Recalling and anticipating positive events to improve the positive affect and mental health of adolescents: A cluster randomized controlled trial in secondary schools.

This cluster randomized controlled trial examined the effectiveness of Positive Events Training (PET), a combined group training aimed at simultaneously improving positive autobiographical memory (AM) and episodic future thinking (EFT) among adolescents (12-16 years). Delivered as a universal school-based program, PET was compared with an active (creative writing) control group (CREAT). Effects on resilience, wellbeing, positive emotions, emotional response styles towards positive emotions (savoring, dampening), anhedonia, depressive symptoms, and multiple AM and EFT indices were examined. Adolescents (NPET = 95, NCREAT = 93) completed self-report scales at baseline, post-training and two-month follow-up. Multilevel models revealed that PET led to significant improvements in certain AM and EFT skills. Moreover, a decrease in anhedonia was observed at post-training. However, this effect did not withstand correction for multiple testing. Absence of changes in the other outcomes should be interpreted within the context of the universal school-based approach and the potential limited scope for detectable changes. Exploratory analyses suggest the importance of further investigating PET's potential in addressing positive affect dysregulations in indicated samples, and exploring perceived likelihood of generated future events and dampening as potential underlying mechanisms. Study limitations and future directions to maximize the demonstrated potential of PET are discussed.

Molecular and immunohistochemical distinction of equine sarcoid from schwannoma.

Ten equine skin tumors that had been classified as schwannomas on routine histological examination were analyzed by polymerase chain reaction for bovine papillomavirus DNA. All 10 were positive for bovine papillomavirus 1 or 2, and all 10 were immunohistochemically negative for S-100 protein and strongly positive for vimentin. Nine tumors were moderately positive for laminin and 8, for smooth muscle actin. Five tumors were variably and weakly positive for type IV collagen. The lack of S-100 protein expression made Schwann cells an unlikely cell of origin, as opposed to peripheral nerve sheath tumors, which typically express S-100 protein, at least in some neoplastic cells. The immunohistochemical reactivity is consistent with myofibroblastic origin of the neoplastic cells, although smooth muscle cell or pericyte origin cannot be ruled out. These tumors represent an atypical form of equine sarcoid. Polymerase chain reaction for bovine papillomavirus and S-100 immunohistochemistry are strongly recommended for all equine skin tumors with histological characteristics typical of schwannoma or peripheral nerve sheath tumor.

Revising the primigravid partogram: does it make any difference?

OBJECTIVE: To investigate the distribution of the rate of cervical dilatation of primigravid labour and its deviation from the standard partogram. DESIGN: Retrospective observational study. SETTING: South African district hospital serving an indigent rural population. POPULATION: Expectant management of labour of healthy nulliparous women in active labour, at term, with a singleton pregnancy and cephalic presentation. METHODS: Audit of 1,595 partograms of spontaneous primigravid labour. The standard partogram's alert line was replaced by a customised alert line based on the lowest 10th centile of the rate of cervical dilatation of the study population and an alert line representing the 10% slowest labours. The action line was placed parallel and 4 h to the right of the alert lines. MAIN OUTCOME MEASURE: The distribution of labours left to and on the respective alert lines, and right to the action lines. RESULTS: The lowest 90th centile of the customised alert line yielded a rate of cervical dilatation of 0.860 cm/h. Three quarters of labours evolved left to the revised alert line as opposed to 56.1% left of the standard alert line [Odds ratio (OR) 0.49, 95% confidence interval (CI) 0.42-0.56]. The mean rate of cervical dilatation of the 10% slowest labours was 0.535 +/- 0.076 cm/h (P < 0.0001), and 95.7% of labours evolved left to the corresponding alert line (OR 8.40, 95% CI 6.44-11.0). CONCLUSION: The alert line representing the mean of the 10% slowest labours leads to an unrealistic distribution of labour on the partogram. A revised alert line based on the lowest 10th centile of the local population is more representative and should perhaps be used in the management of labour.

Distal limb cast sores in horses: risk factors and early detection using thermography.

