Standardization of radiograph readings during bowel management week.

INTRODUCTION: During "bowel management week," abdominal radiographs are used to monitor the amount and location of stool. A radiologist familiar with the treatment plan can provide an improved interpretation. The goal of this paper is to standardize the radiological reports during a bowel management week. METHODS: We saw 744 patients during bowel management week from May 2016 until March 2023. Diagnosis included: anorectal malformation (397), idiopathic constipation (180), Hirschsprung disease (89), and spina bifida (78). Laxatives were the treatment for 51% of patients, and 49% received enemas. Characteristic radiographs were selected for each treatment group for a proposed reading standardization. RESULTS: When the stool is visualized, it is crucial to report its location. Having a contrast enema helps with the correct interpretation of the colonic anatomy. It is also essential to always compare the amount of stool with the radiograph from the previous day to determine if there is an increase or decrease in stool. Examples of radiographs are shown to guide the use of the preferred proposed terminology. CONCLUSION: Providing information regarding which treatment modality the patient is receiving and stating that a patient is on a bowel management week treatment is crucial for the radiologist to provide adequate interpretation. The radiologist must be familiar with the treatment goals and purpose of the daily radiograph.

Investigation of Brain Iron in Niemann-Pick Type C: A 7T Quantitative Susceptibility Mapping Study.

BACKGROUND AND PURPOSE: While brain iron dysregulation has been observed in several neurodegenerative disorders, its association with the progressive neurodegeneration in Niemann-Pick type C is unknown. Systemic iron abnormalities have been reported in patients with Niemann-Pick type C and in animal models of Niemann-Pick type C. In this study, we examined brain iron using quantitative susceptibility mapping MR imaging in individuals with Niemann-Pick type C compared with healthy controls. MATERIALS AND METHODS: A cohort of 10 patients with adolescent- and adult-onset Niemann-Pick type C and 14 age- and sex-matched healthy controls underwent 7T brain MR imaging with T1 and quantitative susceptibility mapping acquisitions. A probing whole-brain voxelwise comparison of quantitative susceptibility mapping between groups was conducted. Mean quantitative susceptibility mapping in the ROIs (thalamus, hippocampus, putamen, caudate nucleus, and globus pallidus) was further compared. The correlations between regional volume, quantitative susceptibility mapping values, and clinical features, which included disease severity on the Iturriaga scale, cognitive function, and the Social and Occupational Functioning Assessment Scale, were explored as secondary analyses. RESULTS: We observed lower volume in the thalamus and voxel clusters of higher quantitative susceptibility mapping in the pulvinar nuclei bilaterally in patients with Niemann-Pick type C compared with the control group. In patients with Niemann-Pick type C, higher quantitative susceptibility mapping in the pulvinar nucleus clusters correlated with lower volume of the thalamus on both sides. Moreover, higher quantitative susceptibility mapping in the right pulvinar cluster was associated with greater disease severity. CONCLUSIONS: Our findings suggest iron deposition in the pulvinar nucleus in Niemann-Pick type C disease, which is associated with thalamic atrophy and disease severity. This preliminary evidence supports the link between iron and neurodegeneration in Niemann-Pick type C, in line with existing literature on other neurodegenerative disorders.

Giant electron-phonon coupling of the breathing plane oxygen phonons in the dynamic stripe phase of [Formula: see text].

Doped antiferromagnets host a vast array of physical properties and learning how to control them is one of the biggest challenges of condensed matter physics. [Formula: see text] (LSNO) is a classic example of such a material. At low temperatures holes introduced via substitution of La by Sr segregate into lines to form boundaries between magnetically ordered domains in the form of stripes. The stripes become dynamic at high temperatures, but LSNO remains insulating presumably because an interplay between magnetic correlations and electron-phonon coupling localizes charge carriers. Magnetic degrees of freedom have been extensively investigated in this system, but phonons are almost completely unexplored. We searched for electron-phonon anomalies in LSNO by inelastic neutron scattering. Giant renormalization of plane Ni-O bond-stretching modes that modulate the volume around Ni appears on entering the dynamic charge stripe phase. Other phonons are a lot less sensitive to stripe melting. Dramatic overdamping of the breathing modes indicates that dynamic stripe phase may host small polarons. We argue that this feature sets electron-phonon coupling in nickelates apart from that in cuprates where breathing phonons are not overdamped and point out remarkable similarities with the colossal magnetoresistance manganites.

