The ethics of a work strike.

No abstract provided.

Neonatal bartter syndrome.

We report a case of neonatal Bartter syndrome in a 31 weeks premature baby girl with antenatal unexplained polyhydramnios requiring amnioreduction. She presented with early onset E. coli septicaemia and severe dehydration leading to pre-renal renal impairment which obscure the typical biochemical changes of hypokalaemic hypochloraemic metabolic alkalosis.

Oesophageal intubation and ventilation as initial airway support of newborn infant with tracheal agenesis.

Tracheal agenesis is a rare congenital airway anomaly which presents as an airway emergency at birth. We report a case of late premature Chinese infant with tracheal agenesis type II (by Floyd's classification) who presented with severe respiratory distress at birth. He had multiple failed attempts at intubations with accidental oesophageal intubation and ventilation. Tracheal agenesis with tracheo-oesophageal fistula was suspected from an emergency optical laryngoesophagoscopy done. The infant was subsequently stabilized on oesophageal ventilation. The diagnosis was confirmed on CT scan and parents were counseled regarding the poor outcome and decided for withdrawal at day 7 of life.

Microplastics pollution in the rivers of a metropolitan city and its estimated dependency on surrounding developed land.

The spatial distribution and abundance of suspected microplastics (SMPs) in the surface water of a metropolitan city, as represented by four Hong Kong rivers, was studied during the dry season. Shing Mun River (SM), Lam Tsuen River (LT), and Tuen Mun River (TM) are located in urbanized areas, and SM and TM are tidal rivers. The fourth river, Silver River (SR) is situated in a rural area. TM had a significantly higher SMP abundance (53.80 ± 20.67 n/L) than the other rivers. The SMP abundance increased from upstream to downstream in non-tidal rivers (LT and SR), but not in tidal rivers (TM and SM), probably due to the tidal influence and a more homogeneous urban development along the tidal rivers. Inter-site differences in the SMP abundance were strongly correlated with the built area ratio (defined as the percentage of surrounding developed land area), human activities, and the nature of the river. About half (48.72 %) of the SMPs were <250 µm. Fibers and fragments were most abundant (>98 %), with most of them being transparent (58.54 %), black (14.68 %), or blue (12.12 %). Polyethylene terephthalate (26.96 %) and polyethylene (20.70 %) were the most common polymers. However, the MP abundance could be overestimated due to the presence of natural fibers. By contrast, an underestimation of the MP abundance could result from a smaller volume of water samples collected, due to a low filtration efficiency caused by high organic content and particle concentrations in the water. A more effective solid waste management strategy and upgrading of the sewage treatment facilities for removing microplastics are recommended to ameliorate the microplastic pollution in local rivers.

Sensorineural Hearing Loss in Nasopharyngeal Carcinoma Survivors in the Modern Treatment Era - The Early and Late Effects of Radiation and Cisplatin.

AIMS: Hearing loss is a common debilitating complication in nasopharyngeal carcinoma (NPC) survivors. The aim of the present study was to investigate the impact of inner ear/cochlear radiation dose and cisplatin use on early and late sensorineural hearing loss (SNHL) in NPC patients treated with radiotherapy alone, concurrent chemoradiation (cCRT) and induction chemotherapy followed by cCRT (iCRT) in the intensity-modulated radiotherapy era. MATERIALS AND METHODS: The study included 81 NPC patients treated with intensity-modulated radiotherapy between 2014 and 2016. Pure tone audiometry was carried out at baseline and follow-up. The effects of cochlear/inner ear radiation and cisplatin doses on early (<12 months) and late (≥24 months) SNHL were analysed using multivariable regression after adjusting for important predictors. RESULTS: In total, 156 ears were examined. In early SNHL (n = 136), cisplatin use predicted the incidence of early high-frequency SHNL (HF-SNHL) (odds ratio 6.4, 95% confidence interval 1.7-23.9, P = 0.005). Ninety ears were analysed for late SNHL (median follow-up 38 months). Inner ear/cochlear radiation and cisplatin doses and better pre-treatment hearing were independent predictors of threshold change at 4 kHz. Every 10 Gy increase in inner ear/cochlear Dmean resulted in 5-dB and 6-dB threshold changes, respectively (cochlear Dmean: B = 0.005, 95% confidence interval 0.0004-0.009, P = 0.031; inner ear Dmean: B = 0.006, 95% confidence interval 0.001-0.010, P = 0.014). Cisplatin use was associated with late HF-SNHL (odds ratio 3.74, 95% confidence interval 1.1-12.3, P = 0.031). In the cCRT and iCRT subgroups, no cisplatin dose-dependent ototoxicity was observed. Severe (≥30 dB) late HF-SNHL occurred in 14% and 25% of the patients when the cochlear dose constraints were 40 Gy and 44 Gy, respectively. The radiotherapy-alone group did not develop severe late HF-SNHL. CONCLUSION: Cochlear/inner ear radiation dose and cisplatin use showed differential and independent ototoxicity in early and late SNHL. As cochlear/inner ear dose-dependent ototoxicity was demonstrated, the cochlear dose constraint should be as low as reasonably achievable, especially when cisplatin is also administered.

