Dispersal and population state of an endangered island lizard following a conservation translocation.

Population size is widely used as a unit of ecological analysis, yet to estimate population size requires accounting for observed and latent heterogeneity influencing dispersion of individuals across landscapes. In newly established populations, such as when animals are translocated for conservation, dispersal and availability of resources influence patterns of abundance. We developed a process to estimate population size using N-mixture models and spatial models for newly established and dispersing populations. We used our approach to estimate the population size of critically endangered St. Croix ground lizards (Ameiva polops) five years after translocation of 57 individuals to Buck Island, an offshore island of St. Croix, United States Virgin Islands. Estimates of population size incorporated abiotic variables, dispersal limits, and operative environmental temperature available to the lizards to account for low species detection. Operative environmental temperature and distance from the translocation site were always important in fitting the N-mixture model indicating effects of dispersal and species biology on estimates of population size. We found that the population is increasing its range across the island by 5-10% every six months. We spatially interpolated site-specific abundance from the N-mixture model to the entire island, and we estimated 1,473 (95% CI, 940-1,802) St. Croix ground lizards on Buck Island in 2013 corresponding to survey results. This represents a 26-fold increase since the translocation. We predicted the future dispersal of the lizards to all habitats on Buck Island, with the potential for the population to increase by another five times in the future. Incorporating biologically relevant covariates as explicit parameters in population models can improve predictions of population size and the future spread of species introduced to new localities.

A holistic investigation of the ecological correlates of abundance and body size for the endangered White's seahorse Hippocampus whitei.

Analysing the associations between the endangered White's seahorse Hippocampus whitei and characteristics of its environment (including habitat, prey and predator variables) in an estuary in New South Wales, Australia, revealed that seahorses had a greater number of significant associations with environmental correlates within a single seagrass bed than among seagrass beds. Predator abundance was negatively correlated with H. whitei abundances among seven seagrass beds (200-6,000 m apart) and no ecological correlate was associated with H. whitei body size distributions. Within the seagrass bed with the greatest number of H. whitei, individuals preferentially selected locations that were deeper, had denser seagrass, more epiphytic prey types and fewer predators. Smaller H. whitei were associated with greater depths within the bed. In this study, each class of ecological correlate (habitat, prey, predators) was found to have at least one significant relationship with H. whitei, depending on the scale, demonstrating that all three are important to H. whitei populations. As such, future studies that evaluate animal populations may benefit from holistic approaches that consider each of these together. For animals that are experiencing dramatic population declines due to habitat destruction, as H. whitei has over the last decade, a better understanding of its relationship to its environment is important to inform conservation action.

Randomized trial of near-infrared spectroscopy for personalized optimization of cerebral tissue oxygenation during cardiac surgery.

BACKGROUND: We assessed whether a near-infrared spectroscopy (NIRS)-based algorithm for the personalized optimization of cerebral oxygenation during cardiopulmonary bypass combined with a restrictive red cell transfusion threshold would reduce perioperative injury to the brain, heart, and kidneys. METHODS: In a randomized controlled trial, participants in three UK centres were randomized with concealed allocation to a NIRS (INVOS 5100; Medtronic Inc., Minneapolis, MN, USA)-based 'patient-specific' algorithm that included a restrictive red cell transfusion threshold (haematocrit 18%) or to a 'generic' non-NIRS-based algorithm (standard care). The NIRS algorithm aimed to maintain cerebral oxygenation at an absolute value of > 50% or at > 70% of baseline values. The primary outcome for the trial was cognitive function measured up to 3 months postsurgery. RESULTS: The analysis population comprised eligible randomized patients who underwent valve or combined valve surgery and coronary artery bypass grafts using cardiopulmonary bypass between December 2009 and January 2014 ( n =98 patient-specific algorithm; n =106 generic algorithm). There was no difference between the groups for the three core cognitive domains (attention, verbal memory, and motor coordination) or for the non-core domains psychomotor speed and visuo-spatial skills. The NIRS group had higher scores for verbal fluency; mean difference 3.73 (95% confidence interval 1.50, 5.96). Red cell transfusions, biomarkers of brain, kidney, and myocardial injury, adverse events, and health-care costs were similar between the groups. CONCLUSIONS: These results do not support the use of NIRS-based algorithms for the personalized optimization of cerebral oxygenation in adult cardiac surgery. CLINICAL TRIAL REGISTRATION: http://www.controlled-trials.com , ISRCTN 23557269.

