Long-term Treatment with Methylene Blue in a Dog with Hereditary Methemoglobinemia Caused by Cytochrome b5 Reductase Deficiency.

A juvenile male mixed breed dog was presented for lethargy, exercise intolerance, and aggression when touched on the head. Cyanosis, tachycardia, and tachypnea were observed and persisted during oxygen supplementation. Arterial blood gas analysis by co-oximetry identified an increased methemoglobin concentration (27%; normal, <2%) with normal arterial oxygen tension. The methemoglobinemia and associated clinical signs resolved after administration of methylene blue (1 mg/kg) IV, and the dog was discharged. The affected dog's whole-genome sequence contained 2 potentially causal heterozygous CYB5R3 missense mutations suggesting that cytochrome b5 reductase deficiency was responsible for the methemoglobinemia. This hypothesis was confirmed by enzyme analysis that identified cytochrome b5 reductase activity in the affected dog's erythrocytes to only approximately 6% of that in a control sample. Clinical signs recurred 11 days after discharge but normalized and the methemoglobin concentration decreased with methylene blue administration PO (1.5 mg/kg, initially daily and then every other day).

Does the working temperature affect the outcome following microwave endometrial ablation?

BACKGROUND: Menorrhagia is a common gynaecological complaint, with significant burden to both its sufferers and health service providers. The first line of treatment is usually medical/pharmaceutical although in some cases surgery is required. There are now a number of minimally invasive surgical techniques available that ablate the uterine lining and prevent the need for the removal of the uterus. Microwave endometrial ablation (MEA) is one of these techniques, and this paper investigates the effect of the working temperature on outcome. METHODS: A retrospective case note review of women who underwent MEA between June 2000 and August 2004. All women had a hysteroscopy followed by MEA. The duration of the procedure and mean working temperature of the MEA treatment was calculated. Women were followed up 6-8 months after surgery. FINDINGS: Two hundred and eleven women underwent the procedure, with an average duration of menorrhagia of 30 months prior to the procedure. Eighty-nine percent attended follow-up, 80 % were satisfied with the procedure and 40 % were amenorrhoeic. When the procedure was performed at higher working temperature within the manufacturers guidelines women were more likely to be amenorrhoeic (78.4 vs. 77.1 °C, p = 0.014). CONCLUSION: MEA is more effective in treating menorrhagia when used at a higher operating temperature.

A radiological approach to benign and malignant lesions of the mandible.

There is a wide range of pathological conditions that affect the mandible. Although some lesions demonstrate characteristic imaging features, many of the pathological processes encountered in the mandible often exhibit similar imaging appearances resulting in uncertainty for the reporting radiologist. Many mandibular lesions remain impossible to distinguish without histological analysis. Therefore, this review aims to reassure the radiologist that although imaging findings may not always lead to a specific diagnosis, they narrow the differential diagnosis and guide further work-up. In this regard, we aim to provide a clinically useful framework and approach for radiologists to use when they encounter lesions within the mandible.

Hemodynamic and biochemical alterations in dogs with lymphoma after induction of chemotherapy.

BACKGROUND: Doxorubicin is a common antineoplastic agent with dose-dependent cardiotoxic adverse effects, and pre-existing myocardial dysfunction is a contraindication to its use. OBJECTIVES: To systematically define the hemodynamic and biochemical alterations in dogs undergoing chemotherapy for newly diagnosed lymphoma and assess the reversibility of these alterations with fluid administration. ANIMALS: Twenty-one client-owned dogs with newly diagnosed lymphoma were evaluated 1 week after induction of chemotherapy. Underlying degenerative valve disease was exclusionary. Eighteen healthy age- and weight-matched dogs were used as controls. METHODS: Physical examination, blood pressure by Doppler, echocardiography, and biochemical evaluation (routine serum biochemistry, plasma renin activity and aldosterone concentrations, plasma and urine osmolalities, and urine electrolyte concentrations) were measured in dogs with lymphoma and compared to controls. Dogs with lymphoma received crystalloids IV at 6 mL/kg/h for 24 hours. All variables were reassessed at 4 and 24 hours. Deuterium oxide dilution and bromide dilution were used to determine total body water and extracellular water space, respectively. RESULTS: Baseline echocardiograms showed significantly smaller chamber dimensions in dogs with lymphoma compared to controls. These changes were reversed by fluid administration. Systolic blood pressure and urine sodium concentration were significantly increased, and bromide dilution space, PCV, urine specific gravity, and urine potassium concentration were significantly decreased compared to controls. CONCLUSION AND CLINICAL IMPORTANCE: Echocardiographic and biochemical abnormalities in dogs with lymphoma appear consistent with volume depletion, and may be the result of systemic hypertension and subsequent pressure natriuresis.