Patient-initiated mandatory boluses for ambulatory continuous interscalene analgesia: an effective strategy for optimizing analgesia and minimizing side-effects.

BACKGROUND: This prospective, randomized study tested the hypothesis that a reduced dose continuous interscalene regimen incorporating a low background infusion with mandatory boluses would provide similar shoulder surgery analgesia compared with a dose regimen incorporating a conventional higher background infusion. METHODS: After rotator cuff surgery, patients received via an interscalene catheter, one of two elastomeric pumps, each having a 5 ml per 60 min bolus function and a 2 ml h⁻¹ (n=38) or 5 ml h⁻¹ (n=43) ropivacaine 2 mg ml⁻¹ infusion. Boluses commenced from the onset of pain and continued for >48 h as required (pro re nata, PRN) up to every hour for a numerical rating pain score (NRPS, 0-10) >2. Group 2 ml h⁻¹ received mandatory 6 hourly boluses irrespective of the NRPS. Rescue tramadol was available. Patients were questioned on postoperative days 1 and 2 for treatment effectiveness and side-effects. RESULTS: Postoperative pain was similar between the groups [Group 2 ml h⁻¹ day 2 median (IQR) (95% confidence interval of the mean) worst movement pain=4 (1-5) (2.8-4.7) vs 4 (2-5) (3.1-4.6), P=0.99], as were night awakenings and tramadol consumption. Numerically rated numbness and weakness were similar between the groups; however, nine patients (21%) in the 5 ml h⁻¹ group vs one (3%) in the 2 ml h⁻¹ group required a temporary infusion cessation due to side-effects (predominantly hand numbness) (P=0.02). CONCLUSIONS: Continuous interscalene ropivacaine 0.2% 2 ml h⁻¹ with mandatory 6 hourly (and PRN) boluses provides similar analgesia after rotator cuff repair but with reduced side-effects compared with 5 ml h⁻¹ with PRN only boluses.

Relationship between age and peripapillary retinal nerve fibre layer thickness: an optical coherence tomography study.

OBJECTIVE: To evaluate the relationship between age and peripapillary retinal nerve fibre layer thickness in healthy Chinese subjects. DESIGN: Cross-sectional study. SETTING: Regional hospital, Hong Kong. PARTICIPANTS: Healthy volunteers (n=218) of Chinese ethnicity with spherical equivalent of -6 to +4 dioptres were recruited for study from October 2001 to March 2003. Ocular examination was carried out and measurements of peripapillary retinal nerve fibre layer thickness were performed using optical coherence tomography (Carl Zeiss Humphrey OCT 2 machine), in a circular pattern of 3.4 mm diameter, centred on the optic disc. MAIN OUTCOME MEASURES: Mean retinal nerve fibre layer thickness and age. RESULTS: The mean age was 40 (standard deviation, 17; range, 11-69) years. The mean peripapillary retinal nerve fibre layer thickness was 111.6 (standard deviation, 18.5; range, 52.0-155.0) micrometres. Age correlated significantly with peripapillary retinal nerve fibre layer thickness (r= -0.28, P<0.0001). CONCLUSION: Mean peripapillary retinal nerve fibre layer thickness (based on optical coherence tomography) correlates negatively with age, which can interfere with the assessment and monitoring of glaucoma patients. An age-adjusted normogram may be necessary to interpret results.

