Clinical and technical factors in endoscopic skull base surgery associated with reconstructive success.

BACKGROUND: In this study, we identified key discrete clinical and technical factors that may correlate with primary reconstructive success in endoscopic skull base surgery (ESBS). METHODS: ESBS cases with intraoperative cerebrospinal fluid (CSF) leaks at four tertiary academic rhinology programs were retrospectively reviewed. Logistic regression identified factors associated with surgical outcomes by defect subsite (anterior cranial fossa [ACF], suprasellar [SS], purely sellar, posterior cranial fossa [PCF]). RESULTS: Of 706 patients (50.4% female), 61.9% had pituitary adenomas, 73.4% had sellar or SS defects, and 20.5% had high-flow intraoperative CSF leaks. The postoperative CSF leak rate was 7.8%. Larger defect size predicted ACF postoperative leaks; use of rigid reconstruction and older age protected against sellar postoperative leaks; and use of dural sealants compared to fibrin glue protected against PCF postoperative leaks. SS postoperative leaks occurred less frequently with the use of dural onlay. Body-mass index, intraoperative CSF leak flow rate, and the use of lumbar drain were not significantly associated with postoperative CSF leak. Meningitis was associated with larger tumors in ACF defects, nondissolvable nasal packing in SS defects, and high-flow intraoperative leaks in PCF defects. Sinus infections were more common in sellar defects with synthetic grafts and nondissolvable nasal packing. CONCLUSIONS: Depending on defect subsite, reconstructive success following ESBS may be influenced by factors, such as age, defect size, and the use of rigid reconstruction, dural onlay, and tissue sealants.

[Comparative characteristics of enzymatic hydrolysis methods for isolating toxic substances from blood and hair]. / Sravnitel'naya kharakteristika metodik fermentativnogo gidroliza dlya izolirovaniya toksichnykh veshchestv iz tsel'noi krovi i volos.

The aim of study was to develop methods for the hydrolysis with hyaluronidases for the isolation of drugs (phenobarbital, diphenhydramine hydrochloride and phenibut) from biological objects (blood, hair) and to compare their effectivenes with previously developed methods of enzymatic hydrolysis. The studies were carried out using model «blood - model drug substance (MDS)¼, a natural and artificially colored wool (hair) of laboratory animals - guinea pigs of white, red and black natural colors, which were daily given a solution of MDS and then were subjected to cosmetic effects - coloring. The isolation of MDS from the model complex «blood - MDS¼ and from wool was carried out using the developed methods of hydrolysis with proteolytic enzymes (papain, chymopsin and chymotrypsin) and hyaluronidase. Phenobarbital and diphenhydramine from hydrolysates were extracted by liquid-liquid extraction method, phenibut - by direct freezing extraction with acetonitrile. The analysis of the extracts was carried out by gas chromatography with mass selective detection. The results showed that the developed methods of enzymatic hydrolysis can be recommended for isolating substances of various properties (acidic, amphoteric and alkaline) from blood, natural and artificially colored wool (hair).

[The development of the method for enzymatic hydrolysis for the extraction of toxic substances from the hair samples]. / Razrabotka metodiki fermentativnogo gidroliza dlia izolirovaniia toksichnykh veshchestv iz obraztsov volos.

The objective of the present study was to develop and validate the method for the extraction of toxic substances from the hair samples as exemplified by enzymatic hydrolysis of barbituric acid derivatives. The experiments were carried out with the use of laboratory animals (white female rats and albino guinea pigs) that had been daily given a phenobarbital solution per os during 4 months preceding the study. The hairs obtained from the experimental animals were subjected to acid hydrolysis with a 6 mole hydrochloric acid and enzymatic hydrolysis with the use of chymopsin, trypsin, chymotrypsin, and papain solutions. The analysis of the extracted materials was performed by means of gas chromatography with mass-selective detection. The application of the proposed method for enzymatic hydrolysis produced the better results than acid hydrolysis. This technique was validated. The results of the study made possible the comparative characteristic of the effectiveness of acid and enzymatic hydrolysis.

