CT scan-guided percutaneous osteosynthesis of a complex, multifocal fracture of the pelvic girdle in a 14-year-old adolescent.

We report on a 14-year-old girl with minimally displaced pelvic girdle and acetabular roof fracture following motor vehicle trauma, treated percutaneously under CT and C-arm fluoroscopic guidance by an interventional radiologist. After informed consent from the patient's parents, under surgical aseptic conditions and under general anesthesia, three screws were positioned adequately under dual guidance by a radiologist and without immediate or long-term complication. The patient was mobilized 48 h after the procedure and resumed normal activities after 1 month. Even though the technique has been described before on adults, to our knowledge this is the first time it has been described on a pediatric patient.

Women who kill their mates.

Spousal homicide perpetrators are much more likely to be men than women. Accordingly, little research has focused on delineating characteristics of women who have committed spousal homicide. A retrospective clinical review of coroners' files containing all cases of spousal homicide occurring in Quebec over a 20-year period was carried out. A total of 276 spousal homicides occurred between 1991 and 2010, with 42 homicides by female spouses and 234 homicides by male spouses. Differences between homicides committed by female offenders and male offenders are discussed, and findings on spousal homicide committed by women are compared with those of previous studies. Findings regarding offenses perpetrated by females in the context of mental illness, domestic violence, and homicide-suicide are explored. The finding that only 28% of the female offenders in the Quebec sample had previously been subjected to violence by their victim is in contrast to the popular belief and reports that indicate that most female-perpetrated spousal homicide occurs in self-defense or in reaction to long-term abuse. In fact, women rarely gave a warning before killing their mates. Most did not suffer from a mental illness, although one-fifth were acutely intoxicated at the time of the killing. In the vast majority of cases of women who killed their mates, there were very few indicators that might have signaled the risk and helped predict the violent lethal behavior.

Investigation of PARP-1, PARP-2, and PARG interactomes by affinity-purification mass spectrometry.

BACKGROUND: Poly(ADP-ribose) polymerases (PARPs) catalyze the formation of poly(ADP-ribose) (pADPr), a post-translational modification involved in several important biological processes, namely surveillance of genome integrity, cell cycle progression, initiation of the DNA damage response, apoptosis, and regulation of transcription. Poly(ADP-ribose) glycohydrolase (PARG), on the other hand, catabolizes pADPr and thereby accounts for the transient nature of poly(ADP-ribosyl)ation. Our investigation of the interactomes of PARP-1, PARP-2, and PARG by affinity-purification mass spectrometry (AP-MS) aimed, on the one hand, to confirm current knowledge on these interactomes and, on the other hand, to discover new protein partners which could offer insights into PARPs and PARG functions. RESULTS: PARP-1, PARP-2, and PARG were immunoprecipitated from human cells, and pulled-down proteins were separated by gel electrophoresis prior to in-gel trypsin digestion. Peptides were identified by tandem mass spectrometry. Our AP-MS experiments resulted in the identifications of 179 interactions, 139 of which are novel interactions. Gene Ontology analysis of the identified protein interactors points to five biological processes in which PARP-1, PARP-2 and PARG may be involved: RNA metabolism for PARP-1, PARP-2 and PARG; DNA repair and apoptosis for PARP-1 and PARP-2; and glycolysis and cell cycle for PARP-1. CONCLUSIONS: This study reveals several novel protein partners for PARP-1, PARP-2 and PARG. It provides a global view of the interactomes of these proteins as well as a roadmap to establish the systems biology of poly(ADP-ribose) metabolism.

Quality assessment of peptide tandem mass spectra.