REASONS FOR PERFORMING STUDY: There is a lack of evidence-based data on the prevalence, outcome and risk factors of distal limb cast sores, and no objective tool has been described for the early detection of cast sores. OBJECTIVES: To investigate the prevalence, location, outcome and risk factors of cast sores after application of a distal limb cast and to determine whether static thermography of the cast is a valuable tool for the assessment of sores. METHODS: A prospective study was conducted on horses treated with a distal limb cast. At each cast removal, cast sores were graded as superficial sores (SS), deep dermal sores (DS) or full thickness skin ulcerations (FS). In several cases, a thermographic evaluation of the cast was performed immediately prior to removal and differences in temperature (AT) between the coolest point of the cast and 2 cast regions predisposed for sore development (dorsoproximal mc/mtIII and palmar/plantar fetlock) were calculated. RESULTS: Mean +/- s.d. total casting time of 70 horses was 31 +/- 18 days. Overall, 57 legs (81%) developed at least SS. Twenty-four legs (34%) ultimately developed DS and one horse had an FS. Multivariable analysis showed that the severity of sores was positively associated with increasing age (OR: 1.111, P = 0.028), a normal (vs. swollen) limb (OR: 3387, P = 0.023) and an increase in total casting time (OR per week: 1.363, P = 0.002). The thermographic evaluation (35 casts) revealed that the severity of sores was positively associated with increasing deltaT (OR: 2.100, P = 0.0005). The optimal cut-off values for the presence of SS and DS were set at, respectively, deltaT = 23 and 43 degrees C. CONCLUSION AND POTENTIAL RELEVANCE: Distal limb cast is a safe coaptation technique with increasing risk of developing sores with time. Thermography is a valuable and rapid clinical tool to monitor the development of cast sores.

Peritoneal closure or non-closure at caesarean section.

At caesarean section, the closure or non-closure of the parietal and/or the visceral peritoneum has short-term and long-term advantages and disadvantages. The majority of reports have compared double closure vs double non-closure, non-closure of the parietal, or non-closure of the visceral parietal, with special emphasis on operation time, febrile morbidity, and duration of hospital stay. The present study compares the three methods in 692 consecutive caesarean sections in a South African rural hospital, with special emphasis on wound sepsis, operation time and febrile morbidity. The prevalence of wound sepsis and febrile morbidity was 4.9% and 2.5%, respectively. The only significant difference between the three groups was that double closure resulted in the longest operation time.

High prevalence of bovine papillomaviral DNA in the normal skin of equine sarcoid-affected and healthy horses.

Bovine papillomavirus (BPV), the causative agent of papillomas in cattle, has been shown to play a major role in the pathogenesis of equine sarcoids in horses. BPV has also been detected occasionally in normal equine skin. In this study, presence and activity of BPV in normal skin and peripheral blood of 4 groups of horses were evaluated: sarcoid-affected horses, horses living in contact with sarcoid-affected horses, horses living in contact with papilloma-affected cattle and control horses. From each horse, 3 samples on 4 locations were collected: a swab of the intact skin surface and both a swab and a biopsy after decontamination. BPV DNA was found in the normal skin of 24 of 42 horses (57%). Mainly sarcoid-affected horses and horses living in contact with cattle were carriers (73%), but BPV DNA was also detected in 50% of the horses living in contact with sarcoid-affected horses and in 30% of the control population. BPV mRNA was detected in 58% of the samples positive for BPV DNA, although in a much lower quantity compared to sarcoids. In most of the BPV DNA positive samples mild acanthosis, slight basophilic cytoplasmic swelling of the epidermal layers and/or thickening of the basal membrane were noticed, but these observations were also present in several BPV DNA negative normal skin samples. BPV DNA could not be detected in peripheral blood. These findings suggest latent infection and a wide-spread occurrence of BPV in the horse population.

Neonatal outcome after caesarean birth for fetal distress and/or meconium staining in a South African rural setting.

The aim was to evaluate the effect of caesarean delivery on the neonatal outcome after labour with fetal distress and/or meconium staining (MS). We audited 199 caesarean sections performed for non-reassuring fetal condition (NRFC) and/or MS in a rural regional hospital. The 1 and 5 min Apgar scores were compared with those of 33 vaginal births after labour with MS. There were five neonates out of 232 (2.2%) with an Apgar score <7 at 5 min; one died early, neonatally. In the caesarean section group for NRFC, there were two fresh stillbirths and one early neonatal death, a perinatal mortality of 15.1/1,000 births. The 5 min Apgar score was not statistically significantly affected by the mode of delivery. Caesarean delivery does not improve the neonatal outcome when the amniotic fluid is meconium stained.

Factors affecting outcome of extensor tendon lacerations in the distal limb of horses. A retrospective study of 156 cases (1994-2003).