The potential for coral reef restoration to mitigate coastal flooding as sea levels rise.

The ability of reefs to protect coastlines from storm-driven flooding hinges on their capacity to keep pace with sea-level rise. Here, we show how and whether coral restoration could achieve the often-cited goal of reversing the impacts of coral-reef degradation to preserve this essential function. We combined coral-growth measurements and carbonate-budget assessments of reef-accretion potential at Buck Island Reef, U.S. Virgin Islands, with hydrodynamic modeling to quantify future coastal flooding under various coral-restoration, sea-level rise, and storm scenarios. Our results provide guidance on how restoration of Acropora palmata, if successful, could mitigate the most extreme impacts of coastal flooding by reversing projected trajectories of reef erosion and allowing reefs to keep pace with the ~0.5 m of sea-level rise expected by 2100 with moderate carbon-emissions reductions. This highlights the potential long-term benefits of pursuing coral-reef restoration alongside climate-change mitigation to support the persistence of essential coral-reef ecosystem services.

Posterior cruciate ligament and posterolateral corner deficiency results in a reverse pivot shift.

BACKGROUND: As measured via static stability tests, the PCL is the dominant restraint to posterior tibial translation while the posterolateral corner is the dominant restraint to external tibial rotation. However, these uniplanar static tests may not predict multiplanar instability. The reverse pivot shift is a dynamic examination maneuver that may identify complex knee instability. QUESTIONS/PURPOSES: In this cadaver study, we asked whether (1) isolated sectioning or (2) combined sectioning of the PCL and posterolateral corner increased the magnitude of the reverse pivot shift and (3) the magnitude of the reverse pivot shift correlated with static external rotation or posterior drawer testing. METHODS: In Group I, we sectioned the PCL followed by structures of the posterolateral corner. In Group II, we sectioned the posterolateral corner structures before sectioning the PCL. We performed posterior drawer, external rotation tests, and mechanized reverse pivot shift for each specimen under each condition and measured translations via navigation. RESULTS: Isolated sectioning of the PCL or posterolateral corner had no effect on the reverse pivot shift. Conversely, combined sectioning of the PCL and posterolateral corner structures increased the magnitude of the reverse pivot shift. The magnitude of the reverse pivot shift correlated with the posterior drawer and external rotation tests. CONCLUSIONS: Combined sectioning of the PCL and posterolateral corner was required to cause an increase in the magnitude of the mechanized reverse pivot shift. The reverse pivot shift correlated with both static measures of stability. CLINICAL RELEVANCE: Combined injury to the PCL and posterolateral corner should be considered in the presence of a positive reverse pivot shift.

Surfactant protein D concentrations in serum and bronchoalveolar lavage fluid from young healthy horses on pasture and in a barn environment.

OBJECTIVE: To evaluate surfactant protein D (SP-D) concentrations in serum and bronchoalveolar lavage fluid (BALF) from young healthy horses on pasture or housed in a typical barn. ANIMALS: 20 young healthy horses. PROCEDURES: Horses were randomly assigned to 1 of 2 groups (pasture, n = 10; barn, 10), and serum and BALF samples were collected for SP-D determination at baseline (all horses on pasture) and 2 weeks and 4 weeks after the barn group of horses was relocated from the pasture to the barn. Other evaluations included physical and tracheoscopic examinations. Findings were compared within and between groups. RESULTS: Physical and tracheoscopic examinations, CBC, and serum biochemical analysis did not reveal evidence of respiratory disease, and no significant differences were present within and between groups. Serum SP-D concentrations did not significantly differ within and between groups, but BALF SP-D concentrations were significantly lower for the barn group at 2 weeks but not at 4 weeks, compared with baseline. The BALF SP-D concentration-to-BALF total protein concentration ratio was < 1.5 and did not significantly differ within and between groups. CONCLUSIONS AND CLINICAL RELEVANCE: A mild decrease was evident in the concentration of SP-D in the BALF collected from young healthy horses after 2 weeks of exposure to a barn environment. The clinical importance of this finding remains to be determined.

Recovery of a large herbivore changes regulation of seagrass productivity in a naturally grazed Caribbean ecosystem.