BACKGROUND: Tandem mass spectrometry has emerged as a cornerstone of high throughput proteomic studies owing in part to various high throughput search engines which are used to interpret these tandem mass spectra. However, majority of experimental tandem mass spectra cannot be interpreted by any existing methods. There are many reasons why this happens. However, one of the most important reasons is that majority of experimental spectra are of too poor quality to be interpretable. It wastes time to interpret these "uninterpretable" spectra by any methods. On the other hand, some spectra of high quality are not able to get a score high enough to be interpreted by existing search engines because there are many similar peptides in the searched database. However, such spectra may be good enough to be interpreted by de novo methods or manually verifying methods. Therefore, it is worth in developing a method for assessing spectral quality, which can used for filtering the spectra of poor quality before any interpretation attempts or for finding the most potential candidates for de novo methods or manually verifying methods. RESULTS: This paper develops a novel method to assess the quality of tandem mass spectra, which can eliminate majority of poor quality spectra while losing very minority of high quality spectra. First, a number of features are proposed to describe the quality of tandem mass spectra. The proposed method maps each tandem spectrum into a feature vector. Then Fisher linear discriminant analysis (FLDA) is employed to construct the classifier (the filter) which discriminates the high quality spectra from the poor quality ones. The proposed method has been tested on two tandem mass spectra datasets acquired by ion trap mass spectrometers. CONCLUSION: Computational experiments illustrate that the proposed method outperforms the existing ones. The proposed method is generic, and is expected to be applicable to assessing the quality of spectra acquired by instruments other than ion trap mass spectrometers.

A review of methods to assess the economic impact of distributed medical education (DME) in Canada.

BACKGROUND: Canadian distributed medical education (DME) increased substantially in the last decade, resulting in positive economic impacts to local communities. A reliable and simple method to estimate economic contributions is essential to provide managers with information on the extent of these impacts. This review paper fills a gap in the literature by answering the question: What are the most applicable quantitative methods to assess the economic impact of Canadian DME programs? METHODS: The literature is reviewed to identify economic assessment methods. These are evaluated and compared based on the benefits, challenges, data needs, outputs and potential for use in the DME context. RESULTS: We identified five economic impact methods used in similar contexts. Two of these methods have the potential for Canadian DME programs: the Canadian Input-Output (I-O) model and the Simplified American Council on Education (ACE) method. CONCLUSION: Choice of a method is contingent on the ability to measure the salient economic impacts, and provide an output that facilitates sustainable decision making. This paper thus fills a gap by identifying methods applicable to DME. These methods will assist stakeholders to calculate economic impacts, resulting in both the advancement and sustainability of these programs over short-and long-term time frames.

Comparative proteome analysis of human epithelial ovarian cancer.

BACKGROUND: Epithelial ovarian cancer is a devastating disease associated with low survival prognosis mainly because of the lack of early detection markers and the asymptomatic nature of the cancer until late stage. Using two complementary proteomics approaches, a differential protein expression profile was carried out between low and highly transformed epithelial ovarian cancer cell lines which realistically mimic the phenotypic changes observed during evolution of a tumour metastasis. This investigation was aimed at a better understanding of the molecular mechanisms underlying differentiation, proliferation and neoplastic progression of ovarian cancer. RESULTS: The quantitative profiling of epithelial ovarian cancer model cell lines TOV-81D and TOV-112D generated using iTRAQ analysis and two-dimensional electrophoresis coupled to liquid chromatography tandem mass spectrometry revealed some proteins with altered expression levels. Several of these proteins have been the object of interest in cancer research but others were unrecognized as differentially expressed in a context of ovarian cancer. Among these, series of proteins involved in transcriptional activity, cellular metabolism, cell adhesion or motility and cytoskeleton organization were identified, suggesting their possible role in the emergence of oncogenic pathways leading to aggressive cellular behavior. CONCLUSION: The differential protein expression profile generated by the two proteomics approaches combined to complementary characterizations studies will open the way to more exhaustive and systematic representation of the disease and will provide valuable information that may be helpful to uncover the molecular mechanisms related to epithelial ovarian cancer.

Parricide: a comparative study of matricide versus patricide.

Between 1990 and 2005, 64 parents were killed by their children in the province of Quebec, Canada. The authors reviewed all consecutive coroners' files on these cases and found that 27 mothers and 37 fathers were the victims of parricide. The sample included 56 perpetrators: 52 sons and 4 daughters; 9 cases of double parricide were found. Approximately 15 percent of the perpetrators (8/56) attempted suicide following the parricide. A psychiatric motive (stemming from depression or psychotic illness) was determined for 65.5 percent (36/56) of the perpetrators, and 67 percent of them had a psychotic disorder. Similarities and differences were found between cases of matricide and patricide.