Diffuse large B-cell lymphoma masquerading as orbital cellulitis.

Proptosis is commonly encountered in clinical practice. We report on a patient with acute proptosis, eyelid swelling, and chemosis, which was initially treated as cellulitis. After radiological and pathological assessments, a diagnosis of large B-cell lymphoma was made. The patient died within 2 months of presentation. Not all patients with proptosis have cellulitis. Proptosis, especially unilateral proptosis, should always lead to a radiological scan in case of malignancy.

Multiplexing of polarization-maintaining photonic crystal fiber based Sagnac interferometric sensors.

Three multiplexing schemes are presented for polarization-maintaining photonic crystal fiber based Sagnac interferometric sensors. The first technique is wavelength division multiplexing using coarse wavelength division multiplexers (CWDMs) to distinguish signals from each multiplexed sensor in different wavelength channels. The other two schemes are to multiplex sensors in series along a single fiber link and in parallel by using fiber-optic couplers. While for the CWDM scheme, the multiplexed sensing signal can be obtained by direct measurement; for the other two multiplexing techniques, the sensing signal is more complex and cannot be easily demultiplexed. Thus, some signal processing methods are required. In this regard, two mathematical transformations, namely the discrete wavelet transform and Fourier transform, have been independently and successfully implemented into these two schemes. The operating principles, experimental setup, and overall performance are discussed.

Applications of Hairpin DNA-Functionalized Gold Nanoparticles for Imaging mRNA in Living Cells.

Molecular imaging agents are useful for imaging molecular processes in living systems in order to elucidate the function of molecular mediators in health and disease. Here, we demonstrate a technique for the synthesis, characterization, and application of hairpin DNA-functionalized gold nanoparticles (hAuNPs) as fluorescent hybridization probes for imaging mRNA expression and spatiotemporal dynamics in living cells. These imaging probes feature gold colloids linked to fluorophores via engineered oligonucleotides to resemble a molecular beacon in which the gold colloid serves as the fluorescence quencher in a fluorescence resonance energy transfer system. Target-specific hybridization of the hairpin oligonucleotide enables fluorescence de-quenching and subsequent emission with high signal to noise ratios. hAuNPs exhibit high specificity without adverse toxicity or the need for transfection reagents. Furthermore, tunability of hAuNP emission profiles by selection of spectrally distinct fluorophores enables multiplexed mRNA imaging applications. Therefore, hAuNPs are promising tools for imaging gene expression in living cells. As a representative application of this technology, we discuss the design and applications of hAuNP targeted against distinct matrix metalloproteinase enzymes for the multiplexed detection of mRNA expression in live breast cancer cells using flow cytometry and fluorescence microscopy.

Molecular characterisation of the 22q13 deletion syndrome supports the role of haploinsufficiency of SHANK3/PROSAP2 in the major neurological symptoms.

METHODS: The 22q13 deletion syndrome (MIM 606232) is characterised by moderate to profound mental retardation, delay/absence of expressive speech, hypotonia, normal to accelerated growth, and mild dysmorphic features. We have determined the deletion size and parent of origin in 56 patients with this syndrome. RESULTS: Similar to other terminal deletion syndromes, there was an overabundance of paternal deletions. The deletions vary widely in size, from 130 kb to over 9 Mb; however all 45 cases that could be specifically tested for the terminal region at the site of SHANK3 were deleted for this gene. The molecular structure of SHANK3 was further characterised. Comparison of clinical features to deletion size showed few correlations. Some measures of developmental assessment did correlate to deletion size; however, all patients showed some degree of mental retardation and severe delay or absence of expressive speech, regardless of deletion size. CONCLUSION: Our analysis therefore supports haploinsufficiency of the gene SHANK3, which codes for a structural protein of the postsynaptic density, as a major causative factor in the neurological symptoms of 22q13 deletion syndrome.

Hybrid procedure for orbital venous malformation in the endovascular operation room.

