about the conditions that can influence the effectiveness of faithfulness as a protective action. However, women need more than information. Prevention programmes, whether concerned primarily with prevention of MTCT or with HIV prevention more broadly, must promote and elicit cooperation from women's sexual partners to support women's efforts to be tested for HIV, to be tested for HIV themselves, to disclose their test results, to reciprocate women's faithfulness and, if HIV serodiscordant or unwilling to be faithful, to use condoms. These steps may increase the likelihood that women will be able to protect themselves and their infants from HIV infection by being faithful to their partners.

Dysplastic changes in different types of melanocytic nevi. A unifying concept.

We observed histopathologic changes previously described in dysplastic melanocytic nevi in association with a dermal component characteristic of other types of melanocytic nevi or overlapping with features of other varieties of nevi. In order to determine the frequency of these changes, we studied 2,164 cases of compound melanocytic nevi that fulfilled the histopathologic criteria for the diagnosis of compound dysplastic nevus, including architectural pattern, cytologic features, and mesenchymal changes. Of the 2,164 compound dysplastic melanocytic nevi, 1,895 (87.6%) had the histopathologic characteristics previously described for dysplastic nevus, 179 (8.3%) showed a dermal component with a congenital pattern, 67 (3.1%) demonstrated epidermal and dermal characteristics of Spitz's nevus, 8 (0.3%) had features of a combined blue nevus, 13 (0.6%) had a halo phenomenon and 2 (0.1%) showed dermal neuronevus. By considering these nevi as variants of dysplastic nevi, one may apply a unified conceptual basis for their nomenclature. In order to completely describe the appearance of the nevus, we named them by adding the term "dysplastic", to their main histopathologic subtype. Accordingly, six different varieties of dysplastic nevi were identified: 1) dysplastic nevus (original); 2) dysplastic nevus with a congenital pattern; 3) dysplastic Spitz's nevus; 4) dysplastic combined blue nevus; 5) dysplastic halo nevus; and 6) dysplastic neuronevus. In summary, we conclude that the histopathologic criteria previously reported for the diagnosis of dysplastic nevi may be found in association with a dermal component characteristic of other types of melanocytic nevi or may have overlapping features with other variants of nevi.

Patient-controlled intranasal analgesia: effective alternative to intravenous PCA for postoperative pain relief.

PURPOSE: To investigate whether the nasal route for fentanyl administration in patient-controlled analgesia (PCA) provides as effective postoperative analgesia as intravenous PCA. METHODS: Patient-controlled intranasal or intravenous analgesia with fentanyl was investigated in 48 patients (ASA I-III) on the day of surgery (orthopedic, abdominal or thyroid) in a prospective, randomized, double-blind, double-dummy study. Fentanyl was given in a bolus of 25 microg for intranasal and 17.5 microg for i.v. PCA, lockout interval six minutes. The first requested dose was doubled in both groups. Pain intensity (101-point numerical rating scale) and vital parameters were observed at 11 measurement points during the 240 min study. Patients were asked for side effects at every measurement point and for their satisfaction at the end of the study by the same investigator (J.M.). RESULTS: Onset of analgesia, the first reduction in pain intensity on the numerical rating scale, was 21 +/- 11 min (range 15-45 min) in intranasal and 22 +/- 16 min (range 15-90 min) in i.v. PCA. Pain intensity was reduced from 55 +/- 11 to 11 +/- 10 in the intranasal group and from 53 +/- 8 to 11 +/- 6 in the i.v. PCA group. Vital parameters remained stable and side effects were comparable in both groups. The judgement "excellent" or "good" was given by 21 of 23 patients treated intranasally and 24 of 25 patients treated intravenously. CONCLUSION: Intranasal PCA with fentanyl was an effective alternative to i.v. PCA in postoperative patients.

Bilateral facial lipoatrophy secondary to connective tissue panniculitis treated with two microsurgically transplanted latissimus dorsi muscles.

A case of bilateral facial atrophy diagnosed as atrophic connective tissue panniculitis is presented. Reconstruction of both cheeks was performed with two staged latissimus dorsi muscle flaps. The initial good result on the right cheek deteriorated as the disease continued to progress after surgery. The good result on the left cheek, however, remained stable. Detailed clinical examinations, laboratory analysis, and deep biopsies from the affected areas are important for accurate diagnosis. Reconstructive procedures should be delayed while the disease is still active.

System analysis in multiple dose kinetics: evidence for saturable tubular reabsorption of the organic cation N1-methylnicotinamide in humans.

The renal clearance of N1-methylnicotinamide (NMN) was studied in 8 young women at physiological steady state and at steady state following a combined loading bolus and iv infusion. Urinary NMN concentrations were determined using a new HPLC method, plasma levels by a conventional fluorescence method. At physiological levels net tubular secretion of NMN was evident due to a renal fractional excretion, i.e., a ratio of renal NMN clearance to creatinine clearance, above unity. Increasing plasma concentrations lead to an increase in the fractional excretion, indicating saturation of the underlying tubular reabsorption process. Binding to plasma proteins was excluded by ultra-filtration experiments. Clearances measured at physiological levels were about one half of the maximum renal clearance attained following the infusion. This maximum value was approximately six times the creatinine clearance and may be a useful approximation of the renal plasma flow. System analysis, including a novel method to calculate the net response following a multiple input, was used to determine the pharmacokinetic system parameters.

Deep halothane anaesthesia compared with halothane-suxamethonium anaesthesia for tracheal intubation in young children.

