Serous borderline tumor of the ovary with isolated cardiophrenic lymph node spread at diagnosis.

•Serous borderline tumor outside of the peritoneal cavity is rare.•Involvement of cardiophrenic lymph nodes with serous borderline tumor can occur.•Preoperative imaging may aid surgical planning even in serous borderline tumor cases.•Sequencing can help confirm a diagnosis of serous borderline tumor at distant sites.

Arsenic exposure and type 2 diabetes: results from the 2007-2009 Canadian Health Measures Survey.

INTRODUCTION: Inorganic arsenic and its metabolites are considered dangerous to human health. Although several studies have reported associations between low-level arsenic exposure and diabetes mellitus in the United States and Mexico, this association has not been studied in the Canadian population. We evaluated the association between arsenic exposure, as measured by total arsenic concentration in urine, and the prevalence of type 2 diabetes (T2D) in 3151 adult participants in Cycle 1 (2007-2009) of the Canadian Health Measures Survey (CHMS). METHODS: All participants were tested to determine blood glucose and glycated hemoglobin. Urine analysis was also performed to measure total arsenic. In addition, participants answered a detailed questionnaire about their lifestyle and medical history. We assessed the association between urinary arsenic levels and T2D and prediabetes using multivariate logistic regression while adjusting for potential confounders. RESULTS: Total urinary arsenic concentration was positively associated with the prevalence of T2D and prediabetes: adjusted odds ratios were 1.81 (95% CI: 1.12-2.95) and 2.04 (95% CI: 1.03-4.05), respectively, when comparing the highest (fourth) urinary arsenic concentration quartile with the lowest (first) quartile. Total urinary arsenic was also associated with glycated hemoglobin levels in people with untreated diabetes. CONCLUSION: We found significant associations between arsenic exposure and the prevalence of T2D and prediabetes in the Canadian population. Causal inference is limited due to the cross-sectional design of the study and the absence of long-term exposure assessment.

TITRE: Exposition à l'arsenic et diabète de type 2 : résultats de l'Enquête canadienne sur les mesures de la santé de 2007 à 2009. INTRODUCTION: L'arsenic inorganique et ses métabolites sont considérés comme dangereux pour la santé humaine. Même si plusieurs études ont indiqué des associations entre une faible exposition à l'arsenic et le diabète sucré aux États-Unis et au Mexique, ces associations n'ont pas été étudiées chez les Canadiens. Nous avons analysé l'association entre l'exposition à l'arsenic, mesurée par la concentration d'arsenic total dans l'urine, et la prévalence du diabète de type 2 (DT2) chez 3 151 participants adultes du cycle 1 (2007 à 2009) de l'Enquête canadienne sur les mesures de la santé (ECMS). MÉTHODOLOGIE: La glycémie et l'hémoglobine glycosylée ont été mesurées chez les participants. L'arsenic total a été dosé par une analyse d'urine. De plus, les participants ont répondu à un questionnaire détaillé sur leurs habitudes de vie et leurs antécédents médicaux. Nous avons analysé l'association de la concentration urinaire d'arsenic avec le DT2 et le prédiabète à l'aide d'une régression logistique multivariée ajustée pour les facteurs de confusion potentiels. RÉSULTATS: La concentration urinaire d'arsenic total était positivement associée à la prévalence de DT2 et de prédiabète : les rapports de cotes ajustés étaient respectivement de 1,81 (IC à 95% : 1,12 à 2,95) et de 2,04 (IC à 95% : 1,03 à 4,05) lorsqu'on comparait les concentrations urinaires d'arsenic les plus élevées (quatrième quartile) aux plus faibles (premier quartile). L'arsenic total urinaire était également associé au taux d'hémoglobine glycosylée chez les diabétiques non traités. CONCLUSION: Nous avons noté des associations significatives entre l'exposition à l'arsenic et la prévalence de DT2 et de prédiabète dans la population canadienne. L'inférence causale est limitée car il s'agit d'une étude transversale exempte d'évaluation de l'exposition à long terme.