Nephrolithiasis among male patients with newly diagnosed gout.

INTRODUCTION: An elevated serum urate level is recognised as a cause of gouty arthritis and uric acid stone. The level of serum uric acid that accelerates kidney stone formation, however, has not yet been clarified. This study aimed to find out if a high serum urate level is associated with nephrolithiasis. METHODS: Patients were recruited from the rheumatology clinic of Taipei City Hospital (Renai and Zhongxing branches) in Taiwan from March 2015 to February 2016. A total of 120 Chinese male patients with newly diagnosed gout and serum urate concentration of >7 mg/dL and no history of kidney stones were divided into two groups according to their serum urate level: <10 mg/dL (group 1, n=80) and ≥10 mg/dL (group 2, n=40). The mean body mass index, blood urea nitrogen level, creatinine level, urinary pH, and kidney ultrasonography were compared between the two groups. RESULTS: There were no significant differences in blood urea nitrogen or creatinine level between the two groups. The urine pH in both groups was similar and not statistically significant. Kidney stone formation was detected via ultrasonography in 6.3% (5/80) and 82.5% (33/40) of patients in groups 1 and 2, respectively (P<0.05). CONCLUSION: A serum urate level of ≥10 mg/dL may precipitate nephrolithiasis. Further studies are warranted to substantiate the relationship between serum urate level and kidney stone formation.

Risk of adolescent offspring's completed suicide increases with prior history of their same-sex parents' death by suicide.

BACKGROUND: To investigate the risk of completed suicide in offspring during adolescence in relation to prior history of the same-sex parent's death by suicide and other causes. METHOD: A total of 500 adolescents who died by suicide at age 15-19 years between 1997 and 2007 were identified from the Taiwan Mortality Registration (TMR). For each case, 30 age- and time-matched controls were selected randomly from all adolescents registered in the Taiwan Birth Registry (TBR). A multivariate conditional logistic regression model was used to assess the risk of adolescent completed suicide in relation to their same-sex parent. RESULTS: Adolescent suicide risk was positively associated with both paternal [odds ratio (OR) 5.38, 95% confidence interval (CI) 2.17-13.33] and maternal suicide (OR 6.59, 95% CI 1.82-23.91). The corresponding risk estimates associated with paternal and maternal deaths from non-suicidal causes were much lower, at 1.88 and 1.94 respectively. The risk of suicide in male adolescents was significantly associated with prior history of paternal death by suicide (OR 8.23, 95% CI 2.96-22.90) but not of maternal death by suicide (OR 3.50, 95% CI 0.41-30.13). On the other contrary, the risk of suicidal death in female adolescents was significantly associated with prior history of maternal suicide (OR 9.71, 95% CI 1.89-49.94) but not of paternal suicide (OR 2.42, 95% CI 0.30-19.57). However, these differences did not reach statistical significance. CONCLUSIONS: Although limited by sample size, our study indicates that adolescent offspring suicidal death is associated with prior history of their same-sex parent's death by suicide.

QTL analysis of body weight and carcass body length traits in an F2 intercross between Landrace and Korean native pigs.

Growth traits, such as body weight and carcass body length, directly affect productivity and economic efficiency in the livestock industry. We performed a genome-wide linkage analysis to detect the quantitative trait loci (QTL) that affect body weight, growth curve parameters and carcass body length in an F2 intercross between Landrace and Korean native pigs. Eight phenotypes related to growth were measured in approximately 1000 F2 progeny. All experimental animals were subjected to genotypic analysis using 173 microsatellite markers located throughout the pig genome. The least squares regression approach was used to conduct the QTL analysis. For body weight traits, we mapped 16 genome-wide significant QTL on SSC1, 3, 5, 6, 8, 9 and 12 as well as 22 suggestive QTL on SSC2, 3, 4, 5, 6, 7, 8, 9, 10, 12, 16 and 17. On SSC12, we identified a major QTL affecting body weight at 140 days of age that accounted for 4.3% of the phenotypic variance, which was the highest test statistic (F-ratio = 45.6 under the additive model, nominal P = 2.4 × 10(-11) ) observed in this study. We also showed that there were significant QTL on SSC2, 5, 7, 8, 9 and 12 affecting carcass body length and growth curve parameters. Interestingly, the QTL on SSC2, 3, 5, 6, 8, 9, 10, 12 and 17 influencing the growth-related traits showed an obvious trend for co-localization. In conclusion, the identified QTL may play an important role in investigating the genetic structure underlying the phenotypic variation of growth in pigs.