Rate of tree carbon accumulation increases continuously with tree size.

Forests are major components of the global carbon cycle, providing substantial feedback to atmospheric greenhouse gas concentrations. Our ability to understand and predict changes in the forest carbon cycle--particularly net primary productivity and carbon storage--increasingly relies on models that represent biological processes across several scales of biological organization, from tree leaves to forest stands. Yet, despite advances in our understanding of productivity at the scales of leaves and stands, no consensus exists about the nature of productivity at the scale of the individual tree, in part because we lack a broad empirical assessment of whether rates of absolute tree mass growth (and thus carbon accumulation) decrease, remain constant, or increase as trees increase in size and age. Here we present a global analysis of 403 tropical and temperate tree species, showing that for most species mass growth rate increases continuously with tree size. Thus, large, old trees do not act simply as senescent carbon reservoirs but actively fix large amounts of carbon compared to smaller trees; at the extreme, a single big tree can add the same amount of carbon to the forest within a year as is contained in an entire mid-sized tree. The apparent paradoxes of individual tree growth increasing with tree size despite declining leaf-level and stand-level productivity can be explained, respectively, by increases in a tree's total leaf area that outpace declines in productivity per unit of leaf area and, among other factors, age-related reductions in population density. Our results resolve conflicting assumptions about the nature of tree growth, inform efforts to undertand and model forest carbon dynamics, and have additional implications for theories of resource allocation and plant senescence.

Imaging findings in recurrent extramedullary leukaemias.

Acute leukaemias are relatively common malignancies. Treatment has advanced significantly in the recent past and there has been improved patient survival. This improved initial response is leading to an increasing number of cases of relapse. Extramedullary relapse occurs in a wide variety of locations with varying presentations, imaging findings and differentials. The pathophysiology and clinical course of recurrent extramedullary myeloid and lymphocytic leukaemias are reviewed in this article. The wide variety of imaging findings associated with many important sites of recurrence and the associated differential diagnosis are discussed and illustrated.

Impact of temozolomide on gonadal function in patients with primary malignant brain tumors.

BACKGROUND: Cumulative exposure to alkylating agents may produce impaired reproductive function. Temozolomide is an alkylating agent approved for treating malignant gliomas. OBJECTIVE: A pilot study was undertaken to investigate the effects of temozolomide on semen integrity in men with newly diagnosed or recurrent malignant gliomas. METHODS: Eligible patients had no known fertility problems or impotence. Comprehensive semen analysis and serum sex hormones were obtained at baseline and following 3 and at least 6 months of temozolomide. RESULTS: Thirteen men were recruited. Mean age was 42 years (28-58). Three had recurrent and 10 newly diagnosed malignant glioma. Four were unable to ejaculate or were azoospermic at baseline. Four provided samples at baseline and after at least 6 months of temozolomide. Five were unable to complete the study. Two of four patients with paired baseline and 6-month samples received 6 months of standard monthly temozolomide. Two patients received standard radiation and concurrent temozolomide followed by adjuvant temozolomide. At 6 months, three of these four patients demonstrated low sperm motility (two low at baseline); three had abnormally low percent normal forms (one abnormal at baseline); two developed abnormally low sperm density. Sex hormone values were normal in all four patients at all time points. CONCLUSION: Changes in semen analysis parameters following 6 months of temozolomide were observed. The small sample size precludes any firm conclusions regarding the importance and duration of these findings and their relation to temozolomide exposure. With validation in a larger study, these results may have important implications for counseling prior to initiation of temozolomide therapy in these patients.

Plasma inflammatory mediator concentrations at ICU admission in dogs with naturally developing sepsis.