What happens in meadows after populations of natural grazers rebound following centuries of low abundance? Many seagrass ecosystems are now experiencing this phenomenon with the recovery of green turtles (Chelonia mydas), large-bodied marine herbivores that feed on seagrasses. These seagrass ecosystems provide a rare opportunity to study ecosystem-wide shifts that result from a recovery of herbivores. We evaluate changes in regulation of seagrass productivity in a naturally grazed tropical ecosystem by (1) comparing Thalassia testudinum productivity in grazed and ungrazed areas and (2) evaluating potential regulating mechanisms of T. testudinum productivity. We established 129 green turtle exclusion cages in grazed and ungrazed areas to quantify T. testudinum growth (linear, area, mass, productivity : biomass [P:B]). In each exclosure, we recorded temperature, irradiance, water depth, nitrogen : phosphorus ratio (N:P) of blade tissue, grazing intensity before cage placement, and T. testudinum structural and nutrient characteristics. Thalassia testudinum exhibited compensatory growth in grazed areas via stimulated blade linear growth, blade area growth, and P:B across seasonal high and low growth periods and in shallow (3-4 m) and deep (9-10 m) seagrass meadows. Irradiance, depth, and N:P ratios had significant roles in regulating mass growth and P:B of T. testudinum in ungrazed areas. Depth was a significant regulating factor of mass growth and P:B in grazed areas; rates were higher and more variable in shallow meadows than in deep meadows. Grazing intensity was also a significant regulating factor for P:B, stimulating tissue turnover with increasing grazing pressure. This study provides important insights into how recovery of a large marine herbivore can result in dramatic, sustainable changes in the regulation of seagrass productivity. We also highlight the need for a historical perspective and use of appropriate indicators, including P:B and grazing intensity, when evaluating seagrass response to green turtle grazing as meadows are returned to a natural grazed state. In an age of green turtle recovery and global seagrass decline due to anthropogenic threats, a thorough understanding of green turtle-seagrass interactions at the ecosystem level is critical to ensure the restoration of seagrass ecosystems and continued recovery of green turtle populations.

Effects of canola-wheat intercrops on Delia spp. (Diptera: Anthomyiidae) oviposition, larval feeding damage, and adult abundance.

Reductions in oviposition and subsequent damage by root maggots (Diptera: Anthomyiidae, Delia spp.) to brassicaceous crops in the presence of nonhost plants has been demonstrated, but such investigations have not been conducted using intercrops of species commonly grown in the large-scale agricultural production systems of western Canada. A field experiment was conducted at three sites in Alberta, Canada, in 2005 and 2006 to determine interactions between root maggots and the various proportions of canola (Brassica napus L.) making up the total crop plant populations in intercrops with wheat (Triticum aestivum L.). The effect of a neonicotinoid seed treatment also was investigated. Root maggot damage to canola taproots decreased with increasing proportions of wheat in the intercrops. The presence of wheat in the intercrops had little effect on root maggot adult abundance in any single site-by-year combination or when data were combined over all sites and years, with different Delia species and sexes responding differently. Similarly, per plant root maggot egg populations were unaffected by intercropping, although egg populations were reduced on a per unit land area basis in intercrops compared with monocultures. Insecticidal seed treatment did not affect root maggot egg populations or canola root damage. Variable abundances and phenologies of the principal root maggot species infesting canola at different sites and years may influence their responses to canola-wheat intercrops. Intercropping canola and wheat may provide an opportunity for reducing crop damage from root maggot attack without compromising environmental sustainability.

Construction of a BAC library for buckwheat genome research - an application to positional cloning of agriculturally valuable traits.

We have constructed a BAC library for common buckwheat Fagopyrum esculentum Moench. The library includes 142,005 clones with an average insert size of approximately 76 kb, equivalent to approximately a 7 to approximately 8-fold coverage of the genome. Polymerase chain reaction based screening of the library with AGAMOUS and FLORICAULA/LEAFY primers, has identified 7 and 9 BACs, respectively, which are consistent with the genome coverage. This library represents the first large insert genomic library for F. esculentum and it can be served as a genetic resource facilitating agricultural, pharmacological, physiological, and evolutionary studies of the species. To demonstrate the utilization of the library for characterizing agriculturally valuable traits, we developed a sequence tagged site marker tightly linked to the dwarf E locus as well as to the self-incompatibility complex locus and screened the library to initiate positional cloning of the causative genes.

Emergence and seasonal activity of the entomophagous rove beetle Aleochara bilineata (Coleoptera: Staphylinidae) in canola in Western Canada.