First Report of Impatiens Downy Mildew Outbreaks Caused by Plasmopara obducens Throughout the Hawai'ian Islands.

Downy mildew of impatiens (Impatiens walleriana Hook.f.) was first reported from the continental United States in 2004. In 2011 to 2012, severe and widespread outbreaks were documented across the United States mainland, resulting in considerable economic losses. On May 5, 2013, downy mildew disease symptoms were observed from I. walleriana 'Super Elfin' at a retail nursery in Mililani, on the Hawai'ian island of Oahu. Throughout May and June 2013, additional sightings of the disease were documented from the islands of Oahu, Kauai, Maui, and Hawai'i from nurseries, home gardens, and botanical park and landscape plantings. Symptoms of infected plants initially showed downward leaf curl, followed by a stippled chlorotic appearance on the adaxial leaf surfaces. Abaxial leaf surfaces were covered with a layer of white mycelia. Affected plants exhibited defoliation, flower drop, and stem rot as the disease progressed. Based on morphological and molecular data, the organism was identified as Plasmopara obducens (J. Schröt.) J. Schröt. Microscopic observation disclosed coenocytic mycelium and hyaline, thin-walled, tree-like (monopodial branches), straight, 94.0 to 300.0 × 3.2 to 10.8 µm sporangiophores. Ovoid, hyaline sporangia measuring 11.0 to 14.6 × 12.2 to 16.2 (average 13.2 × 14.7) µm were borne on sterigma tips of rigid branchlets (8.0 to 15.0 µm) at right angle to the main axis of the sporangiophores (1,3). Molecular identification of the pathogen was conducted by removing hyphae from the surface of three heavily infected leaves using sterile tweezers, then extracting DNA using the QIAGEN Plant DNA kit (QIAGEN, Gaithersburg, MD). The nuclear rDNA internal transcribed spacer was sequenced from each of the three samples bidirectionally from Illustra EXOStar (GE Healthcare, Piscataway, NJ) purified amplicon generated from primers ITS1-O and LR-0R (4). Resultant sequences (GenBank KF366378 to 80) shared 99 to 100% nucleotide identity with P. obducens accession DQ665666 (4). A voucher specimen (BPI892676) was deposited in the U.S. National Fungus Collections, Beltsville, MD. Pathogenicity tests were performed by spraying 6-week-old impatiens plants (I. walleriana var. Super Elfin) grown singly in 4-inch pots with a suspension of 1 × 104 P. obducens sporangia/ml until runoff using a handheld atomizer. Control plants were sprayed with distilled water. The plants were kept in high humidity by covering with black plastic bags for 48 h at 20°C, and then maintained in the greenhouse (night/day temperature of 20/24°C). The first symptoms (downward curling and chlorotic stippling of leaves) and sporulation of the pathogen on under-leaf surfaces of the inoculated plants appeared at 10 days and 21 days after inoculation, respectively. Control plants remained healthy. Morphological features and measurements matched those of the original inoculum, thus fulfilling Koch's postulates. To our knowledge, this is the first report of downy mildew on I. walleriana in Hawai'i (2). The disease appears to be widespread throughout the islands and is likely to cause considerable losses in Hawai'ian landscapes and production settings. References: (1) O. Constantinescu. Mycologia 83:473, 1991. (2) D. F. Farr and A. Y. Rossman. Systematic Mycology and Microbiology Laboratory, ARS, USDA. Retrieved from http://nt.ars-grin.gov/fungaldatabases/ July 16, 2013. (3) P. A. Saccardo. Syllogue Fungorum 7:242, 1888. (4) M. Thines. Fungal Genet Biol 44:199, 2007.