BACKGROUND: Identifying biomarkers to aide in the diagnosis and prognostication of sepsis in dogs would be valuable to veterinarians. OBJECTIVE: To compare plasma inflammatory mediator concentrations among dogs with sepsis, noninfectious systemic inflammatory response syndrome (NSIRS), and healthy dogs. ANIMALS: Dogs with sepsis (n = 22), NSIRS (n = 23), and healthy dogs (n = 13) presenting to the intensive care unit (ICU) at a veterinary teaching hospital. METHODS: Prospective observational study. Clinical parameters were recorded for each dog and plasma tumor necrosis factor (TNF) bioactivity and concentrations of interleukin (IL)-6, CXC chemokine ligand (CXCL)-8 and IL-10 were determined at ICU presentation. RESULTS: Dogs with sepsis and NSIRS were significantly more likely to have measurable TNF activity (sepsis 20/22; NSIRS 19/20; healthy 0/13) and IL-6 concentration (sepsis 12/22; NSIRS 15/23; healthy 2/13), than healthy dogs. Healthy dogs (9/13) were significantly more likely to have measurable plasma IL-10 concentrations than dogs with sepsis (4/19), but not NSIRS (7/20). None of the inflammatory mediators evaluated had optimal sensitivity or specificity for the diagnosis of sepsis. Twelve of 22 dogs with sepsis and 15/23 dogs with NSIRS survived to discharge; none of the measured biomarkers correlated with survival to discharge. CONCLUSIONS AND CLINICAL IMPORTANCE: Sepsis and NSIRS are associated with increased production of the proinflammatory cytokines TNF and IL-6. In addition, sepsis is associated with decreased production of the anti-inflammatory cytokine IL-10. Despite this, plasma TNF, IL-6, CXCL-8, and IL-10 measured at ICU presentation do not appear to be valuable biomarkers to differentiate sepsis from NSIRS, or predict hospital outcome.

Effect of opioids on CXCL-8 production in healthy cats.

The aim of this study was to evaluate the effect of opioid exposure on CXC chemokine ligand (CXCL)-8 production in cats using whole blood culture. Morphine, buprenorphine, fentanyl, and saline control were administered intravenously to five cats and whole blood pathogen associated molecular pattern motif-induced CXCL-8 production capacity was evaluated. Morphine potentiated CXCL-8 production. To further characterize this effect of morphine, morphine was incubated with whole blood ex vivo and pathogen associated molecular pattern motif-induced CXCL-8 production capacity was measured. There was a time and concentration dependent effect on CXCL-8 production, suggesting the proinflammatory effect of morphine is at least partially mediated by direct stimulatory effects on leukocytes. Additional investigation is indicated to assess the implications of the immunomodulatory actions of opioids in cats.

SU-E-T-463: Biological-Based Optimization and VMAT is Unnecessary for Stereotactic Body Radiation Therapy.

PURPOSE: This study shows that there is no clear dosimetric benefit of biological-based optimization for either fixed-beam IMRT or VMAT. Other than shorter delivery times, even VMAT does not offer additional advantage to fixed-beam IMRT. METHODS: A small number of patients for lung, pancreas, spine and brain CA were planned with fixed-beam IMRT, optimized with (gEUD) and without (DV) biological objectives and, also planned for VMAT with and without gEUD, for comparison. For the lung and brain cases, a non-coplanar 7-11 beam arrangement was used for fixed- beam IMRT and a coplanar 'hybrid' arc simulated VMAT with beams set every 5° spacing. For the other treatment sites, all beams were coplanar. For each case, the fixed-beam IMRT and VMAT plans were optimized with the same objectives. It is important to note that, only 2 segments/beam were allowed for each plan, in order to create small fluence modulation, appropriate for small target volumes during SBRT. RESULTS: For all plans we noticed that there were minor or no dosimetric differences between fixed- beam IMRT and VMAT, whether DV or gEUD objectives were used or whether fixed-beam IMRT or VMAT is used. Keeping the level of beam modulation as-low-as possible, for small SBRT targets, one can show that VMAT with or without gEUD optimization does not offer any dosimetric advantage against fixed-beam IMRT with multiple non-coplanar beams. This is against the expectation that gEUD-optimization can Result superior plans than DV-optimization. The difference is that, for small target volumes like those encountered in SBRT, the complexity of the fluence is not as high as in large field intensity modulated cases. CONCLUSIONS: The fact that VMAT with or without gEUD can produce as good plans as fixed-IMRT does not make VMAT a preferred treatment modality, other than the fact that requires reduced treatment time.

Novel mechanically competent polysaccharide scaffolds for bone tissue engineering.