A double-blind and randomized study design was used to investigate 100 healthy children, aged 1-5 years. Intubating conditions and cardiovascular changes during deep halothane anaesthesia, defined as an end-tidal concentration of 2%, were compared with those changes during 1% halothane and suxamethonium relaxation. Intubating conditions were graded according to the ease of laryngoscopy, vocal cord position, coughing and jaw relaxation. In each group 96% of the children demonstrated acceptable intubating conditions. Jaw relaxation was worse in the 1% halothane/-suxamethonium group (P < 0.01). When anaesthesia with 2% or 1% halothane was compared there was a more pronounced decrease in systolic blood pressure (18 vs. 8%, P < 0.001). Junctional rhythm occurred more frequently during deep halothane anaesthesia (46 vs. 18%, P < 0.01). Intravenously (i.v.) administered atropine attenuated blood pressure depression significantly and reinstituted sinus rhythm in most cases.

Hypomelanosis of Ito: diagnostic criteria and report of 41 cases.

We conducted a 20-year prospective review of 41 pediatric patients with a diagnosis of hypomelanosis of Ito. No evidence pointed to hereditary transmission of the disease. Associated extracutaneous pathology was mainly of the nervous and musculoskeletal systems. Three of 19 patients had chromosomal anomalies. Hypomelanosis of Ito is a clinically well-characterized syndrome in which chromosomal instability may be a component. Criteria for its presumptive and definitive diagnosis are proposed.

[Extracorporeal membrane oxygenation of the newborn infant--an example of interdisciplinary project management]. / Extrakorporale Membranoxigenierung des Neugeborenen--ein Beispiel für interdisziplinäres Projektmanagement.

In the last three years an interdisciplinary ECMO (extracorporeal membrane oxygenation) team has been set up at the Free University of Berlin in the Steglitz clinic. With this form of management, newborns only a few hours or days old who present with pulmonary failure can temporarily be managed with extracorporeal oxygenation until normal lung function is restored. The set up of this ECMO team, starting with experimental training in animal models, to the bedside clinical use is discussed. The following presentation of the first four cases managed here with ECMO aims to clarify the problems which may be encountered as well as amplifying its use as a life-saving measure.

Helicobacter pylori associated antigastric autoantibodies: role in Sjögren's syndrome gastritis.

BACKGROUND: Previous studies have shown that Helicobacter pylori seroprevalence in Sjögren's syndrome is comparable with that of the general population. However, the origin of the chronic gastropathy associated with this syndrome and the role of local autoimmunity--possibly triggered by bacterial infection--in its pathogenesis remain unclear. MATERIALS AND METHODS: We initially determined the prevalence of IgG anti H. pylori in dyspeptic subjects with and without Sjögren's syndrome. In subsets of both groups we then determined anti CagA and human tissue-tested anticanalicular/antifoveolar autoantibodies. We also compared activity, atrophy and Mucosa Associated Lymphoid Tissue (MALT) scores, as well as symptoms, before and after bacterial eradication. RESULTS: Prevalence of H. pylori in Sjögren's syndrome patients was similar to controls: 31/54 (57%) vs. 93/150 (62%). Anti CagA prevalence was also similar in the two groups. Twenty weeks after H. pylori eradication, histological activity decreased in both groups, however, atrophy and MALT decreased significantly only in controls. Sixteen months after H. pylori eradication, 75% of Sjögren's syndrome patients still complained of dyspepsia compared with 13% of controls. Finally, antigastric autoantibodies were present in 29% of tested Sjögren's syndrome patients vs. 28% of controls. CONCLUSIONS: H. pylori infection was equally prevalent among dyspeptic Sjögren's syndrome patients and dyspeptic controls. Likewise, there were no differences regarding anti CagA prevalence or antigastric autoantibodies among the two groups. The persistence of symptoms as well as of the lymphocytic infiltration and atrophy after H. pylori eradication in Sjögren's syndrome may underlie the 'endogenous' and still unknown nature of the gastropathy in this condition.

HIV-1 viral load and other risk factors for mother-to-child transmission of HIV-1 in a breast-feeding population in Cote d'Ivoire.

Short-course antiretroviral regimens have been evaluated to reduce mother-to-child transmission of HIV in resource-limited settings. This report from Abidjan, Cote d'Ivoire, examines the risk factors for HIV transmission by 1 and 24 months among breast-feeding women. Eligible HIV-1-seropositive pregnant women enrolled in this randomized double-blind clinical trial were randomly assigned to receive either oral zidovudine (ZDV) (n = 126) prophylaxis or placebo (n = 124). Maternal prophylaxis began at 36 weeks of gestation (300 mg ZDV twice daily antepartum and 300 mg every 3 hours intrapartum); there was no neonatal prophylaxis component. The cumulative risk of transmission in the treatment group was 11.9% and 22.1% by 1 and 24 months, respectively. In adjusted analyses, viral load at enrollment was the strongest predictor of transmission (per log increment: odds ratio [OR] = 4.8, 95% confidence interval [CI]: 2.5-9.5 at 1 month; OR = 5.7; 95% CI: 3.1-10.8 at 24 months). Overall, ZDV prophylaxis was not significantly protective for infection at 1 or 24 months. Comparing ZDV with placebo following dichotomization of viral load (<50,000 vs. > or =50,000 copies/mL) at enrollment, however, there was a significant effect of ZDV seen only among those women with a low viral load at enrollment. The substantial risk of transmission despite ZDV prophylaxis, particularly among those with higher viral loads, underscores the need to find more effective regimens appropriate for use in resource-limited settings.