Aleochara bilineata Gyllenhal (Coleoptera: Staphylinidae) is an important natural enemy of root maggots (Delia spp.) (Diptera: Anthomyiidae), which are serious pests of brassicaceous crops in North America and Europe. Adults of A. bilineata feed on eggs and larvae of root maggots, and A. bilineata larvae parasitize Delia spp. pupae. Emergence and seasonal activity patterns of A. bilineata were investigated during 2003-2005 in canola (Brassica rapa L. and Brassica napus L.) in central Alberta, Canada, in relation to degree-day (DD) accumulations and Julian date. Captures of A. bilineata adults from pitfall traps within emergence cages situated over canola stubble from the previous year indicated that approximately 428, 493, and 455 DD (soil base 5.57 degrees C) and 187, 189, and 180 Julian days were required for 50% emergence in 2003, 2004, and 2005, respectively (3-yr mean = 185.1 +/- 2.8 Julian days [SEM]). Captures of A. bilineata adults from pitfall traps placed in current canola crops determined that 50% levels of activity density required 379 DD and 180 Julian days in 2004. A logistic model that described the relationship of degree-days and Julian days with emergence of adult beetles was appraised, and good correspondence was evident between predicted and observed cumulative emergence patterns. Emergence and seasonal activity periods of A. bilineata in canola were well synchronized with occurrence of preimaginal life stages of its principal hosts, Delia radicum (L.) and Delia platura Meigen, with beetle emergence beginning shortly after the onset of root maggot oviposition.

The pivot shift.

The Lachman and the pivot shift are the two clinical tests most commonly used to assess instability in the anterior cruciate ligament (ACL)-deficient knee. Because it is quantifiable, the Lachman test has become the benchmark for assessing the success of ACL reconstruction. As a result, surgical techniques have been developed that effectively eliminate anterior laxity of the knee. Recent studies have shown, however, that rotational stability is not always restored after ACL reconstruction. Furthermore, there is mounting evidence that the pivot shift examination correlates with functional instability and patient outcomes better than does any other physical examination test. This test attempts to reproduce the functional combined rotary and translational instability in the ACL-deficient knee. Although the pathologic kinematics of the pivot shift are difficult to measure, recent technological advances have allowed more accurate and objective descriptions of the pivot shift, which have furthered our understanding of the complex motions involved. These advances may lead to a method of quantifying the pivot shift for research purposes and, ultimately, to ACL reconstruction that is tailored specifically to each patient's objectively measured rotational instability.

Acute Blood Pressure Changes Associated With Antipsychotic Administration to Psychiatric Inpatients.

OBJECTIVE: To investigate blood pressure (BP) changes within the first 3 days after initiating antipsychotic medication in psychiatric inpatients. METHODS: Through retrospective chart review using a repeated measures design, vital signs data were collected on 60 adult psychiatric inpatients who were psychiatrically hospitalized May 26, 2011, through September 4, 2012, at 9 time points within 3 days of initiation of 1 of 6 different antipsychotic medications. The random sample included patients with the following DSM-IV-TR diagnoses: schizophrenia (n = 25), schizoaffective disorder (either type; n = 19), and bipolar I disorder (n = 16). Data were analyzed using mixed-effects repeated measures analysis of variance to evaluate associations between the antipsychotic initiated and subsequent changes in BP. The main outcome variable was change in BP from baseline, and independent variables included age, sex, psychiatric diagnosis, and type of antipsychotic medication. Logistic regression was used to assess the relationship between each type of antipsychotic and hypotension (BP < 90/60 mm Hg) and hypertension (BP ≥ 140/90 mm Hg). RESULTS: Olanzapine (P < .01) and risperidone (P = .01) raised systolic BP to a statistically significant degree during the first 3 days after initiation. Clozapine, on the other hand, significantly reduced systolic BP (P = .02) and was associated with hypotension on linear regression. No statistically significant associations were found between the other antipsychotics and acute systolic BP changes or between any of the 6 antipsychotics and diastolic BP changes. CONCLUSIONS: Initiation of certain antipsychotic medications may be associated with statistically significant acute BP changes. These findings require further evaluation in well-designed prospective studies.

Iterative image-based modeling and control for higher scanning probe microscope performance.