Dissociation: Defining the Concept in Criminal Forensic Psychiatry.

Claims of amnesia and dissociative experiences in association with a violent crime are not uncommon. Research has shown that dissociation is a risk factor for violence and is seen most often in crimes of extreme violence. The subject matter is most relevant to forensic psychiatry. Peritraumatic dissociation for instance, with or without a history of dissociative disorder, is quite frequently reported by offenders presenting for a forensic psychiatric examination. Dissociation or dissociative amnesia for serious offenses can have legal repercussions stemming from their relevance to the legal constructs of fitness to stand trial, criminal responsibility, and diminished capacity. The complexity in forensic psychiatric assessments often lies in the difficulty of connecting clinical symptomatology reported by violent offenders to a specific condition included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This article provides a review of diagnostic considerations with regard to dissociation across the DSM nomenclature, with a focus on the main clinical constructs related to dissociation. Forensic implications are discussed, along with some guides for the forensic evaluator of offenders presenting with dissociation.

Dechlorane Plus induces oxidative stress and decreases cyclooxygenase activity in the blue mussel.

Dechlorane Plus (DP) is a chlorinated flame retardant used mainly in electrical wire and cable coating, computer connectors, and plastic roofing materials. Concentrations of DP (syn and anti isomers) are increasingly being reported in aquatic ecosystems worldwide. However, there is exceedingly little information on the exposure-related toxicity of DP in aquatic organisms, especially in bivalves. The objective of this study was to investigate the in vivo and in vitro effects of DP exposure on histopathology, lipid peroxidation (LPO) levels, cyclooxygenase (COX) activity, phagocytosis capacity and efficiency, and DNA strand breakage in the blue mussel (Mytilus edulis) following a 29days exposure (0.001, 0.01, 0.1 and 1.0µg DP/L). Blue mussels accumulated DP in muscle and digestive gland in a dose-dependent manner. LPO levels in gills were found to increase by 82% and 67% at the 0.01 and 1.0µg DP/L doses, respectively, while COX activity in gills decreased by 44% at the 1µg/L dose. No histopathological lesion was found in gonads following DP exposure. Moreover, no change in hemocyte DNA strand breakage, phagocytosis rate, and viability was observed following DP exposure. Present study showed that toxicity of DP may occur primarily via oxidative stress in the blue mussel and potentially other bivalves, and that gills represent the most responsive tissue to this exposure.

Poly(ADP-ribose) glycohydrolase is a component of the FMRP-associated messenger ribonucleoparticles.

PARG [poly(ADP-ribose) glycohydrolase] is the only known enzyme that catalyses the hydrolysis of poly(ADP-ribose), a branched polymer that is synthesized by the poly(ADP-ribose) polymerase family of enzymes. Poly(ADP-ribosyl)ation is a transient post-translational modification that alters the functions of the acceptor proteins. It has mostly been studied in the context of DNA-damage signalling or DNA transaction events, such as replication and transcription reactions. Growing evidence now suggests that poly(ADP-ribosyl)ation could have a much broader impact on cellular functions. To elucidate the roles that could be played by PARG, we performed a proteomic identification of PARG-interacting proteins by mass spectrometric analysis of PARG pulled-down proteins. In the present paper, we report that PARG is resident in FMRP (Fragile-X mental retardation protein)-associated messenger ribonucleoparticles complexes. The localization of PARG in these complexes, which are components of the translation machinery, was confirmed by sedimentation and microscopy analysis. A functional link between poly(ADP-ribosyl)ation modulation and FMRP-associated ribonucleoparticle complexes are discussed in a context of translational regulation.

Fratricide: a forensic psychiatric perspective.