The success of the scaffold-based bone regeneration approach critically depends on the biomaterial's mechanical and biological properties. Cellulose and its derivatives are inherently associated with exceptional strength and biocompatibility due to their ß-glycosidic linkage and extensive hydrogen bonding. This polymer class has a long medical history as a dialysis membrane, wound care system and pharmaceutical excipient. Recently cellulose-based scaffolds have been developed and evaluated for a variety of tissue engineering applications. In general porous polysaccharide scaffolds in spite of many merits lack the necessary mechanical competence needed for load-bearing applications. The present study reports the fabrication and characterization of three-dimensional (3D) porous sintered microsphere scaffolds based on cellulose derivatives using a solvent/non-solvent sintering approach for load-bearing applications. These 3D scaffolds exhibited a compressive modulus and strength in the mid-range of human trabecular bone and underwent degradation resulting in a weight loss of 10-15% after 24 weeks. A typical stress-strain curve for these scaffolds showed an initial elastic region and a less-stiff post-yield region similar to that of native bone. Human osteoblasts cultured on these scaffolds showed progressive growth with time and maintained expression of osteoblast phenotype markers. Further, the elevated expression of alkaline phosphatase and mineralization at early time points as compared to heat-sintered poly(lactic acid-glycolic acid) control scaffolds with identical pore properties affirmed the advantages of polysaccharides and their potential for scaffold-based bone regeneration.

Town vs. gown: a direct comparison of community residents and student mock jurors.

The use of students as mock jurors in the majority of legal psychology studies on jury behavior has been criticized (e.g., Bray & Kerr, 1979; Diamond, 1997). This study examined the degree to which student mock jurors' decisions were generalizable to those of real jurors. The participants of the study included 297 jury-eligible university students and 297 volunteers from the venire in the same community as that in which the students resided. All participants viewed one of six versions of a videotaped criminal trial. The defendant testified in English or in Spanish. In addition, the race of defendant was varied. Three bilingual individuals served as defendants with one appearing to be of northern European origin, one of Latino background, and one of African origin. Dependent variables included verdict and, for those who found the defendant guilty, the number of years to which he should be sentenced, and whether he should be fined. Student mock jurors differed reliably from their community counterparts on several demographic characteristics. However, the two groups had mixed results in relation to decision-making tasks. There was no difference in individual verdict preferences, but the students' sentence recommendations were more punitive. These results are interpreted in the context of the generalizability of mock juror studies.

Effects of an alibi witness's relationship to the defendant on mock jurors' judgments.

Two studies tested the impact of an alibi witness's relationship to a defendant on the perceived credibility of that witness. In the first study, 291 mock jurors estimated the frequency with which individuals would invent alibis, the frequency they themselves would do so, and the frequency of interpersonal contact among individuals of varying relationships. The degree of relationship between an alibi witness and a defendant remained a predictor of witness credibility when contact frequency was controlled. In the second study, 512 mock jurors were randomly assigned to case scenarios. Skepticism toward witnesses who are biologically or affinally related to a defendant was greater than skepticism toward a socially linked witness. Both studies supported predications from kinship theory and reciprocal altruism.

Chemistry and long-term decomposition of roots of Douglas-fir grown under elevated atmospheric carbon dioxide and warming conditions.

Elevated atmospheric CO(2) concentrations and warming may affect the quality of litters of forest plants and their subsequent decomposition in ecosystems, thereby potentially affecting the global carbon cycle. However, few data on root tissues are available to test this feedback to the atmosphere. In this study, we used fine (diameter < or = 2 mm) and small (2-10 mm) roots of Douglas-fir (Pseudotsuga menziesii (Mirb.) Franco) seedlings that were grown for 4 yr in a 2 x 2 factorial experiment: ambient or elevated (+ 180 ppm) atmospheric CO(2) concentrations, and ambient or elevated (+3.8 degrees C) atmospheric temperature. Exposure to elevated CO(2) significantly increased water-soluble extractives concentration (%WSE), but had little effect on the concentration of N, cellulose, and lignin of roots. Elevated temperature had no effect on substrate quality except for increasing %WSE and decreasing the %lignin content of fine roots. No significant interaction was found between CO(2) and temperature treatments on substrate quality, except for %WSE of the fine roots. Short-term (< or = 9 mo) root decomposition in the field indicated that the roots from the ambient CO(2) and ambient temperature treatment had the slowest rate. However, over a longer period of incubation (9-36 mo) the influence of initial substrate quality on root decomposition diminished. Instead, the location of the field incubation sites exhibited significant control on decomposition. Roots at the warmer, low elevation site decomposed significantly faster than the ones at the cooler, high elevation site. This study indicates that short-term decomposition and long-term responses are not similar. It also suggests that increasing atmospheric CO(2) had little effect on the carbon storage of Douglas-fir old-growth forests of the Pacific Northwest.

