Pattern of upper limb amputation associated with lower limb amputation: the UK military experience from Iraq and Afghanistan.

INTRODUCTION: The conflicts in Iraq and Afghanistan resulted in large numbers of personnel sustaining extremity injuries. In the context of polytrauma, partial hand amputation is often unrecorded. The aim of this work was to quantify the burden of upper limb (UL) amputation at any level occurring concurrently with a major (ankle and proximal) lower limb (LL) amputation. Knowledge of this cohort could aid in prosthetic modification to further improve quality of life outcomes in a population with dexterity loss. METHOD: A trauma database search was undertaken for all UK military LL amputees from the conflicts in Iraq and Afghanistan. A manual search method was employed to identify from the major LL amputees those who had a concurrent UL amputation at any level (including isolated finger amputation). Demographics, level of amputation, and injury profile data were recorded. RESULTS: Sixty-eight individuals were identified; the most prevalent population was bilateral LL with a unilateral UL amputation (60%). Most UL amputations were partial hand (75%). The was no statistically significant difference between left or right side (p=0.13). On the left side, correlation was found between amputation of the thumb and third digit (rho=0.34; p=0.005) not seen on the right. CONCLUSION: We have determined the rate of UL amputation at any level, in combination with LL amputation as a result of blast injury. Knowledge of these combinations enables further research to support anecdotal evidence that there is a need for tailored prosthetics in the context of potential dexterity loss making donning and doffing problematic.

Potential biological control of Erwinia tracheiphila by internal alimentary canal interactions in Acalymma vittatum with Pseudomonas fluorescens.

AIMS: We aim to determine if Pseudomonas fluorescens is a viable biological control for Erwinia tracheiphila within the insect vector, Acalymma vittatum. METHODS AND RESULTS: Pseudomonas fluorescens secreted fluorescein and inhibited growth of E. tracheiphila in disc diffusion assays. To determine if this antagonism was conserved within the insect vector, we performed in vivo assays by orally injecting beetles with bacterial treatments and fluorescent in situ hybridization to determine bacterial presence within the alimentary canal. CONCLUSIONS: Pseudomonas fluorescens inhibited the growth of E. tracheiphila on a nutrient-limiting medium. In situ experiments demonstrated that P. fluorescens is maintained within the alimentary canal of the beetle for at least 4 days, and co-occurred with E. tracheiphila. When beetles were first presented with Pseudomonas and then challenged with E. tracheiphila, E. tracheiphila was not recovered via FISH after 4 days. These data suggest that P. fluorescens has potential as a biological control agent to limit E. tracheiphila within the insect vector. SIGNIFICANCE AND IMPACT OF THE STUDY: This is a novel approach for controlling E. tracheiphila that has the potential to decrease reliance on insecticides, providing a safer environment for pollinators and growers.

Horticultural Production Systems Influence Ground Beetle (Coleoptera: Carabidae) Distribution and Diversity in Cucurbits.

Commercial cucurbit production typically involves agriculturally intensive practices, with fields prepared using conventional tillage, plasticulture, and chemically based pest management. Conservation-based management options are limited. In this study, we consider two alternative strategies, strip tillage and the use of row covers. We compare their impact on the beneficial carabid beetle (Coleoptera: Carabidae) community in melons and squash, following conventional or organic systems, over two years. Multivariate analysis demonstrated that soil management system (strip tillage versus plasticulture) was the primary variable influencing carabid distribution; row cover was a less important factor. The response to soil management was species dependent. Some dominant species, such as Harpalus pensylvanicus DeGeer, demonstrated no preference for a particular soil treatment. For others, including the tiger beetle, Cicindela punctulata Olivier, and a slug predator, Chlaenius tricolor Dejean, activity-density was higher in strip-tillage production systems. Our analysis suggested that strip-tillage production systems support a richer, more diverse carabid community. These results demonstrate that even within intensive annual horticultural systems, production practices can play a critical role in shaping the beneficial arthropod community, potentially encouraging or limiting ecosystem services.

Venous thromboembolism following elbow, wrist and hand surgery: a review of the literature and prophylaxis guidelines.

This review summarizes the literature regarding venous thromboembolism and examines the prophylaxis guidelines with relation to hand, wrist and elbow surgery. We performed an extensive literature search identifying any relevant case reports or outcome studies. Of 680 potential articles, only four contained data relevant to thrombosis after elbow, wrist and hand surgery. No isolated deep vein thromboses and only nine pulmonary embolisms were identified suggesting that the rate of venous thromboembolism is extremely low following this subset of upper limb surgery. We identified nine guidelines, of which only two (the British Society for Surgery of the Hand and the National Institute of Health and Clinical Excellence) addressed the upper limb. We present a set of recommendations based on the results of this review.