Nematic Correlation Length in Iron-Based Superconductors Probed by Inelastic X-Ray Scattering.

Nematicity is ubiquitous in electronic phases of high-T_{c} superconductors, particularly in the Fe-based systems. We used inelastic x-ray scattering to extract the temperature-dependent nematic correlation length ξ from the anomalous softening of acoustic phonon modes in FeSe, underdoped Ba(Fe_{0.97}Co_{0.03})_{2}As_{2}, and optimally doped Ba(Fe_{0.94}Co_{0.06})_{2}As_{2}. In all cases, we find that ξ is well described by a power law (T-T_{0})^{-1/2} extending over a wide temperature range. Combined with the previously reported Curie-Weiss behavior of the nematic susceptibility, these results point to the mean-field character of the nematic transition, which we attribute to a sizable nematoelastic coupling that is likely detrimental to superconductivity.

First case of a dog infected with Aspergillus (Phialosimplex) caninus in Australasia.

Case history: A 2-year-old Rottweiler dog from Perth (WA, Australia) was referred for assessment of a chronic productive cough and weight loss.Clinical findings: Severely enlarged bilateral superficial cervical lymph nodes and severely enlarged abdominal organs were present. The body condition score was poor and there was moderate muscle wasting. Thoracic and abdominal computed tomography images revealed severe diffuse enlargement of thoracic and abdominal lymph nodes, hepatomegaly and diffuse splenomegaly. A diffuse bronchial pattern with severe multifocal saccular bronchiectasis was identified in the lungs.Diagnostic findings: Fungal organisms were seen within macrophages on cytological preparations and on histopathological sections of biopsies of the superficial cervical lymph node. Macrophages contained intracytoplasmic, non-filamentous round-to-ovoid organisms, which varied in size from 5-30 µm in diameter with variable morphology. Budding was not observed, and no hyphae were present. Fungal culture of lymph node tissue resulted in growth of Aspergillus (Phialosimplex) caninus which was confirmed by amplification and sequencing of a segment of the 16S-23S rRNA internal transcribed spacer. Concurrent bacterial bronchitis was diagnosed on culture of broncho-alveolar fluid.Diagnosis: Disseminated aspergillosis caused by Aspergillus caninus.Clinical relevance: This is believed to be the first report of infection caused by A. caninus in a dog in Australasia. The dog was treated with itraconazole for 7 months and was still alive 7 months after the start of treatment.

Assessing the pathogenicity of RYR1 variants in malignant hyperthermia.

BACKGROUND: . Missense variants in the ryanodine receptor 1 gene ( RYR1 ) are associated with malignant hyperthermia but only a minority of these have met the criteria for use in predictive DNA diagnosis. We examined the utility of a simplified method of segregation analysis and a functional assay for determining the pathogenicity of recurrent RYR1 variants associated with malignant hyperthermia. METHODS: . We identified previously uncharacterised RYR1 variants found in four or more malignant hyperthermia families and conducted simplified segregation analyses. An efficient cloning and mutagenesis strategy was used to express ryanodine receptor protein containing one of six RYR1 variants in HEK293 cells. Caffeine-induced calcium release, measured using a fluorescent calcium indicator, was compared in cells expressing each variant to that in cells expressing wild type ryanodine receptor protein. RESULTS.: We identified 43 malignant hyperthermia families carrying one of the six RYR1 variants. There was segregation of genotype with the malignant hyperthermia susceptibility phenotype in families carrying the p.E3104K and p.D3986E variants, but the number of informative meioses limited the statistical significance of the associations. HEK293 functional assays demonstrated an increased sensitivity of RyR1 channels containing the p.R2336H, p.R2355W, p.E3104K, p.G3990V and p.V4849I compared with wild type, but cells expressing p.D3986E had a similar caffeine sensitivity to cells expressing wild type RyR1. CONCLUSIONS: . Segregation analysis is of limited value in assessing pathogenicity of RYR1 variants in malignant hyperthermia. Functional analyses in HEK293 cells provided evidence to support the use of p.R2336H, p.R2355W, p.E3104K, p.G3990V and p.V4849I for diagnostic purposes but not p.D3986E.

Cavitation clusters in lipid systems - surface effects, local heating and streamer formation.