A new SEMA7A variant found in Native Americans with alloantibody.

BACKGROUND AND OBJECTIVES: John Milton Hagen (JMH) antigens are carried by Semaphorin 7A that plays important roles in the nervous system and the immune responses. Its role on the erythrocytes is unclear. Over the years, few samples were referred to our Immunohaematology Reference Laboratory to elucidate their JMH status. MATERIALS AND METHODS: Seven blood samples with antibodies compatible with JMH1-negative red cells were studied at the molecular level to identify polymorphisms and explain the JMH diversity observed. Four samples were of Native American background and three were Caucasians. Molecular analyses of the SEMA7A were undertaken, and soluble form of recombinant Sema7A proteins was produced to characterize the antibodies. RESULTS: Sequencing of the cDNA showed a polymorphism in SEMA7A exon 9 at position 1040 (G>T) in the four Native American samples. Caucasians had a normal sequence. This polymorphism precludes a change at position 347 where an Arg is replaced by a Leu. Plasma was assayed in ELISA on wild-type Sema7AArg347 and variant Sema7ALeu347 proteins. Results clearly indicated a specific recognition of the antibody produced by the Native Americans for the wild-type Sema7AArg347 protein and not the variant one. CONCLUSION: A new SEMA7A variant was identified in this study. The antibody present in the Native American plasma samples should be considered as an alloantibody because it recognizes the wild-type protein.

[Genotyping of 21,000 blood donors in Quebec and RHD analysis]. / Génotypage de 21 000 donneurs de sang au Québec et analyse du RHD.

STUDY GOAL: A repeat blood donor genotyping project was launched by Héma-Québec in October 2007. The objective was to screen 21,000 samples for 22 polymorphisms for red blood cell and platelet blood groups to build a database to easily find compatible donors. MATERIALS AND METHODS: Donors who have donated at least three times during the last year were selected. A drop of blood was spotted on FTA paper and sent to the Pharmacogenomic Centre at the Montreal Heart Institute for analysis. All genotype results were compared to the known phenotype. In parallel, the RHD gene of D negative blood donors was examined. RESULTS: Less than two years were necessary to complete the database. The genotype/phenotype concordance was 99.6% with only 165 discrepancies observed and further analysed. More than 55% of these discrepancies confirmed the initial genotype. The RHD study done on D negative samples found 13 donors positive for a variant RHD gene. Four were RHD*Ψ positive, while the other nine presented variant polymorphisms precluding a reduced expression of the D antigen. CONCLUSION: Thanks to this project, Héma-Québec is able to answer increasing demands for compatible blood more rapidly. The organisation has also demonstrated the security of its D negative inventory.

Asthma, airway inflammation and epithelial damage in swimmers and cold-air athletes.

Endurance athletes show an increased prevalence of airway hyperresponsiveness. The aim of the present study was to evaluate the long-term effects of training on airway responsiveness, inflammation and epithelial damage in swimmers and cold-air athletes. In total, 64 elite athletes (32 swimmers and 32 cold-air athletes), 32 mild asthmatic subjects and 32 healthy controls underwent allergy skin prick testing, methacholine challenge and induced sputum analysis. Overall, 69% of swimmers and 28% of cold-air athletes had airway hyperresponsiveness. Sputum neutrophil count correlated with the number of training hours per week in both swimmers and cold-air athletes. Eosinophil counts were higher in swimmers than in healthy subjects, although they were lower than in asthmatic subjects, and correlated with airway hyperresponsiveness in swimmers only. The eosinophil count in cold-air athletes was similar to that in healthy subjects. Bronchial epithelial cell count was not correlated with airway hyperresponsiveness but was significantly increased in swimmers, compared with healthy and asthmatic controls. In conclusion, the present authors observed significant airway inflammation only in competitive athletes with airway hyperresponsiveness. However, the majority of elite athletes showed evidence of bronchial epithelial damage that could possibly contribute to the development of airway hyperresponsiveness.