Popliteal vasculature injuries in paediatric trauma patients.

Popliteal-artery injuries in the paediatric-trauma patient are uncommon, difficult to diagnose and with prolonged ischaemia lead to substantial complications. We report three cases of popliteal-vasculature injury in paediatric-trauma patients with diverse mechanisms of injury: blunt trauma, penetrating injury and a Salter-Harris I fracture. We present a range of the significant sequelae that can result from paediatric popliteal-artery injury, both physically and psychologically. It is imperative that clinicians have a high index of suspicion when confronted with paediatric patients with trauma around the knee and that popliteal-vasculature injuries are diagnosed early. If insufficiencies are detected, further imaging should be considered, but surgical exploration should not be delayed in the presence of ischaemia.

Short-acting cocaine and long-acting GBR-12909 both elicit rapid dopamine uptake inhibition following intravenous delivery.

The rewarding effects of cocaine have been reported to occur within seconds of administration. Extensive evidence suggests that these actions involve the ability of cocaine to inhibit the dopamine (DA) transporter. We recently showed that 1.5 mg/kg i.v. cocaine inhibits DA uptake within 5 s. Despite this evidence, there remains a lack of consensus regarding how quickly i.v. cocaine and other DA uptake inhibitors elicit DA uptake inhibition. The current studies sought to better characterize the onset of cocaine-induced DA uptake inhibition and to compare these effects to those obtained with the high-affinity, long-acting DA transporter inhibitor, GBR-12909 (1-(2-bis(4-fluorphenyl)-methoxy)-ethyl)-4-(3-phenyl-propyl)piperazine). Using in vivo fast scan cyclic voltammetry, we showed that i.v. cocaine (0.75, 1.5, and 3.0 mg/kg) significantly inhibited DA uptake in the nucleus accumbens of anesthetized rats within 5 s. DA uptake inhibition peaked at 30 s and returned to baseline levels in approximately 1 h. The effects of cocaine were dose-dependent, with the 3.0 mg/kg dose producing greater uptake inhibition at the early time points and exhibiting a longer latency to return to baseline. Further, the blood-brain barrier impermeant cocaine-methiodide had no effect on DA uptake or peak height, indicating that the generalized peripheral effects of cocaine do not contribute to the CNS alterations measured here. Finally, we show that GBR-12909 (0.75, 1.5, and 3.0 mg/kg) also significantly inhibited DA uptake within 5 s post-injection, although the peak effect and return to baseline were markedly delayed compared with cocaine, particularly at the highest dose. Combined, these observations indicate that the central effects of dopamine uptake inhibitors occur extremely rapidly following i.v. drug delivery.

Receptor-receptor interactions within receptor mosaics. Impact on neuropsychopharmacology.

Future therapies for diseases associated with altered dopaminergic signaling, including Parkinson's disease, schizophrenia and drug addiction or drug dependence may substantially build on the existence of intramembrane receptor-receptor interactions within dopamine receptor containing receptor mosaics (RM; dimeric or high-order receptor oligomers) where it is believed that the dopamine D(2) receptor may operate as the 'hub receptor' within these complexes. The constitutive adenosine A(2A)/dopamine D(2) RM, located in the dorsal striato-pallidal GABA neurons, are of particular interest in view of the demonstrated antagonistic A(2A)/D(2) interaction within these heteromers; an interaction that led to the suggestion and later demonstration that A(2A) antagonists could be used as novel anti-Parkinsonian drugs. Based on the likely existence of A(2A)/D(2)/mGluR5 RM located both extrasynaptically on striato-pallidal GABA neurons and on cortico-striatal glutamate terminals, multiple receptor-receptor interactions within this RM involving synergism between A(2A)/mGluR5 to counteract D(2) signaling, has led to the proposal of using combined mGluR5 and A(2A) antagonists as a future anti-Parkinsonian treatment. Based on the same RM in the ventral striato-pallidal GABA pathways, novel strategies for the treatment of schizophrenia, building on the idea that A(2A) agonists and/or mGluR5 agonists will help reduce the increased dopaminergic signaling associated with this disease, have been suggested. Such treatment may ensure the proper glutamatergic drive from the mediodorsal thalamic nucleus to the prefrontal cortex, one which is believed to be reduced in schizophrenia due to a dominance of D(2)-like signaling in the ventral striatum. Recently, A(2A) receptors also have been shown to counteract the locomotor and sensitizing actions of cocaine and increases in A(2A) receptors have also been observed in the nucleus accumbens after extended cocaine self-administration, probably representing a compensatory up-regulation to counteract the cocaine-induced increases in dopamine D(2) and D(3) signaling. Therefore, A(2A) agonists, through antagonizing D(2) and D(3) signaling within A(2A)/D(2) and A(2A)/D(3) RM heteromers in the nucleus accumbens, may be found useful as a treatment for cocaine dependence. Furthermore, antagonistic cannabinoid CB(1)/D(2) interactions requiring A(2A) receptors have also been discovered and possibly operate in CB(1)/D(2)/A(2A) RM located principally on striatal glutamate terminals but also on some ventral striato-pallidal GABA neurons, thereby opening up a new mechanism for the integration of endocannabinoid, DA and adenosine mediated signals. Thus, A(2A), mGluR5 and/or CB(1) receptors can form integrative units with D(2) receptors within RM displaying different compositions, topography and localization. Also galaninR/5-HT(1A) RM probably participates in the transmission of the ascending 5-hydroxytryptamine neurons, where galanin receptors antagonize 5-HT(1A) recognition and signaling. Subtype specific galanin receptor antagonists may therefore represent novel antidepressant drugs. These results suggest the importance of a complete understanding of the function of these RM with regard to disease. Ultimately receptor-receptor interactions within RM that modify dopaminergic and serotonergic signaling may give new strategies for treatment of a wide range of diseases associated with altered dopaminergic and serotonergic signaling.