First Report of the Powdery Mildews Leveillula taurica and Podosphaera pannosa on Rose Periwinkle in the United States.

In April 2013, unthrifty rose periwinkle (Catharanthus roseus (L.) G. Don) from a residential garden in Mililani, HI, was sent to the Hawaii Department of Agriculture. Symptoms, present on all plants, included leaf chlorosis, defoliation, and premature flower drop with necrotic spots on the adaxial side of leaves corresponding to patches of grayish mildew-like growth on the abaxial side. Samples were collected and sent to USDA PPQ National Identification Services (NIS) for confirmation. At NIS, stereoscope examination of the plants revealed two distinct powdery mildews. One, on the stems and leaves, had dimorphic conidia, with lanceolate primary (54 to 72 × 14 to 22 µm) and cylindrical secondary conidia (49 to 75 × 11 to 21 µm) (n = 25 for each), both with a reticulate surface. This fungus was identified morphologically as Leveillula taurica (Lév.) G. Arnaud (1). The second powdery mildew appeared confined to the sepals and petals. The external hyphae of this fungus produced upright chains of cylindrical to ovoid conidia (up to eight per chain), which contained fibrosin bodies and measured 22 × 12 µm (n = 50) with straight foot cells averaging 43 µm long, placing this fungus in the genus Podosphaera Kunze (1). Plants containing both fungi were accessioned as BPI892677 in the US National Fungal Collection. For molecular characterization, genomic DNA of the Podosphaera was obtained by scraping conidia from a petal and extracting with Thermo Scientific's Lyse and Go PCR Reagent. DNA of the Leveillula was extracted from 5 mm2 of infected leaf using Qiagen's Plant mini kit. The ITS region of each fungus was amplified and sequenced directly with primers ITS1F and ITS4. Each consensus sequence was created from manually edited chromatograms, searched against NCBI's GenBank using MegaBLAST and phylogenetically analyzed in MEGA5.2 under maximum parsimony (MP) in context with most similar hits and representatives from phylogenetic studies (2,3). Sequences from types of these fungi are not available for comparison. The resulting Podosphaera phylogeny grouped the Podosphaera suspect (GenBank KF703448) within a clade of P. pannosa (e.g., AB525938; bootstrap = 90). The Leveillula phylogeny grouped the Leveillula suspect (KF703447) within a clade (bootstrap = 88) of L. taurica (e.g., AB044346), L. chrozophorae (AB044346), and L. elaeagni (AB048350). Although the ITS sequences of these taxa are phylogenetically indistinguishable, morphological characters differentiate each species and the suspect as L. taurica (1). L. taurica has been recorded on C. roseus in India and Korea (1). This is the first report of L. taurica on C. roseus in the United States. This is the first report of P. pannosa on C. roseus worldwide. P. pannosa is commonly known as a powdery mildew of Rosaceae hosts, and has also been reported on hosts in the Anacardaciae and Oleaceae (1). P. pannosa represents the second Podosphaera species reported on any member of the Apocynaceae, with P. sparsa reported on other Apocynaceae genera (1). The presence of two powdery mildew genera on different parts of the same plant could cause multiple forms of damage and impact the production of this popular landscape ornamental plant. References: (1) U. Braun and R. T. A. Cook. Taxonomic Manual of the Erysiphales (Powdery Mildews), CBS Biodiversity Series No. 11. CBS, Utrecht, Netherlands, 2012. (2) S. A. Khodoparast et al. Mycol. Res. 105:909, 2001. (3) S. Takamatsu et al. Persoonia 24:38, 2010.