In this article, we develop an image-based approach to model and control the dynamics of scanning probe microscopes (SPMs) during high-speed operations. SPMs are key enabling tools in the experimental investigation and manipulation of nano- and subnanoscale phenomena; however, the speed at which the SPM probe can be positioned over the sample surface is limited due to adverse dynamic effects. It is noted that SPM speed can be increased using model-based control techniques. Modeling the SPM dynamics is, however, challenging because currently available sensing methods do not measure the SPM tip directly. Additionally, the resolution of currently available sensing methods is limited by noise at higher bandwidth. Our main contribution is an iterative image-based modeling method which overcomes these modeling difficulties (caused by sensing limitations). The method is applied to model an experimental scanning tunneling microscope (STM) system and to achieve high-speed imaging. Specifically, we model the STM up to a frequency of 2000 Hz (corresponds to approximately 23 of the resonance frequency of our system) and achieve approximately 1.2% error in 1 nm square images at that same frequency.

Effects of fall and spring seeding date and other agronomic factors on infestations of root maggots, Delia spp. (Diptera: Anthomyiidae), in canola.

Several agronomic benefits can result from fall seeding of canola (Brassica spp.), but extensive research data are lacking on the potential impact of this practice on infestations of root maggots (Delia spp.) (Diptera: Anthomyiidae), which are major pests of the crop in western Canada. Field experiments making up 13 location by year combinations were conducted in central Alberta, Canada, from 1998 to 2001 to determine the effect of fall versus spring seeding of canola on root maggot damage. Depending on the experiment, interactions with seeding rate, seed treatment, timing of weed removal, and canola species (cultivar) also were investigated. Root maggot damage declined with an increase in seeding rate for plots seeded in May but not in fall or April. Susceptibility to infestation was greater for plants of Brassica rapa L. than Brassica napus L., but seed treatment had no effect on damage by these pests. Combined analysis using data from all experiment by location by year combinations indicated that seeding date had no significant effect on root maggot damage. The extended emergence of Delia spp. adults, which spans the appearance of crop stages vulnerable to oviposition regardless of seeding date, prevented reduced root maggot attack. Covariance analysis demonstrated the importance of increasing seeding rate for reducing root maggot infestations, a practice that can be especially beneficial for May-seeded canola when growing conditions limit the ability of plants to compensate for root maggot damage. Results determined with the small plot studies described here should be validated in larger plots or on a commercial field scale, but both the combined and covariance analyses indicate that seeding canola in fall does not predispose plants to greater damage by larval root maggots than seeding in spring.

Annular pancreas - a rare cause of gastric obstruction in an 82-year-old patient.

Annular pancreas is an uncommon and rarely reported congenital anomaly and thus is rarely suspected. A case is reported of an 82-year-old patient who presented with a 3-month history of nausea and vomiting associated with weight loss who at laparotomy was found to have an annular pancreas.

A multidisciplinary team approach minimises prophylactic mastectomy rates.

BACKGROUND: Prophylactic mastectomy (PM) has become increasingly common but is not without complications especially if accompanied by reconstructive surgery. In patients with sporadic unilateral breast cancer, contralateral PM offers no survival advantage. Multidisciplinary team (MDT) communication and interaction may facilitate shared decision-making and curtail PM rates. The aim of this study was investigate the effect of a regional MDT meeting on PM decision-making. METHODS: We conducted an observational study involving retrospective review of prospectively recorded MDT meeting records for a 151 patient requests for PM from 2011 to 2014. Final MDT decisions were recorded as PM 'accepted', 'declined' or 'pending'. For MDT sanctioned requests, the factors justifying PM were recorded. Where PM was declined, justification for MDT refusal was sought and recorded. RESULTS: Approximately half of all requests for PM have been upheld (53.0%) and 1/3 of requests have been declined (32.5%). Of those declined, low risk of contralateral breast cancer versus relatively high risk of systemic relapse were commonly cited as justification for PM refusal (45.7%). A proportion of patients who initiated PM discussion subsequently changed their minds (19.6%), or failed to attend clinic appointments (6.5%). Some patients were deemed medically unfit for complex reconstructive surgery (13%), or were declined on the basis of an apparent cosmetic drive for surgery (6.5%), concerns regarding depression or anxiety (2.2%) and/or if family history could not be substantiated (6.5%). DISCUSSION: MDT meetings facilitate cross-specialty interrogation of requests for PM, minimise unnecessary surgery and restrict PM to those likely to derive maximum benefit.