PURPOSE: To describe a hybrid procedure for orbital venous malformation in the endovascular operating room (EVOR). METHODS: Five consecutive patients with venous malformation in the periocular and orbital region were included. All patients received a one-stage direct puncture venogram, image-guided glue injection, and surgical resection in the EVOR equipped with a biplane digital subtraction angiography system (BDSAS). RESULTS: The mean age at the time of operation was 37.4 years (range, 22-69 years). The mean operative time was 193 min (range, 138-324 min). No intraoperative complications were noted. The mean follow-up duration was 18.8 months (range, 10-24 months). Three patients had complete removal of the vascular lesions. At the latest follow-up, no recurrence of symptoms related to the lesions was noted. All patients had an uneventful recovery and satisfactory outcome. CONCLUSIONS: The hybrid procedure of orbital venous malformation in the EVOR is a novel application in ophthalmology. It is a safe and well-controlled procedure with real-time high-quality BDSAS surveillance to facilitate surgical resection. Its success requires collaboration between the interventional radiologist, the surgeon, and the ophthalmologist.

D1- and D2-like dopamine receptors are co-localized on the presynaptic varicosities of striatal and nucleus accumbens neurons in vitro.

The neuromodulatory actions of dopamine in the striatum and nucleus accumbens are likely to depend on the distribution of dopamine receptors on individual postsynaptic cells. To address this, we have visualized D1- and D2-like receptors on living medium-spiny GABAergic neurons in cultures from the striatum and nucleus accumbens using receptor antagonist fluoroprobes. We labeled D1-like receptors with rhodamine-SCH23390, D2-like receptors with rhodamine-N-(p-aminophenethyl)spiperone and synaptic sites with K+-stimulated uptake of the activity-dependent endocytic tracer FM-143. The fluoroprobes were applied in sequence to assess co-localization. We found that D1- or D2-like receptors were present on about two-thirds of the cells, and co-localized on 22+/-3% (mean +/- S.E.M.) of striatal and 38+/-6% of nucleus accumbens cells. On either D1 or D2 labeled cells, postsynaptic labeling continuously outlined the cell body membrane and extended to proximal dendrites, but not axons. About two-thirds of synaptic varicosities showed D1 or D2 labeling. D1- and D2-like receptors were co-localized on 21+/-4% of striatal and 27+/-3% of nucleus accumbens varicosities. Presynaptic labeling was typically more intense than postsynaptic labeling. The distribution of presynaptic dopamine receptors contrasted with that of postsynaptic GABA(A) receptors, which were clustered in longer patches on neighboring postsynaptic membranes. The extensive presence of D1- and D2-like receptors on presynaptic varicosities of medium-spiny neurons suggests that the receptors are likely to play an important and interacting role in the presynaptic modulation of inhibitory synaptic transmission in the striatum and nucleus accumbens. The significant overlap in labeling suggests that D1-D2 interactions, which occur at the level of individual postsynaptic cells, the circuit level and the systems level, may also be mediated at the presynaptic level. Finally, the ability to visualize dopamine, as well as GABA(A), receptors on the individual synapses of living neurons now makes possible physiological studies of individual mesolimbic system synapses with known receptor expression.

On the behavioral significance of head direction cells: neural and behavioral dynamics during spatial memory tasks.

Current theories assume that rats use the directional information reflected by head direction (HD) cells when performing spatial tasks. This assumption was assessed by monitoring anterior thalamic HD cell activity and relating it to the subject's behavioral response on 2 spatial memory tasks that tested either reference memory or working memory. In both tasks, there was a significant number of trials where there was not a tight coupling between the preferred firing direction of HD cells and the direction of the behavioral response. In addition, it was possible to intentionally change the preferred direction of HD cells without affecting performance accuracy. An additional experiment showed that manipulations that affected internal, but not external, cues impaired performance on the reference memory task. These findings suggest that HD cell activity was not consistently guiding the subjects' behavior on these 2 spatial tasks.

Competitive exclusion of Salmonella enteritidis in chicks by treatment with a single culture plus dietary lactose.