Distal limb lacerations are common injuries in horses, with a better prognosis reported for extensor tendons lacerations compared to flexor tendons lacerations. The objective of the present study was to determine the influence of type and location of injury, modalities of treatment and post surgical complications on the outcome of extensor tendon lacerations. The medical records of 156 horses surgically treated for extensor tendon lacerations over a 10-year period were analysed retrospectively. Information was obtained for 124 horses with a minimum of 18 months follow-up. Statistical analysis was performed on 129 horses (five horses were euthanatized during hospitalization) in order to determine factors affecting outcome. Seventy-four percent of the horses returned to soundness, 17% had moderate gait impairment and 9% remained lame. Approximately 60% of the sports horses returned to an equal or higher level of performance, and 17.5% returned to a lower level. In the multivariate statistical analysis, the only significant factor that favourably influenced outcome was complete suture of the wound. A significant association could not be detected between outcome and absence of a functional extensor tendon, The most important post-surgical complication was extensive scarring of the wound. The present results report outcome of extensor tendon lacerations in a large number of horses and outline the importance of primary wound healing in order to avoid major scarring with potential functional consequences.

A comparison of women's, providers' and ultrasound assessments of pregnancy duration among termination of pregnancy clients in South Africa.

OBJECTIVE: To compare providers' and women's estimates of duration of pregnancy with ultrasound estimates for determining medical abortion eligibility. DESIGN: Cross-sectional study. SETTING: Public termination of pregnancy (TOP) services in three provinces. SAMPLE: A total of 673 women attending the above services for TOP. METHODS: Women participating in a medical abortion feasibility study in South Africa provided estimates of pregnancy duration and date of last menstrual period (LMP). Each woman also had clinical and ultrasound exams. We compared estimates using the four methods, calculating the proportion of women in the 'caution zone' (< or = 8 weeks gestation by woman or provider estimate and > 8 weeks by ultrasound). MAIN OUTCOME MEASURES: Mean gestational age by each method; difference between provider and LMP estimates and ultrasound estimates; and percentage of women in the 'caution zone'. RESULTS: Women's estimates of pregnancy duration were 19 days fewer than ultrasound estimates (95% CI = -27 to 63). Mean provider- and LMP-based estimates were two (95% CI = -30 to 35) and less than one day(s) (95% CI = -46 to 51) fewer than ultrasound estimates. Comparing provider and ultrasound estimates, 15% of women were in the 'caution zone'; this fell to 12% if estimates of 9 weeks or fewer were considered acceptable. CONCLUSIONS: Provider estimates of gestational age were sufficiently accurate for determining eligibility for medical abortion. LMP-based estimates were also accurate on average, but included more extreme differences from ultrasound estimates. Medical abortion could be provided in TOP facilities without ultrasound or with ultrasound on referral.

Detection of bovine papillomavirus DNA on the normal skin and in the habitual surroundings of horses with and without equine sarcoids.

The purpose of the present study was to examine whether bovine papillomavirus (BPV) DNA can be detected on the normal skin and in the habitual surroundings of horses with and without equine sarcoids by means of superficially taken swabs. In affected horses, no significant difference in presence of BPV-DNA could be observed between samples obtained from the equine sarcoid surface, from normal skin close to the tumour and from a normal skin site in direct contact with the tumour. From the group of healthy horses living in contact with affected horses, 44% were BPV-DNA positive. The surroundings of affected and non-affected horses are probably not a major source of BPV-DNA contamination. It can be concluded that BPV-DNA is present on the normal skin of horses affected by equine sarcoid and to a lesser degree, on the normal skin of horses living in contact with affected horses.

Estriol-induced dose-dependent DNA synthesis in normal human mammary epithelium in vitro.

Normal human adult resting mammary gland explants were cultured during 7 days. The influence of hormones on DNA synthesis was assessed by autoradiography after incubation with tritiated-thymidine. Estriol was added to the medium at 3 different concentrations. With 0.01 ng/ml the labeling index remained at the level observed in the controls in the basic unenriched medium. A 10- and 100-fold increase of estriol elicited a transient, significant and dose-related increase of DNA synthesis on the 2nd day of organ culture. Estriol gave a qualitatively different profile of DNA synthesis than estradiol at 1.0 ng/ml. The results are compared with the effect of progesterone.

LY377770, a novel iGlu5 kainate receptor antagonist with neuroprotective effects in global and focal cerebral ischaemia.