First Report of Rust Caused by Pucciniastrum boehmeriae on Mamaki (Pipturus albidus) in Hawaii.

Pipturus albidus (Hook. & Arn.) A. Gray or mamaki is a flowering plant species in the Urticaceae (nettles) endemic to the Hawaiian Islands. Mamaki is a forest and agricultural commodity, as well as a traditional medicinal and fiber crop. In August 2013, leaf rust was observed in Kuristown, Hawaii, on 15 mamaki plants. Infected leaves had vein-delimited chlorotic spots on the adaxial surface and yellow to orange uredinia on the abaxial surface. Uredinia were scattered, minute, pulverulent, subepidermal, and dome-shaped with a central pore, consistent with Pucciniastrum. Urediniospores were 16 to 23 × 10 to 14 µm, echinulate, ellipsoid to pyriform, walls hyaline, 0.5 µm thick, contents pale yellow to bright yellow. No teliospores were observed. A voucher specimen was deposited in the U.S. National Fungus Collections (BPI 892695). The only species of Pucciniastrum previously known on Pipturus, Pucciniastrum pipturi Syd. [syn. Uredo pipturi (Syd.) Hirats. f.], has larger urediniospores, 26.5 to 40.0 × 19.5 to 27.5 µm, and is currently reported from Japan and the Philippines (3). The pathogen was identified as Pucciniastrum boehmeriae (Dietel) Syd. & P. Syd., which infects Boehmeria Jacq., also in the Urticaceae, and has urediniospores that are 18 to 27 × 13 to 18 µm and similar in shape (2). DNA was extracted from uredinial lesions and the nuclear ribosomal internal transcribed spacer (ITS2) region and the 5' end of large subunit (28S) rDNA were amplified and sequenced following the protocol of Aime (1). The resulting fragment (GenBank Accession No. KF711854) was 100% identical to authenticated and vouchered P. boehmeriae ITS2/28S rDNA sequences (AB221449 to AB221451 and AB221391 to AB221393) (4). Sequences from P. pipturi are not available for comparison, but host family, molecular, and morphological data support the identification of the rust as P. boehmeriae, which is found throughout eastern Asia. To our knowledge, this is the first report of P. boehmeriae on mamaki and the first report in Hawaii on any host. Plant health professionals and regulatory officials can utilize this information to establish survey methods and implement appropriate management practices for this rust disease. References: (1) M. C. Aime. Mycoscience 47:112, 2006. (2) N. Hiratsuka. Revision of Taxonomy of the Pucciniastreae. Kasai Publishing and Printing, Tokyo, 1958. (3) M. Kakishima and T. Kobayashi. Mycoscience 35:125, 1994. (4) Y.-M. Liang et al. Mycoscience 47:137, 2006.

[Expression of BDNF neurotrophin in the hippocampus and neocortex of rats during the development of post-stress anxiety and its correction by hypoxic postconditioning].

Using quantitative immunohistochemistry, changes in the expression of the BDNF (Brain-Derived Neurotrophic Factor) were studied in the hippocampus and neocortex of 24 male Wistar rats during the development of post-stress-related anxiety state in the experimental model of posttraumatic stress disorder, and its correction by hypoxic postconditioning (PC). For the induction of anxiety state, combined severe psychoemotional stress was applied (immobilization, forced swimming, ether stress followed 7 days later by repeated immobilization - restress). Correction of the anxiety state was achieved by application of hypoxic PC, which included three sessions of mild hypobaric hypoxia (360 mm Hg, 2 h, daily). The formation of the anxiety pathology was accompanied by a significant reduction in the expression of immunoreactive BDNF in dorsal (CA1) and ventral (dentate gyrus) hippocampus and neocortex, while hypoxic PC resulted in partial (hippocampus) or complete (neocortex) restoration of BDNF expression. The results indicate that the neurotrophic factors, and BDNF in particular, seem to play an important role in the pathogenesis of the anxiety-depressive disorders as well as in mechanisms of proadaptive and neuroprotective effects of hypoxic PC.