Finite-time collapse of N classical fields described by coupled nonlinear Schrödinger equations.

We prove the finite-time collapse of a system of N classical fields, which are described by N coupled nonlinear Schrödinger equations. We derive the conditions under which all of the fields experiences this finite-time collapse. Finally, for two-dimensional systems, we derive constraints on the number of particles associated with each field that are necessary to prevent collapse.

Effects of baclofen on operant performance for food pellets and vegetable shortening after a history of binge-type behavior in non-food deprived rats.

Operant performance of non-food deprived rats (n=8) was assessed under progressive ratio (PR) and concurrent PR-fixed ratio schedules of food pellet and/or vegetable shortening reinforcement. Post operant baselines, rats were matched and divided into 2 groups based upon the schedule of shortening availability: High restriction binge group (H, 1-hr home cage shortening access each week on Monday, Wednesday, and Friday) and Low restriction (L, 1-hr shortening access daily). Chow and water were continuously available; only access to the shortening was restricted. After 8 weeks, operant performance was reassessed. Lever pressing for shortening increased in the H rats for all schedules, but was either unaffected or decreased in the L rats. Pellet responding under the concurrent schedules increased for both groups. The effects of four dosages of (R)-baclofen (0.3-1.8 mg/kg, i.p.) on operant performance were also assessed. For both groups, 1.0 mg/kg baclofen significantly reduced shortening responding relative to saline for all schedules except one, but had no or minimal effect on pellet responding. This suggests a specific effect of baclofen on responding maintained by fat. These results indicate that intermittent episodes of bingeing on fat can increase the reinforcing efficacy of fat and that GABAB receptor activation can attenuate this effect.

Casimir-like force arising from quantum fluctuations in a slowly moving dilute Bose-Einstein condensate.

We calculate a force due to zero-temperature quantum fluctuations on a stationary object in a moving superfluid flow. We model the object by a localized potential varying only in the flow direction and model the flow by a three-dimensional weakly interacting Bose-Einstein condensate at zero temperature. We show that this force exists for any arbitrarily small flow velocity and discuss the implications for the stability of superfluid flow.

The effectiveness of nutrition counselling by Australian General Practitioners.