We have evaluated the neuroprotective effects of the decahydroisoquinoline LY377770, a novel iGlu5 kainate receptor antagonist, in two models of cerebral ischaemia. Global ischaemia, induced in gerbils by bilateral carotid artery occlusion (BCAO) for 5 min, produced a large increase in locomotor activity at 96 hr post-occlusion and a severe loss of CA1 cells in the hippocampus histologically at 120 hr post-occlusion. LY377770 (80 mg/kg i.p. 30 min before or 30 min after BCAO followed by 40 mg/kg i.p. administered at 3 and 6 hr after the initial dose) attenuated the ischaemia-induced hyperactivity and provided (92%) and (29%) protection in the CA1 cells respectively. This protection was greater than that seen with maximally tolerated doses of other glutamate receptor antagonists (CGS19755, CPP, MK-801, ifenprodil, eliprodil, HA-966, ACEA1021, L701,324, NBQX, LY293558, GYKI52466 and LY300164). Focal ischaemia was induced by infusing 200 pmol of endothelin-1 (Et-1) adjacent to the middle cerebral artery and LY377770 was administered at 80 mg/kg i.p. immediately, 1 or 2 hr post-occlusion followed by 40 mg/kg i.p. 3 and 6 hr after the first dose. The infarct volume, measured 72 hr later, was reduced by LY377770 when given immediately (P<0.01), at 1 hr (P<0.05) but not significantly at 2 hr post-occlusion. Reference compounds, LY293558 (20 mg/kg i.p. and then 10 mg/kg as above) and MK-801 (2.5 mg/kg i.p. ), both administered immediately post-occlusion produced significant (P<0.05) but somewhat less neuroprotection. In parallel microdialysis studies, LY377770 (75 mg/kg i.p.) attenuated ischaemia-induced increases in extracellular levels of glutamate, but not of dopamine. In conclusion, these results indicated that iGlu5 kainate receptors play a central role in ischaemic brain damage following global and focal cerebral ischaemia. LY377770 is a novel, soluble, systemically active iGlu5 antagonist with efficacy in global and focal ischaemia, even when administered post-occlusion. LY377770 may therefore be useful as a neuroprotectant in man.

Clinicopathologic hallmarks of mammary tubular carcinoma.

Tubular carcinoma of the human breast is a rather uncommon neoplasm, which is characterized by particular histopathologic features and which seems to be either "scored down" (as grade I carcinoma) or overdiagnosed. Since this special variant of mammary cancer has been shown to respond more favorably to therapy than do common infiltrating carcinomas, its recognition as a genuine entity is important. Nineteen cases were studied and compared with the 110 tubular carcinomas reported in the literature. The basic clinicopathologic and histopathologic characteristics of true tubular carcinoma are discussed.

Histologic classification of pure primary epithelial breast cancer.

Current classifications of breast cancer are based on either morphologic descriptive or histogenetic criteria. The positive features and shortcomings of the most commonly used systems are presented. Our knowledge of breast cancer leads validity to a histogenetic topographic classification, a modification of which is suggested.

Clinicopathologic findings in endometrial polyps.

A study of endometrial polyps in biopsy specimens of symptomatic women showed 311 cases in a population of 1305 patients, an incidence of 23.8%. The highest incidence was seen in the fifth decade of life, and approximately one-fifth occurred after menopause. More than half of the subjects complained of metrorrhagia. Nearly half of the endometria exhibited proliferative changes; basal-type polyps accounted for only one-fifth of the total.

Endometrial biopsy interpretation. Shortcomings and problems in current gynecologic practice.

The analysis of 345 endometrial biopsies was carried out with special regard to the relation between pathologic findings and presenting symptoms or complaints. Only 52.4% of the biopsies showed microscopic features possibly related to the complaints. Endometrial polyps and chronic endometritis were diagnosed in 21.1 and 9.8%, respectively, of the entire study group. The currently accepted definitions of dysfunctional uterine bleeding raise the question whether endometrial polyps and atypical secretory changes may or may not be included in the syndrome.

Neurochemical changes and laser Doppler flowmetry in the endothelin-1 rat model for focal cerebral ischemia.