[The suppression of a herpes simplex virus reproduction with drug resistance by combination 15lys-bis-nt and phosphate of acycloguanosine with some antiherpetic drugs].

Antiherpetic activity of the double and triple combinations, including original connections 15Lys-bis-Nt and phosphate of acycloguanosine (P-ACG), was studied in vitro. For the first time, it was demonstrated that in case of their combined use with known antiherpetic agents, whose activity does not depend on TK of HSV (PFA, AraA, CDV, Rib, GLN, αa-IFN), synergistic or additive effects of interaction was observed. The antiviral effect of the tested combinations was studied on the model of ACG-resistant viral strain. The tested combinations could be of interest for practical medicine.

[Effect of a new derivative of glutamic and apovincaminic acids on brain metabolism in post-ischemic period].

Neuroprotective properties of the new derivative of glutamic and apovincaminic acids, ethyl -(3-alpha,16-alpha)-eburnamenin-14-carbopxylate of 2-aminopentadionic acid (LHT 1-02) were studied on a model of acute brain ischemia in cats. LHT 1-02 has proved to be more effective than the reference drugs vinpocetin and glycine in preventing the reperfusive damage, which was manifested by decreased postischemic hyperglycemia, activated utilization of oxygen in the brain, and suppressed postischemic metabolic lactate acidosis. Thus, the results of this comparative study show expediency of further investigations of LHT 1 - 02 as a potential neuroprotective drug.

First Report in Hawai'i of Xanthomonas citri pv. mangiferaeindicae Causing Bacterial Black Spot on Mangifera indica.

Bacterial black spot of mango (Mangifera indica) caused by Xanthomonas citri pv. mangiferaeindicae (Xcm), is an economically important disease in tropical and subtropical areas (3). Xcm can infect a wide range of mango cultivars and induces raised, angular, black leaf lesions, sometimes with a chlorotic halo. Fruit symptoms appear as small, water-soaked spots on the lenticels that become star-shaped, erumpent, and exude an infectious gum (3). The bacterium can also cause latent infections (2). Immature mango fruit with black spots on the epidermis were collected in August 2012 from mango trees of the cvs. Raposa and Pirie at a residence in Pukalani, Hawai'i, on the island of Maui. Similar symptoms were seen on a tree of the mango cv. Common (also known as 'Spanish' or 'Lahaina') at a nearby golf course. Mango fruit with black lesions, and leaves showing black lesions with yellow halos, were collected in August 2012 from mango trees of the cv. Haden at a residence in Kaimuki, Hawai'i, on the island of O'ahu. Xanthomonas-like bacterial colonies were isolated on TZC agar. Suspect colonies were non-pigmented on YDC agar. A fruit strain of the bacterium from Maui (A6081A) and a strain from each of a fruit (A6081B) and a leaf (A6082) from O'ahu were each gram-negative, oxidative, positive for both starch and esculin hydrolysis, and negative for nitrate reduction, resulting in presumptive identification as a Xanthomonas sp. The three strains were further characterized by Microlog (Biolog, Inc. Hayward, CA), which showed the closest match with X. campestris. In addition, 16S rDNA PCR assays showed the closest match (99% similarity) with X. citri strains, and RIF marker analysis of dnaA (4) grouped the three strains with Xcm strain LMG 941 (Accession No. CAHO01000002.1). Hypersensitivity responses typical of xanthomonads were observed when these strains were infiltrated into tobacco leaves, whereas no response was observed using sterile water. Leaves of 3-week-old mango seedlings were infiltrated using 10 µl (~108 CFU/ml) of each strain suspended in sterilized water (six to eight inoculations per leaf, four leaves per plant, and three replicate plants per strain). The negative control treatments consisted of inoculation with sterile water, as well as an incompatible pathogen, X. hortorum pv. vitians (A6076), isolated from lettuce. Typical symptoms of bacterial black spot were observed for all strains assayed approximately 2 weeks after inoculation. No lesions were observed on the negative control plants. Koch's postulates were satisfied following reisolation and identification of the Xanthomonas strains from the infected plant tissues, using the biochemical and PCR methods described above. Results for strains from the two islands confirmed published descriptions of the pathogen, indicating that the pathogen causing symptoms on these mango trees is Xcm (1). Cultures and infected plant samples were sent to USDA APHIS and CPHST NPGLB facilities where this identification was confirmed. To our knowledge, this is the first report of bacterial black spot of mango in Hawai'i or anywhere in the United States. It is unknown whether this disease is a new occurrence or has not been reported previously. The origin of the primary inoculum is unknown. References: (1) B. Manicom and F. Wallis. Int. J. Syst. Bacteriol. 34:77, 1984. (2) O. Pruvost et al. Microbial Ecol. 58:928. (3) O. Pruvost et al. Plant Dis. 95:774, 2011. (4) K. Schneider et al. PLoS 6:e18496, 2011.