Oral inoculation of lactose utilizing cecal bacteria plus 2.5% lactose treatments were tested in young chicks for protective efficacy against infection by Salmonella enteritidis. One-day-old chicks were treated with cecal bacteria upon arrival and challenged orally on day 3 with 10(4)-10(6) cfu S. enteritidis. A single culture identified as Escherichia coli O75:H10 was found significantly more protective than all other isolates tested. This isolate excreted a metabolite(s) in vitro that was inhibitory towards the growth of S. enteritidis. The results of this study indicate that discovery of protective strains can be facilitated by screening isolates in vitro for lactose utilization and growth inhibition of S. enteritidis before administration of treatment.

Influence of culture conditions on biofilm formation by Escherichia coli O157:H7.

Biofilms of Escherichia coli O157:H7 were developed on stainless steel chips in trypticase soy broth (TSB), 1/5 dilution of TSB, 0.1% Bacto peptone (BP) and a minimal salts medium (MSM) supplemented with 0.04% of one of the following carbon sources: glucose, glycerol, lactose, mannose, succinic acid, sodium pyruvate or lactic acid. It was found that biofilms developed faster and a higher number of adherent cells (ca. 10(6) CFU/cm2) were recovered when the organisms were grown in the low nutrient media. Regardless of the carbon source, biofilms developed in MSM consisted of shorter bacterial cells and thicker extracellular matrix (ECM), with glucose as the best substrate for stable biofilm formation. Fewer bacteria in initial attachment, non-hydrophobicity of bacterial cells, lack of ECM formation and easy detachment of the biofilm bacteria may contribute to poor biofilm formation in TSB. ECM is probably important for the stability of biofilms; however, at 10 degrees C and under anaerobic conditions, ECM seems to be unnecessary.

Production of staphylococcal enterotoxin H under controlled pH and aeration.

The effects of controlled pH and aeration on the growth of Staphylococcus aureus strain FRI-569 and production of enterotoxin H (SEH) were studied. S. aureus FRI-569 did not grow well anaerobically. Aeration permitted better growth of cells especially at a flow rate of 300 cc/min. The optimal pH for S. aureus FRI-569 growth was 7.0, with less growth being observed at pH 6.5 and 7.5 or with no pH control. Very little SEH (< 21 ng/ml) was produced by S. aureus strain FRI-569 under anaerobic incubation. High SEH production was observed with aeration at 300 cc/min. Increasing aeration to 400 cc/min or decreasing it to 200 cc/min resulted in reduced SEH production. Larger amounts of SEH were produced when the pH was controlled at 7.0, while maintaining the pH at 6.5 or 7.5 resulted in lower levels of SEH being produced. However, the amounts were still greater than those observed when the pH was not controlled.

Heterogeneity observed in the components of hemolysin BL, an enterotoxin produced by Bacillus cereus.

Hemolysin BL (HBL), a diarrheal enterotoxin originally isolated from Bacillus cereus strain F837/76, is composed of three antigenically distinct proteins designated B, L1, and L2. All three components are required for biological activity. Here, we report antigenic and physical variations in HBL components produced by other B. cereus isolates. Reactions of partial identity were observed in double gel immunodiffusion assays using antibodies to highly purified B, L1, and L2 components of F837/76 and culture supernatants of strains F837/76 and S1C. Western blot analysis showed that F837/76 produced one 38-kDa B protein, one 38-kDa L1, and one 43-kDa L1 protein. In strain S1C, two B (38 and 42 kDa), two L1 (38 and 41 kDa), and one L1 (43 kDa) proteins were detected. Further Western blot analysis of 127 B. cereus isolates showed that 90 produced one or more of the three HBL components. Approximately half of these 90 isolates (43/90; 48%) produced protein profiles which differed from that of F837/76. A total of four B, two L1, and three L2 component profiles with proteins of different sizes were observed. Individual strains produced various combinations of single or multiple bands of each component. In addition, some strains produced only one or two of the three HBL components. The public health significance of these strains is unknown, as all three components are required for biological activity. The data presented here demonstrates a high degree of heterogeneity in HBL and provide the basis for further studies to characterize the variations in HBL and to determine the role of the variant components in pathogenicity.