Analyses of fratricide rates based on national homicide data have provided some general information pertaining to offenders and victims of sibling homicide but are limited by data constraints to examining a few major variables. Exploring fratricide from a forensic psychiatric perspective could uncover other related factors and provide insight into why some individuals murder their siblings. In a retrospective study of data from coroners' files on domestic homicide pertaining to individuals killed by their siblings over a 10-year period in Quebec, Canada, we identified several specific offender and victim characteristics and circumstances surrounding offenses. The impact of mental illness and substance abuse on fratricidal behavior is indicated, underscoring the importance of identifying existing psychopathology. From a forensic psychiatric perspective, we identify characteristic patterns and discuss potential dynamics operating in fratricide. We raise some issues relevant to treatment and prevention, including the fact that most cases are alcohol-related, impulsive, and unpredictable until the moment they occur.

Atrial fibrillation: basic and clinical research at the Montreal Heart Institute.

The present article reviews pertinent contributions from the Montreal Heart Institute, Montreal, Quebec, to the understanding of the mechanisms and treatment of atrial fibrillation. The article discusses the usefulness of anticoagulant therapy, antiarrhythmic drug therapy for sinus rhythm maintenance, the electrophysiological basis of atrial fibrillation and the investigation of new energy sources for catheter ablation. Future directions at the Montreal Heart Institute are also briefly addressed.

Paternal filicide in Québec.

In this retrospective study, relevant demographic, social, and clinical variables were examined in 77 cases of paternal filicide. Between 1991 and 2001, all consecutive coroners' files on domestic homicide in Québec, Canada, were reviewed, and 77 child victims of 60 male parent perpetrators were identified. The results support data indicating that more fathers commit filicide than do mothers. A history of family abuse was characteristic of a substantial number of cases, and most of the cases involved violent means of homicide. Filicide was frequently (60%) followed by the suicide of the perpetrator and more so (86%) in cases involving multiple sibling victims. The abuse of drugs and alcohol was rare. At the time of the offense, most of the perpetrators were suffering from a psychiatric illness, usually depressive disorder. Nearly one-third were in a psychotic state. The proportion of fatal abuse cases was comparatively low. Many of the perpetrators had had contact with health professionals prior to the offense, although none had received treatment for a psychiatric illness.

Thromboembolic events occur despite sinus rhythm maintenance in patients treated for atrial fibrillation: The Canadian Trial of Atrial Fibrillation experience.

BACKGROUND: Anticoagulation reduces the risk of stroke in patients with atrial fibrillation. It is not clear whether patients who revert and are maintained in sinus rhythm should continue to receive warfarin. The recommendation is to anticoagulate these patients for a minimum of four weeks after cardioversion. Whether warfarin should be maintained for a longer period of time is unknown. METHODS AND RESULTS: To address this question, data from the Canadian Trial of Atrial Fibrillation were reviewed. Among the 403 patients, 81.9% had at least one risk factor for stroke, of whom only 60% were on warfarin. Nine thromboembolic events occurred in nine patients (2.2%): all had at least one risk factor for stroke. Six events occurred in patients who were either not anticoagulated (n=4) or for whom the international normalization ratio was subtherapeutic (n=2). Eight of the nine patients were in sinus rhythm at the last follow-up visit before and at the time of evaluation of the thromboembolic event. CONCLUSIONS: Anticoagulants are underused in atrial fibrillation patients at risk of stroke. Thromboembolic events are most often associated with suboptimal levels of anticoagulation and they occur despite the appearance of sinus rhythm maintenance.

Maternal filicide in Québec.

In an eight-year review (1991 to 1998) of all consecutive coroners' files in Québec, Canada, the authors identified a total of 34 cases of victims who were killed by their mothers. Most victims were less than six years of age, and there were several cases in which multiple siblings were murdered. There were 27 mothers in the sample, and 15 of those women committed suicide after the filicide. A psychiatric motive was determined for more than 85 percent of the mothers, and most of the mothers had received previous treatment for a depressive or psychotic disorder. Based on the characteristics of this sample, the authors developed a filicide classification system that is flexible and simple to use but must be standardized to become a useful tool for clinicians.

Regional medical campuses: a new classification system.