OBJECTIVE: To determine whether General Practitioners (GPs) consider or provide nutrition counselling for hypertension, diabetes, lipid disorders, ischaemic heart disease (IHD), overweight or obesity, and whether GPs include assessment of the patient's usual diet, assessment of the patient's readiness to change their diet, provision and discussion of nutrition leaflets when counselling. DESIGN: A self-completed questionnaire. SETTING: New South Wales, Australia. SUBJECTS: A total of 399 GPs were surveyed using a division mailing list. METHODS: Questionnaires were distributed in May 2004 with two reminders provided at four-weekly intervals. RESULTS: Of the 399 GPs, 28 no longer practiced at the address while nine were on extended leave. Of the remaining 362, 50% responded, 5% declining to participate, while 163 (45%) completed the questionnaire. GPs were less likely to strongly agree to consider nutrition for hypertension (37%), IHD (61%) and overweight (68%), than diabetes (86%), lipid disorders (82%) and obesity (83%). They were also less likely to strongly agree to provide nutrition for hypertension (22%), IHD (46%) and overweight (45%), than diabetes (79%), lipid disorders (71%) and obesity (68%). In total, 97% of GPs provided some nutrition counselling, with 66% 'often' assessing the patients diet and 59% 'often' assessing the patient's readiness to change their diet. In total, 45% were unaware of stage of change behaviour theory. A total of 85% used nutrition leaflets and 59% 'often' discussed these with their patients. CONCLUSIONS: Determining what are the barriers to nutrition counselling for hypertension, IHD and overweight is urgently needed. Educating GPs on stage of change behaviour theory could increase the efficacy of the counselling provided.

Effects of cocaine self-administration on food-reinforced responding using a discrete trial procedure in rats.

Cocaine addiction has been characterized by a shift from controlled to uncontrolled and compulsive drug use. Using novel self-administration procedures, we attempted to model this transitional phase and characterize the behavioral changes that underlie it. We chose to use food-reinforced responding across the light/dark cycle as an indicator of the degree to which cocaine was disrupting ongoing behavior as a potential measure of dysregulation. Four groups of rats (n=5-6) were given 24-h access to cocaine (1.5 mg/kg/inj) available in 2, 3, 4, or 5 discrete trials/h. All rats were given continuous access to a second lever that resulted in the delivery of a 45 mg food pellet under a fixed ratio 1 schedule. The results showed that under low access conditions (eg 2 discrete trials/h), both food- and cocaine-reinforced responding were diurnally regulated and occurred coincidentally. As access to cocaine was increased, there was a progressive disruption in the diurnal control over both food- and cocaine-maintained responding. High access conditions also produced transient decreases in the total levels of food-reinforced responding. These findings suggest that high access to cocaine under the discrete trial cocaine self-administration procedure produces a transient disruption in the diurnal control over behavior maintained by food and that the level of control (or loss of) may be a useful marker of dysregulation.

Probing states in the Mott insulator regime in the case of coherent bosons trapped in an optical lattice.

We propose a method to probe states in the Mott insulator regime produced from a condensate in an optical lattice. We consider a system in which we create time-dependent number fluctuations in a given site by turning off the atomic interactions and lowering the potential barriers on a nearly pure Mott state to allow the atoms to tunnel between sites. We calculate the expected interference pattern and number fluctuations from such a system and show that one can potentially observe a deviation from a pure Mott state. We also discuss a method in which to detect these number fluctuations using time-of-flight imaging.

Cross-axis adaptation of torsional components in the yaw-axis vestibulo-ocular reflex.

The three pairs of semicircular canals within the labyrinth are not perfectly aligned with the pulling directions of the six extraocular muscles. Therefore, for a given head movement, the vestibulo-ocular reflex (VOR) depends upon central neural mechanisms that couple the canals to the muscles with the appropriate functional gains in order to generate a response that rotates the eye the correct amount and around the correct axis. A consequence of these neural connections is a cross-axis adaptive capability, which can be stimulated experimentally when head rotation is around one axis and visual motion about another. From this visual-vestibular conflict the brain infers that the slow-phase eye movement is rotating around the wrong axis. We explored the capability of human cross-axis adaptation, using a short-term training paradigm, to determine if torsional eye movements could be elicited by yaw (horizontal) head rotation (where torsion is normally inappropriate). We applied yaw sinusoidal head rotation (+/-10 degrees, 0.33 Hz) and measured eye movement responses in the dark, and before and after adaptation. The adaptation paradigm lasted 45-60 min, and consisted of the identical head motion, coupled with a moving visual scene that required one of several types of eye movements: (1) torsion alone (-Roll); (2) horizontal/torsional, head right/CW torsion (Yaw-Roll); (3) horizontal/torsional, head right/CCW torsion (Yaw+Roll); (4) horizontal, vertical, torsional combined (Yaw+Pitch-Roll); and (5) horizontal and vertical together (Yaw+Pitch). The largest and most significant changes in torsional amplitude occurred in the Yaw-Roll and Yaw+Roll conditions. We conclude that short-term, cross-axis adaptation of torsion is possible but constrained by the complexity of the adaptation task: smaller torsional components are produced if more than one cross-coupling component is required. In contrast, vertical cross-axis components can be easily trained to occur with yaw head movements.

Increases in the reinforcing efficacy of cocaine after particular histories of reinforcement.