The impact on juror verdicts of judicial instruction to disregard inadmissible evidence: a meta-analysis.

The effect on juror verdicts of judicial instructions to disregard inadmissible evidence was evaluated using meta-analysis. One hundred seventy-five hypothesis tests from 48 studies with a combined 8,474 participants were examined. Results revealed that inadmissible evidence (IE) has a reliable effect on verdicts consistent with the content of the IE. Judicial instruction to ignore the inadmissible evidence does not effectively eliminate IE impact. However, if judges provide a rationale for a ruling of inadmissibility, juror compliance may be increased. Contested evidence ruled admissible accentuates that information, resulting in a significant impact on verdicts. Suggestions for how the courts may mitigate the impact of inadmissible evidence more effectively are discussed.

The factor structure of the Need for Cognition Short Form in a Hispanic sample.

The authors conducted a series of studies to validate the factor structure of the English version of the Need for Cognition-Short Form (NFC-SF; J. T. Cacioppo, R. E. Petty, & C. F. Kao, 1984) in a U.S. Hispanic sample. Study 1 is an exploration of the factor structure in 238 Hispanic and relationships between gender and acculturation. Analyses in Study 2 confirmed the factor structure from the sample in Study 1 in a group of 185 U.S. Hispanics. Results indicated that the English version of the NCS-SF has a one-factor structure and is reliable for use with U.S. Hispanics.

Crime victims serving as jurors: is there bias present?

This project examined the decisions of 2435 mock jurors of whom 984 reported being a victim of some type of crime and 982 reported knowing a close friend or relative who had been a victim. Participants watched a videotape of a trial of a burglary of a habitation and were asked to give individual verdicts. Results indicated that jurors who identified themselves as victims of the same crime convicted significantly more frequently than those who had not been victims. Victims of violent crimes (a type of crime dissimilar to that for which the defendant was on trial) were not more likely to convict than were non-victims. Implications of this research are discussed.

An examination of jury verdicts for evidence of a similarity-leniency effect, an out-group punitiveness effect or a black sheep effect.

Archival data from cases adjudicated by jury in El Paso and Bexar County, Texas, were used to test whether a similarity-leniency effect, an out-group punitiveness effect, or a black sheep effect (BSE; J. M. Marques, V Y. Yzerbyt, & J. P. Leyens, 1988) influenced jury decisions. Defendant ethnicity, jury ethnic composition, and strength of evidence against the defendant were coded for 418 closed noncapital, felony cases to test their impact on trial verdicts and sentence lengths. Results indicated complex relations exist among juror and defendant characteristics and their influence on trial outcomes. No support was found for any of the theoretical models as predictors of jury decision-making. Strength of evidence was the most influential variable for both verdicts and length of sentences. Case strength, defendant ethnicity, and jury composition were related to sentence lengths.

A tale of three aspirations: foreign bodies in the airway.

Tracheobronchial foreign body aspiration is a serious medical problem, with clinical manifestations ranging from acute asphyxiation to insidious lung damage, as demonstrated by the three presented cases. Patient 1 aspirated during dinner, emergency bronchoscopy retrieved pieces of food, and she fully recovered the following day. Patient 2 presented with recurrent pneumonia and a right lower lobe lung abscess. After right lower lobectomy, pathology revealed a foreign object in the right main stem bronchus, a peanut aspirated one year earlier. Patient 3 became unresponsive several days after spinal surgery. The differential diagnosis included myocardial infarction, stroke, and foreign body aspiration. The patient died and necropsy revealed a foreign body in the right main stem bronchus (cooked meat). Thus, foreign body aspiration is not always suspected clinically, and the pathologist may play an important role in making the diagnosis. Histological identification of the aspirated material may be necessary for definitive diagnosis. Therefore, sections of commonly aspirated foods are presented, together with a 10 year history of aspirated objects received by this institution's surgical pathology department.