There is burgeoning belief that regional medical campuses (RMCs) are a significant part of the narrative about medical education and the health care workforce in the United States and Canada. Although RMCs are not new, in the recent years of medical education enrollment expansion, they have seen their numbers increase. Class expansion explains the rapid growth of RMCs in the past 10 years, but it does not adequately describe their function. Often, RMCs have missions that differ from their main campus, especially in the areas of rural and community medicine. The absence of an easy-to-use classification system has led to a lack of current research about RMCs as evidenced by the small number of articles in the current literature. The authors describe the process of the Group on Regional Medical Campuses used to develop attributes of a campus separate from the main campus that constitute a "classification" of a campus as an RMC. The system is broken into four models-basic science, clinical, longitudinal, and combined-and is linked to Liaison Committee on Medical Education standards. It is applicable to all schools and can be applied by any medical school dean or medical education researcher. The classification system paves the way for stakeholders to agree on a denominator of RMCs and conduct future research about their impact on medical education.

Psychopathology and Suicide among Quebec Physicians: A Nested Case Control Study.

Objective. To describe a psychiatric profile and characteristics of physicians who killed themselves in Quebec between 1992 and 2009. Method. The cases of 36 physicians (7 females and 29 males) and 36 nonphysicians who committed suicide were matched for age and gender and examined in a nested case control design. All subjects were judged as definite suicide by the Quebec Coroner Head Office. Consensus regarding DSM-IV diagnoses was established by two forensic psychiatrists. Results. Rates of all Axis I diagnoses were 83% for physicians and 91% for nonphysicians at the time of suicide. Major depressive disorders were the most frequently observed pathology in both groups (61% and 56%, resp.). Conclusions. Physicians and nonphysicians who committed suicide in Quebec suffered from the same type of psychiatric disorder at the time of killing themselves. The findings advocate strongly for more efficient suicide prevention measures including early detection and treatment of mood disorders for the physicians.

Evaluation of resynchronization therapy for heart failure in patients with a QRS duration greater than 120 ms (GREATER-EARTH) trial: rationale, design, and baseline characteristics.

BACKGROUND: Heart failure is considered an epidemic of the modern era. In selected candidates on optimal medical therapy, cardiac resynchronization therapy (CRT) has emerged as a valuable adjunctive treatment. Despite its demonstrated salutary effects on clinical evolution, left ventricular (LV) function, and overall survival, at least 30% of patients fail to respond to CRT. METHODS: The Greater Evaluation of Resychronization Therapy for Heart Failure (GREATER-EARTH) (ClinicalTrials.gov Identifier NCT00901212) is a randomized, double-blind, multicentre study involving 11 centres across Canada and compares LV CRT with biventricular CRT in patients with severe LV dysfunction and a QRS duration>120 ms. RESULTS: This article describes the rationale and design of the study and presents the baseline characteristics of all randomized patients. The primary outcome consists of the effects of CRT on submaximal exercise tolerance (treadmill test), and secondary outcomes explore mechanisms of asynchrony and effects of CRT on asynchrony and LV function. CONCLUSION: The study was initiated in November 2003, with the last patient randomized on February 12, 2009. As expected, follow-up was in February 2010 and the results are presently being analyzed in March 2010.

Domestic homicide and homicide-suicide: the older offender.

The importance of clarifying the features characteristic of older homicide offenders is highlighted by recent research that indicates an increase in rates of homicides followed by suicides of older perpetrators. In a retrospective study of data from coroners' files on domestic homicides involving individuals killed by an older spouse or family member (65+ years of age) over a 15-year period in Quebec, Canada, we identified several specific offender and victim characteristics and circumstances surrounding the offenses. The homicide was frequently followed by the suicide of the perpetrator. Several victims had pre-existing medical illnesses, indicating that the offenses may have been committed by individuals who were caregivers to chronically ill spouses. At the time of the offense, most of the perpetrators had a mental illness, usually depressive disorder, but few had received psychiatric help. The impact of mental illness on domestic homicide-suicide is indicated, underscoring the importance of identifying existing psychopathology.