Influence of smoking on airway inflammation and remodelling in asthma.

BACKGROUND: Although exposure to tobacco smoke has been associated with increased morbidity and mortality, cigarette smoking is still common in the asthmatic population. Induced sputum neutrophilia has been observed in asthmatic smokers, but the effects of regular smoking on their bronchial mucosa morphology remain to be defined. This study documents the inflammatory and remodelling features in bronchial biopsies of smoking compared with non-smoking asthmatics. METHODS: We analysed bronchial biopsies from 24 steroid-naïve young subjects with mild asthma: 12 non-smoking and 12 currently smoking subjects. In addition to airway morphology assessment, inflammation and remodelling were analysed by immunohistochemistry using antibodies against CD3, CD68, major basic protein, neutrophil elastase, and tryptase. Expression of the cytokines IL-4, IL-5, IL-8, IFN-gamma, transforming growth factor-beta, and TNF was determined by in situ hybridization. RESULTS: Compared with non-smoking asthmatic subjects, smoking asthmatics' bronchial mucosa showed squamous cell metaplasia, in addition to increased expression of subepithelial neutrophil elastase, IFN-gamma, and intraepithelial IL-8. CONCLUSIONS: Smoking status modifies morphological and inflammatory processes in young subjects with mild asthma. The changes may possibly affect asthma treatment responses and clinical outcomes.

Comparison between personal exposure to 60 Hz magnetic fields and stationary home measurements for people living near and away from a 735 kV power line.

This study compares stationary home measurements with a personal exposure monitor of 60 Hz magnetic fields in a group of 18 people living near a 735 kV line and 17 people living far away from the line. Most of them were white collar workers who worked during the day. They wore a personal Positron meter for 24 h, while a similar meter was left in their home, away from any appliances. For people living away from the line, the impact of residential activities appeared rather weak when considering the average intensity of the field during the awake period (at home): 0.22 microT for personal exposure versus 0.18 microT for stationary measurements (P = 0.09). The impact of residential activities during the awake period was more detectable when using the percentage of time with exposure above 0.78 microT: median 0.4 for personal vs. 0.0 for stationary measurements (P =.01). The temporal variability of the exposure during the awake period was also significantly higher for personal exposure than for stationary measurements. For people living near the line, the intensity of the magnetic field from the line dominated the personal exposure when considering the mean of measurements and the percentage of time above a threshold. However, the temporal variability was greater for the personal exposure during the awake period. Although limited due to its small sample size, the present study seems to demonstrate the usefulness of considering different indexes of exposure when assessing residential exposure to 60 Hz magnetic fields.

Resurfacing of the donor defect after wrap-around toe transfer with a free lateral forearm flap.

In thumb reconstruction, the wrap-around free flap has many advantages; however, delayed wound healing, pain, and skin ulcerations at the donor site can be a problem. In 5 patients, a free lateral forearm fasciocutaneous flap was successfully used for immediate resurfacing of the donor defect of the big toe during wrap-around procedures. This flap was selected after preliminary anatomic studies that showed that it could be safely raised if based on the anterior terminal division of the posterior radial collateral artery. The average follow-up period was 2 years. The time required for healing of the great-toe defect was less than 1 month. All patients were satisfied with the outcome of the procedure. The skin of this flap is very pliable and thin, and the subcutaneous tissue is about half the thickness of that of the lateral arm flap. This technique is especially indicated for closure of moderate to big skin defects at the great-toe level, whenever a larger than usual amount of skin is required, during wrap-around procedures for thumb reconstruction.

Ecotoxicity hazard assessment of styrene.