Generalized neurotransmitter overflow into the extracellular space, after cerebral ischemia, has been suggested to contribute to subsequent neuronal death. This study aims to investigate the striatal release of the neurotransmitters dopamine (DA), glutamate (Glu) and gamma-aminobutyric acid (GABA) by means of microdialysis, in a rat model for focal transient cerebral ischemia. Ischemia was induced by the application of 120 pmol endothelin-1 (Et-1), adjacent to the middle cerebral artery (MCA) in freely moving rats. Ischemia produced a large increase in extracellular striatal DA concentrations (2400%), Glu (5500%) and GABA (800%) concentrations. Laser Doppler flowmetry in anaesthetized rats, indicated that the blood flow within the striatum decreased by 75+/-11%. The period of sustained drop of blood flow, was dose-dependently related to the concentration Et-1 injected. Histological analysis of brain slices, taken from anaesthetized and conscious animals, indicated a 500 pmol dose of Et-1 was required to produce a similar infarct in anaesthetized rats to a 120 pmol dose of Et-1 in freely moving rats. The immediate drop in striatal blood flow, and the prompt increase of extracellular DA, after the micro-application of Et-1, were quite striking. This suggests that the DA release, rather than the Glu overflow may be the primary event initiating the cascade of processes ultimately leading to cell death and neurological deficits.

The effects of LY393613, nimodipine and verapamil, in focal cerebral ischaemia.

This study evaluates the effects of N-(2-[bis (4-fluorophenyl)methoxy]ethyl)-1-butanamine hydrochloride (LY393613), a novel neuronal (N/P/Q-type) Ca(2+) channel blocker, in ischaemia. For comparison, two commonly used L-type Ca(2+) channel blockers; nimodipine and verapamil were also evaluated. Ischaemia was induced in freely moving rats by micro-injection of endothelin-1 near the middle cerebral artery. In vivo microdialysis, laser Doppler flowmetry and histology were used to monitor ischaemia. Administration of LY393613, before and after the insult, attenuated the ischaemia-induced glutamate release, but not the dopamine release. Both nimodipine and verapamil failed to affect transmitter releases significantly, when administered post-occlusion. None of the compounds tested, produced any significant change in striatal blood flow. Histology showed that ischaemic damage was significantly less in LY393613 pre-treated rats. In conclusion, LY393613, a neuronal N/P/Q-Ca(2+) channel blocker, can attenuate ischaemic brain damage. The protective mechanism appears to be mainly the attenuation of the ischaemia-induced glutamate release, rather than its effect on cerebral hemodynamics.

Relevance of epidurography and epidural adhesiolysis in chronic failed back surgery patients.

OBJECTIVE: Pain treatment in the chronic failed back surgery patient remains problematic. Defining the pathogenesis of the pain could be helpful in treatment. The assumption that epidural fibrosis and adhesions might play an important role in the origin of the pain is verified. DESIGN: We investigated 34 patients in whom peridural fibrosis was suspected. An epidural catheter was inserted via the sacral hiatus. Injections of contrast dye, local anesthetic, corticosteroid, and hypertonic NaCl 10% were carried out daily for 3 days. Spread of the contrast dye in the epidural space was evaluated after 10 and 20 ml injection volume. SETTING: Subjects were patients in a pain clinic of a university hospital in Belgium. PATIENTS: Chronic pain patients with failed back surgery syndrome were examined. Nerve pathology was demonstrated and epidural fibrosis suspected or proved with magnetic resonance imaging (MRI) examination. OUTCOME MEASURES: Improvement in the contrast filling defects of the epidural space were noticed during treatment and correlated with pain improvement. RESULTS: Filling defects were noted in 30 of the 34 patients investigated. After the third day an objective improvement of contrast spread was documented in 14 patients. In seven patients improvement in pain occurred for only a very limited period (1 month). Statistical analysis (chi square analysis) could not demonstrate that improvement of contrast spread was correlated with better pain behavior. In 16 patients no improvement in contrast spread could be visualized. Pain improvement occurred in only four patients and for a limited period of 1 month. Long-term results are even worse. CONCLUSION: Epidurography might confirm epidural filling defects for contrast dye in the patients with epidural fibrosis. A better contrast dye spread, assuming scar lysis, does not guarantee a sustained pain relief. A more direct visualization of the resulting functional changes after adhesiolysis as with epiduroscopy might be useful.

Ovarian morphology during and after lynestrenol treatment around menopause.

In this histological study, the inhibition of continuous oral administration of lynestrenol 5 mg/day on the ovarian follicle and corpus luteum development was found to be extremely pronounced. Known estrogen - producing structures such as antral, mature follicles and corpora lutea were completely absent during treatment. Structures devoid of cystic function however, as persistent and cystic follicles and follicular cysts, seemed not to be influenced in their histological appearance and frequency. As the recovery of the cyclic ovarian function after cessation of the medication compares favorably with the spontaneous cycle, a continuous lynestrenol treatment of 5 mg/day can be regarded as a safe endocrinological regimen.