Cavitation clusters and streamers are characterised in lipid materials (specifically sunflower oil) and compared to water systems. The lipid systems, which are important in food processing, are studied with high-speed camera imaging, laser scattering and pressure measurements. In these oils, clusters formed at an aged (roughened) tip of the sound source (a piston like emitter, PLE) are shown to collapse with varied periodicity in relation to the drive amplitude employed. A distinct streamer (an area of increased flow emanating from the cavitation cluster) is seen in the lipid media which is collimated directly away from the tip of the PLE source whereas in water the cavitation plume is visually less distinct. The velocity of bubbles in the lipid streamer near the cluster on the order of 10 m s-1. Local heating effects, within the streamer, are detected using a dual thermocouple measurement at extended distances. Viscosity, temperature and the outgassing within the oils are suggested to play a key role in the streamer formation in these systems.

Reduced Cortical Activity Impairs Development and Plasticity after Neonatal Hypoxia Ischemia.

Survivors of preterm birth are at high risk of pervasive cognitive and learning impairments, suggesting disrupted early brain development. The limits of viability for preterm birth encompass the third trimester of pregnancy, a "precritical period" of activity-dependent development characterized by the onset of spontaneous and evoked patterned electrical activity that drives neuronal maturation and formation of cortical circuits. Reduced background activity on electroencephalogram (EEG) is a sensitive marker of brain injury in human preterm infants that predicts poor neurodevelopmental outcome. We studied a rodent model of very early hypoxic-ischemic brain injury to investigate effects of injury on both general background and specific patterns of cortical activity measured with EEG. EEG background activity is depressed transiently after moderate hypoxia-ischemia with associated loss of spindle bursts. Depressed activity, in turn, is associated with delayed expression of glutamate receptor subunits and transporters. Cortical pyramidal neurons show reduced dendrite development and spine formation. Complementing previous observations in this model of impaired visual cortical plasticity, we find reduced somatosensory whisker barrel plasticity. Finally, EEG recordings from human premature newborns with brain injury demonstrate similar depressed background activity and loss of bursts in the spindle frequency band. Together, these findings suggest that abnormal development after early brain injury may result in part from disruption of specific forms of brain activity necessary for activity-dependent circuit development. SIGNIFICANCE STATEMENT: Preterm birth and term birth asphyxia result in brain injury from inadequate oxygen delivery and constitute a major and growing worldwide health problem. Poor outcomes are noted in a majority of very premature (<25 weeks gestation) newborns, resulting in death or life-long morbidity with motor, sensory, learning, behavioral, and language disabilities that limit academic achievement and well-being. Limited progress has been made to develop therapies that improve neurologic outcomes. The overall objective of this study is to understand the effect of early brain injury on activity-dependent brain development and cortical plasticity to develop new treatments that will optimize repair and recovery after brain injury.

A rare case of vulval pilonidal sinus: incidental diagnosis.

A 63-year-old woman presented with a 4-week history of vulval bleeding. On examination, an 8 mm fleshy irregular vascular lesion was present on the vulva in the periclitoreal area. This vulval lesion was treated by surgical excision. Histological analysis showed irregular pieces of skin partly covered by hyperplastic squamous epithelium. There were areas of fistulous-like endophytic proliferations lined by hyperplastic squamous epithelial cells. The intervening stroma showed granulation tissue with severe active chronic inflammation. At least five hair follicle shafts surrounded by foreign body type giant cells were also identified within the inflamed area. There was no evidence of dysplasia or malignancy. This chronically inflamed fistulous tract together with hair shafts within the wall of the tract were diagnostic of a pilonidal sinus of the vulva. This case report summarises the importance of diagnosing pilonidal sinus at an unusual location.

Asthma phenotypes and lung function up to 16 years of age-the BAMSE cohort.

BACKGROUND: Asthma is a disease affecting many locations throughout the airway. Most studies have used spirometry as the primary assessment of airway obstruction, a method that may be less sensitive in regard to peripheral airway obstruction. The aim of this study was to elucidate the associations between asthma phenotypes based on age of onset and duration of symptoms, and (i) spirometry and (ii) small airway involvement measured by impulse oscillometry (IOS) in adolescence. METHODS: Children and adolescents taking part in BAMSE, a prospective birth cohort study, performed spirometry at 8 and 16 years and IOS at 16 years of age. Based on data collected in questionnaires, children were categorized into the following groups: 'never asthma', 'early transient asthma', 'early persistent asthma', and 'late onset asthma'. RESULTS: Compared with the never asthma group, all asthma groups were associated with lower FEV1 at 16 years of age (early transient-119 ml, 95% confidence interval -204 to -34; early persistent-410 ml, 95%CI -533; -287; and late onset-148 ml, 95%CI -237; -58). Between 8 and 16 years, significantly less increase in FEV1 was observed in the early persistent and late onset groups. The small airway index 'R5-20 ' was significantly associated with active asthma at 16 years, but not transient asthma. CONCLUSIONS: All asthma phenotypes studied were negatively associated with FEV1 in adolescence. IOS measurements indicated that active asthma could be associated with small airway impairments. These results provide new insights into the physiology underlying wheezing phenotypes based on age of onset and duration of disease.