The ecotoxicity of styrene was evaluated in acute toxicity studies of fathead minnows (Pimephales promelas), daphnids (Daphnia magna), amphipods (Hyalella azteca), and freshwater green algae (Selenastrum capricornutum), and a subacute toxicity study of earthworms (Eisenia fostida). Stable exposure levels were maintained in the studies with fathead minnows, daphnids, and amphipods using sealed, flowthrough, serial dilution systems and test vessels. The algae were evaluated in a sealed, static system. The earthworms were exposed in artificial soil which was renewed after 7 days. Styrene concentrations in water and soil were analyzed by gas chromatography with flame ionization detection following extraction into hexane. Test results are based on measured concentrations. Styrene was moderately toxic to fathead minnows, daphnids, and amphipods: fathead minnow: LC50 (96 hr), 10 mg/liter, and NOEC, 4.0 mg/liter; daphnids: EC50 (48 hr), 4.7 mg/liter, and NOEC, 1.9 mg/liter; amphipods: LC50 (96 hr), 9.5 mg/liter, and NOEC, 4.1 mg/liter. Styrene was highly toxic to green algae: EC50 (96 hr), 0.72 mg/liter, and NOEC, 0.063 mg/liter; these effects were found to be algistatic rather than algicidal. Styrene was slightly toxic to earthworms: LC50 (14 days), 120 mg/kg, and NOEC, 44 mg/kg. There was no indication of a concern for chronic toxicity based on these studies. Styrene's potential impact on aquatic and soil environments is significantly mitigated by its volatility and biodegradability.

The lateral forearm flap: an anatomic study.

The anatomy of the lateral forearm flap has been studied in 12 fresh cadaver arms with methylene blue and latex injections and arteriography. The posterior radial collateral artery was found to divide constantly into two terminal branches, an anterior and a posterior division. The anterior division is the nutrient vessel of the flap. This artery extends significantly beyond the lateral epicondyle of the elbow into the lateral aspect of the forearm (range 13 to 18 cm, average 15 cm). This allows raising a fasciocutaneous flap in the proximal forearm with a much longer vascular pedicle than the classic lateral arm flap. Other advantages include very thin skin and subcutaneous tissue and less sensory deficit at the donor site. Based on these results, this newly designed lateral forearm flap has been used in 13 clinical cases. Its main indications are whenever soft, thin, pliable skin is needed for small to moderate-sized defects.

Prevention of neuroma in elective digital amputations by utilization of neurovascular island flap.

Following hand surgery, painful neuromas may impair the quality of the functional result. In planned, elective digital amputation, neuroma formation is quasi-unavoidable because the nerve is cut. Several techniques have been proposed to prevent the formation of neuroma but, in our opinion, the only logical way to avoid it, is not to cut the nerve. For this purpose, we proposed, in cases of planned, elective digital amputation, an intervention inspired by the technique described by Littler in 1956. This technique consists of isolating as an island, the pulp of the amputated finger while preserving nerve continuity of both collateral pedicles. Once the amputation is completed, in cases of distal amputation, the pulp flap is used to cover the proximal stump and, in cases of ray amputation, the nerve loop is buried after its deepithelialization between the adjacent metacarpals. Since 1990, this technique has been used for nine-planned, elective amputations in eight patients. Postoperatively, no patient has developed painful neuroma except one patient who had a painful finger preoperatively and in whom the symptoms remained unchanged postoperatively. This simple technique must be part of the therapeutic armamentarium of planned, elective digital amputations in cases with intact collateral nerves.

Electric and magnetic field exposures for people living near a 735-kilovolt power line.