Bilateral testicular tumors in congenital adrenal hyperplasia.

A 22-year-old male with bilateral testicular tumors and the 21-hydroxylase variety of congenital adrenal hyperplasia (CAH) was studied. Preoperatively, on his usual glucocorticoid regimen, his urinary pregnanetriol excretion was increased (8.0-23.5 mg/day), serum LH and FSH were normal to increased (14.3-28.7 mIU/ml and 13.2-19.5 mIU/ml, respectively) and testosterone (T) was normal to decreased (176-600 ng/dl). At surgery, testicular vein concentrations of 17-alpha-hydroxyprogesterone (17-OHP) and adnrostenedione (delta) were increased (30.1 mug/dl and 38.3 mug/dl respectively) while T was decreased (1,503 ng/dl); a positive peripheral vein--testicular vein gradient was not seen for these steroids. Following injection of 10 U of crystalline ACTH into the testicular artery; testicular vein concentrations of 17-OHP, delta and T increased to 729 mug/dl, 2,390 mug/dl and 9,660 ng/dl respectively. Microscopic examination of the testes revealed multinodular tumors composed of polygonal or rounded eosinophilic cells, arranged in cords, nests and clusters. The tumors extended from the hilus and compressed the adjacent testicular tissue. Electron microscopic examination of the tumors showed features, common to steroid-secreting tissues, with abundant smooth endoplasmic reticulum in close proximity to mitochondria which was moderate in number. The adjacent testicular tissue was composed of immature tubules with normally developed Leydig cells in the interstitial tissues. From these data and a survey of previous works, it was postulated that these tumors were dependent upon ACTH for growth and steroid secretion. In view of the high serum LH concentration seen in association with incomplete suppression of adrenal steroid secretion in this study and the association of evidence of gonadotropin secretion with testicular tumors in other CAH patients, LH may also have contributed to the growth of these tumors.

Pitfalls of prenatal diagnosis of 21-hydroxylase deficiency congenital adrenal hyperplasia.

Hormonal measurements and HLA genotyping of amniotic fluid at midgestation correctly predicted the postnatal diagnosis of congenital adrenal hyperplasia (CAH) in 29 of 32 fetuses at risk. Of these 29, 7 were predicted to have prenatal-onset classical 21-hydroxylase deficiency (21-OH def) based on elevated amniotic fluid 17-hydroxyprogesterone (17-OHP) and delta 4-androstenedione (delta 4-A) levels. These 7 fetuses and their index cases were ultimately proven to have salt-wasting classical 21-OH def. Of 5 who were HLA typed, the genotype was identical to the index case in 4; in one, HLA prediction was not possible, because the parents shared identical HLA antigens. Normal amniotic fluid 17-OHP and delta 4-A levels in the remaining 22 fetuses predicted that they were not affected with classical CAH. These children have been clinically asymptomatic to date or proven biochemically not to have classical or nonclassical CAH. Of the 22 fetuses, 11 were predicted by HLA genotyping to be homozygous normal or heterozygous for 21-OH def. In 3 of the 32 fetuses, prenatal diagnosis was incorrect. In one, the fetus was predicted to have CAH based on HLA identity to the index case. However, amniotic fluid 17-OHP and delta 4-A were normal, and the fetus was normal. The index case of this family did not have CAH, but was a normal child. Thus, amniotic fluid hormone levels accurately predicted a normal fetus, while HLA genotyping was not relevant in prenatal diagnosis because the index case was unaffected. The second fetus was predicted to be affected on the basis of HLA genotyping and to be unaffected based on normal amniotic fluid 17-OHP and delta 4-A. During infancy, this female infant had postnatal-onset nonclassical CAH. The index case in this family, presumed to have classical simple virilizing CAH, was later diagnosed to have nonclassical CAH. Thus, in nonclassical CAH, hormonal measurement of 17-OHP and delta 4-A is not useful in prenatal diagnosis; only HLA genotyping of the fetus is valuable. In the third case, the fetus was predicted to be a heterozygote by HLA genotyping and to be unaffected by hormonal measurement. Postnatally, at age 2 7/12 yr, the male child was found to have classical simple virilizing CAH and to be HLA-B-DR identical to his brother (index case) who also has classical simple virilizing CAH.(ABSTRACT TRUNCATED AT 400 WORDS)