First bacteraemic human infection with Escherichia albertii.

The facultative anaerobic Gram-negative species Escherichia albertii has been isolated from human faeces in gastrointestinal infection and from a range of wild bird species. Here we report the first case of a febrile infection associated with E. albertii bacteraemia in a 76-year-old woman with gastric dysplasia.

Systemic, renal, and colonic effects of intravenous and enteral rehydration in horses.

BACKGROUND: Intravenous (IV) and intragastric (IG) administration of fluid therapy are commonly used in equine practice, but there are limited data on the systemic, renal, and enteric effects. HYPOTHESIS: IV fluid administration will increase intestinal and fecal hydration in a rate-dependent manner after hypertonic dehydration, but will be associated with significant urinary water and electrolyte loss. Equivalent volumes of IG plain water will result in comparatively greater intestinal hydration with less renal loss. ANIMALS: Six Thoroughbred geldings. METHODS: Experimental study. 6 by 6 Latin square design investigating constant rate IV administration at 50, 100, and 150 mL/kg/d over 24 hours in horses dehydrated by water deprivation. Equivalent volumes of IG plain water were administered by 4 bolus doses over 24 hours. RESULTS: Water deprivation resulted in a significant decrease in the percentage of fecal water, and increases in serum and urine osmolality. IV fluids administered at 100 and 150 mL/kg/d restored fecal hydration, but increasing the rate from 100 to 150 mL/kg/d did not confer any additional intestinal benefit, but did result in significantly greater urine production and sodium loss. Equivalent 24-hour volumes of plain water resulted in greater intestinal water and less urine output. CONCLUSIONS AND CLINICAL IMPORTANCE: IV polyionic isotonic fluids can be used to hydrate intestinal contents in situations where enteral fluids are impractical. IV fluids administered at three times maintenance are no more efficacious and might be associated with adverse physiological findings after withdrawal. Bolus dosing of IG water can be used to restore intestinal water with minimal adverse effects.

Cross-reactivity of tapentadol specimens with DRI methadone enzyme immunoassay.

A substantial incidence of positive methadone screens for pain management urine specimens using a commercial enzyme immunoassay (EIA) was observed in the absence of a methadone prescription, with negative methadone confirmation by ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS-MS). Tapentadol was the only common prescription among the investigated specimens. Tapentadol or one of its three major metabolites was tested at various concentrations (100-200,000 ng/mL) against the DRI EIAs for methadone and methadone metabolite, to evaluate cross-reactivity. Ninety-seven authentic tapentadol urine specimens that produced false-positive methadone EIA results (cutoff = 130 ng/mL) were analyzed for methadone and tapentadol in compound-specific UPLC-MS-MS confirmation tests. Tapentadol, tapentadol glucuronide, tapentadol sulfate and N-desmethyltapentadol exhibited cross-reactivity with the methadone EIA at 6,500 (2.2%), 25,000 (0.6%), 3,000 (4.4%) and 20,000 ng/mL (0.9%), respectively. No cross-reactivity was observed with the methadone metabolite 2-ethylidine-1,5-dimethyl-3,3-diphenylpyrrolidine EIA. All authentic urine specimens were confirmed to be negative for methadone, but positive for tapentadol and all monitored metabolites. Individual concentrations indicated that separate or combined urinary concentrations of tapentadol and its conjugates may produce false-positive methadone screens through cross-reactivity with the methadone immunoassay. The potential for false-positive results for methadone EIA screening of urine specimens associated with tapentadol prescriptions should be considered when interpreting results.

Effect of maternal tobacco smoking or exposure to second-hand smoke on the levels of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) in urine of mother and the first urine of newborn.