The purpose of this study was to assess the effect of a 735-kV transmission line on the electric and magnetic field exposures of people living at the edge of the line's right of way. Exposure of 18 adults, mostly white-collar workers, living in different bungalows located 190-240 feet from the line (exposed subjects) was compared to that of 17 adults living in similar residences far away from any transmission line. Each subject carried a Positron meter for 24 hr during 1 workday, which measured 60-Hz electric and magnetic fields every minute. All measurements were carried out in parallel for exposed and unexposed subjects during the same weeks between September and December. During measurements the average loading on the line varied between 600 and 1100 A. The average magnetic field intensity while at home was 4.4 times higher among exposed subjects than unexposed (7.1 versus 1.6 mG, p = 0.0001) and 6.2 times higher when considering only the sleeping period (6.8 versus 1.1 mG, p = 0.0001). Based on the 24-hr measurement, average magnetic field exposure was three times higher among the exposed. Electric field intensity was also higher among the exposed while at home (26.3 versus 14.0 V/m, p = 0.03). Magnetic field intensity among the exposed was positively correlated with the loading on the line (r = 0.8, p = 0.001). Percentage of time above a magnetic field threshold (2 mG or 7.8 mG) was a good indicator to distinguish the two types of exposure.(ABSTRACT TRUNCATED AT 250 WORDS)

Behavioral correlates of self-stimulation, flight and ambivalence.

Behavioral phenomena consisting of approach (self-stimulation, SS), flight and ambivalence (approach-flight) elicited by intracranial stimulation (ICS) along the neuraxis from the forebrain to the hindbrain were filmed and analyzed. The main findings were: (1) approach, flight and ambivalence could be obtained from all levels of the brain; (2) no single fixed behavioral pattern was common to approach or ambivalence; (3) there were instead different patterns which varied according to the area but some of the individual features of these patterns were at times common to several brain areas; (4) exploration with sniffing was found to be the most frequent behavior accompanying both approach and ambivalence. For SS, exploration was organized in the following topographical manner: nonsystematically at the level of the dorsal pons, diffused at the raphé, scattered at the level of the ventromedial mesencephalon (VMT), and focalized at the level of the lateral hypothalamus; (5) the highest intensities of SS, flight and ambivalence were found in the more caudal areas, namely the VMT for approach, the posterior mesencephalic reticular formation for ambivalence and the ventral region of the reticularis pontis caudalis (RPC) for flight; (6) in approach behavior for SS, when the point of stimulation was changed from the medio-frontal cortex to the posterior hypothalamus and VMT, an orderly change from depression to excitation of locomotor activity appeared. However, in the case of the locus coeruleus (LC) and adjacent dorsal tegmentum, SS by bursts was correlated with either intense motor activity or transitory periods of adynamia followed eventually by progressive ambivalence after bursts of SS; (7) approach and ambivalence elicited from areas known or believed to be involved in sleep regulation (midbrain raphé, LC and proximal dorsal pontine areas) were accompanied by what at first appeared as disruptive behaviors; but other complex behaviors were noted which suggest that during alertness, these areas may be involved in behaviors that are phylogenetically important for the development of motor and cognitive functions and most likely also in the behavioral manifestations of major psychiatric illnesses.

The effect of lithium on urinary MHPG in unipolar and bipolar depressed patients.

Twenty-four hour urinary excretion of 3-methoxy-4-hydroxphaeylglycol (MHPG), the metabolite thought best to reflect brain norepinephrine metabolism, was studied longitudinally in ten depressed patients before and during the acute and chronic phases of lithium treatment. Five of the patients were identified as bipolar I (prior history of mania), 3 as bipolar II (history of hypomania) and 2 as unipolar (history of depression). During acute lithium administration (first week) there was no consistent pattern of change in MHPG. Comparing the predrug period with the third and fourth week of treatment, all of the responders showed an increase in MHPG, while the non-responders showed no change or a decrease. It is concluded that the change in clinical state is the most important variable contributing to MHPG changes in these patients. There was a tendency for the pretreatment MHPG excretion to be low in the patients who went on to show a clear-cut antidepressant response to lithium compared to those who were unequivocal non-responders. The predrug MHPG for the bipolar patients (prior history of mania) was significantly lower than the unipolar patients, a difference which apparently contributes to the lower MHPG in the lithium responders, all of whom were in the bipolar group.