In humans, the progression to cocaine addiction presumably involves increases in the effectiveness of cocaine to function as a reinforcer. Here we use breakpoints assessed using the progressive ratio (PR) schedule as an index of the efficacy of cocaine as a reinforcer. To date, no preclinical studies have demonstrated an increase in breakpoint as a consequence of self-administration history. In the current study, baseline performances on fixed ratio (FR) and PR schedules were determined. Rats were then exposed to different self-administration histories and deprivation periods, and responding under FR and PR schedules was reassessed. Exposure to a discrete-trials procedure (access to cocaine 4 times/hour, 24 hours/day; DT4) for 7 or 10 days, coupled with a deprivation period of 7 days, resulted in increases in breakpoint on a PR schedule, with no change in FR1 schedule responding. Exposure to an FR1 schedule for 72 consecutive hours followed by 7 days of deprivation, failed to change breakpoints, but increased rates of intake assessed with an FR1 schedule. Thus, the type of self-administration history and the length of deprivation experienced contribute to changes in the reinforcing efficacy of cocaine as measured by a PR schedule.

Cytomegalovirus infection in a pig in South Africa.

An 8-week-old piglet with dyspnoea, bilateral mucopurulent nasal discharge and mouth breathing was euthanased and a necropsy was performed. Apart from histological evidence of diffuse rhinitis, large intranuclear inclusion bodies, pathognomonic forporcine cytomegalovirus infection, were detected within mucous glands on the nasal turbinates. This is the first such case to be diagnosed in South Africa.

Biomarkers, yesterday, today and tomorrow: the basis for health claims.

The development of useful and accurate biomarkers for predicting outcomes of food based interventions is becoming more and more important, given the emphasis being placed on ingredients in foods contributing to disease risk reduction and optimal health promotion. With the human genome now laid bare, opportunities abound to barcode individuals with their risk profiles. The massive increase in DNA sequence information together with the development of new technologies such as genomics, proteomics and bioinformatics, has resulted in a much greater capacity to determine individual risk profiles. Screening for biomarkers at the gene or protein expression level using microarray technology has the potential to identify new biomarkers for disease diagnosis. Whether these techniques will enable a better understanding of food-gene interactions to permit health claims rather than better therapeutic treatment (at high economic cost) remains to be demonstrated.

Cocaine-responsive gene expression changes in rat hippocampus.

Chronic cocaine use is known to elicit changes in the pattern of gene expression within the brain. The hippocampus plays a critical role in learning and memory and may also play a role in mediating behaviors associated with cocaine abuse. To profile the gene expression response of the hippocampus to chronic cocaine treatment, cDNA hybridization arrays were used to illuminate cocaine-regulated genes in rats treated non-contingently with a binge model of cocaine (45 mg/kg/day, i.p.) for 14 days. Validation of mRNA changes illuminated by hybridization array analysis was accomplished by measuring immunoreactive protein (via specific immunoblots). The induction of protein kinase Calpha, potassium channel 1.1, and metabotropic glutamate receptor 5 seen by hybridization arrays was confirmed at the level of protein. Immunoblot screening of previously described cocaine-responsive genes demonstrated increased levels of protein tyrosine kinase 2, beta-catenin, and protein kinase Cepsilon. While some of these changes exist in previously described cocaine-responsive models, others are novel to any model of cocaine use. The inductions of potassium channel 1.1, protein tyrosine kinase 2 and metabotropic glutamate receptor 5 are novel findings to hippocampal cocaine-responsive gene expression. These proteins have been shown to subserve learning and memory and/or long-term potentiation functions within the hippocampus. Additionally, these genes are known to interact with one another, forming a more complex pattern of gene expression changes. The findings suggest altered expression of genes with a number of different functions in the rat hippocampus after a 'binge' style of non-contingent cocaine administration. These changes in gene expression may play roles in neuronal plasticity and the behavioral phenomena associated with cocaine abuse.

Macronutrients and health-steps to ameliorating the nutrition transition trap.

Countries that have made the health transition from a communicable disease base to a non-communicable disease base find themselves gripped in an epidemic of wealth created diseases mediated by altered macronutrient intakes, energy intakes and reduction in physical activity. Avoiding the negative impact of the nutrition transition while accepting the positive aspects of the wealth transition can best be achieved by focussing on publicising the benefits of a low fat diet in the context of an active lifestyle. How this is achieved should reflect ecologically sound food production appropriate to national needs. Countries that achieve this will be in the best position to capitalize on the reduction in communicable disease rates without causing a rise in non-communicable disease rates.