Tobacco smoking during pregnancy is associated with a variety of negative consequences not only for the mother, but also for the developing fetus. Many studies have shown that carcinogens contained in tobacco smoke permeate across the placenta, and are found in fetus. The aim of the study was to determine the prenatal exposure to tobacco-specific carcinogenic N-nitrosamines on the basis of measurements of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) in urine of smoking and second-hand smoke (SHS) exposed women and in the first urine of their newborns. A questionnaire documenting demographics and socio-economical data, smoking habits and exposure to SHS was completed by 121 delivering women near or at term. Maternal concentrations of cotinine and NNAL were measured in urine of the mother and the first urine of her newborn infant by liquid chromatography tandem mass spectrometry (LC/MS/MS). The mean concentration of cotinine was 439.2 ng/mg creatinine and NNAL concentration in urine of smoking women was 74.0 pg/mg creatinine, and for her newborn 78.6 pg/mg creatinine. Among mothers exposed to SHS, cotinine and NNAL mean concentration were 23.1 ng/mg creatinine, and 26.4 pg/mg creatinine. In newborns of SHS exposed mothers during pregnancy the mean concentration of NNAL was 34.1 pg/mg creatinine, respectively. Active tobacco smoking as well as passive exposure to smoking during pregnancy is an important source of tobacco specific N-nitrosamines to the fetuses as evidenced by increased concentrations of this carcinogen. Determination of NNAL in maternal urine samples can be a useful biomarker of prenatal exposure of newborn to carcinogenic nitrosamines.

Virulence gene distribution in clinical, nosocomial and environmental isolates of Pseudomonas aeruginosa.

The virulence factor genotypes of a large cohort of clinical, nosocomial environment and community environment isolates (184 in total) of Pseudomonas aeruginosa from Tasmania, Australia, were determined by PCR. The virulence factor genotype of the majority of isolates was highly conserved, with the exception of the virulence gene exoU, which demonstrated low prevalence (33 isolates; 18 %) in the population tested. Isolates collected from the environment of intensive therapy wards (intensive care unit and neurosurgical units) of the major tertiary referral hospital in Tasmania were found to be more likely (P<0.001 and P<0.05, respectively) to possess the virulence factor gene exoU than all other isolates. Adult cystic fibrosis isolates showed a decreased prevalence of the exoU gene (P<0.01) when compared to other clinical isolates (P<0.01), which may indicate decreased virulence. No specific virulence factor genotype was associated with the cystic fibrosis epidemic strains tested.

Dispersion of horse allergen from stables and areas with horses into homes.

BACKGROUND/AIM: To protect susceptible subjects from exposure to horse allergen, a Swedish national report recommended a distance of at least 500 m between homes and stables and other areas with horses. The aim of this project was to study indoor and outdoor levels of horse allergen in relation to distance from stables and horse tracks. METHODS: Indoor and outdoor samples were collected with Petri dishes at 49 sites in different housing areas and near to a track for trotting horses. In the apartments, Petri dishes were placed on a bookshelf in the living room at a height of approximately 1.5 m. Outdoors, cages containing Petri dishes were attached to tree branches at various distances from the horse track. RESULTS: Six of 45 indoor samples had detectable levels of horse allergen, 3 of those despite the fact that no family member had had any contact with horses, and 16 of 26 outdoor samples were positive. Outdoors, allergen levels drop quickly when the distance from stables or horses increases. Further, the allergen level found at a distance of 45 m from a horse track was around 1% of the allergen level found at 1 m from the track. CONCLUSIONS: Allergens dispersed from horses decline rapidly outdoors and are barely found indoors in homes. We support the view that indirect exposure to horses such as exposure from clothing of horse riders, should be taken into account when measures to protect susceptible people from undesired exposure to horse allergens are taken.

Equine gastrointestinal motility research: where we are and where we need to go.

Equine gastrointestinal motility is a central issue in cases of equine colic, post operative convalescence and alimentary conditions encountered in practice. There are significant syndromes of intestinal dysmotility in the horse such as obstructive disorders and post operative ileus that are still poorly understood. This review describes the various areas of research that aim to elucidate the pathogenesis of intestinal hypo- or hypermotility by research methods, which include studies at the cellular level, and those that employ in vitro or in vivo techniques of evaluating the physiology and mechanical means of ingesta transit through the alimentary tract. The review discusses future directions for studies which will hopefully lead to better understanding and appropriate measures for diagnosis, therapy and prevention of ileus and other motility disorders.