A radiation hybrid map of mouse genes.

A comprehensive gene-based map of a genome is a powerful tool for genetic studies and is especially useful for the positional cloning and positional candidate approaches. The availability of gene maps for multiple organisms provides the foundation for detailed conserved-orthology maps showing the correspondence between conserved genomic segments. These maps make it possible to use cross-species information in gene hunts and shed light on the evolutionary forces that shape the genome. Here we report a radiation hybrid map of mouse genes, a combined project of the Whitehead Institute/Massachusetts Institute of Technology Center for Genome Research, the Medical Research Council UK Mouse Genome Centre, and the National Center for Biotechnology Information. The map contains 11,109 genes, screened against the T31 RH panel and positioned relative to a reference map containing 2,280 mouse genetic markers. It includes 3,658 genes homologous to the human genome sequence and provides a framework for overlaying the human genome sequence to the mouse and for sequencing the mouse genome.

How to approach jaundice in the MRCP PACES exam.

For every medical trainee, the Membership of the Royal College of Physicians' Practical Assessment of Clinical Examination Skills (PACES) exam is one of the most difficult exams they must face in their career. It is designed to assess the clinical knowledge and skills of the trainee doctors who are entering higher specialist training. It sets rigorous standards to ensure the competence of the candidates across a range of skills. This article discusses a systematic approach to a patient with jaundice, which is a commonly encountered station in the exam, so that candidates will become more familiar with common causes and how to differentiate between these, as well as important bedside examination skills.

Urbanization and prevalence of depression in diabetes.

OBJECTIVES: To depict recent secular trend (2001-2005) in prevalence of depression among diabetic population in Taiwan, and to explore the influences of urbanization on the prevalence of depression. STUDY DESIGN: A descriptive correlation study design relating urbanization and prevalence of depression. METHODS: Annual prevalence of depression was calculated as the ratio of number of individuals with depression (ICD-9-CM: 296, 309, or 311) to the size of diabetic population (ICD-9-CM: 250), which were ascertained from ambulatory care claim data of Taiwan's National Health Insurance between 2001 and 2005. Multivariate Poisson regression analysis was used to assess the secular trend in the prevalence of comorbid depression, and to appraise the influence of urbanization on prevalence of depression in diabetic patients. RESULTS: The prevalence of depression among diabetic population increased annually from 22.6/10(3) in 2001 to 27.0/10(3) in 2005 with a significantly and linearly rising trend (ß = 0.0461, p < 0.0001). Diabetic population living in urban areas showed the largest increase in prevalence (6.3/10(3)), followed by those from rural areas (5.6/10(3)). Compared to the diabetic patients residing in rural areas, those living in urban areas (RR = 1.28, 95% CI = 1.25-1.31) and those from satellite towns (RR = 1.22, 95% CI = 1.19-1.25) both had significantly increased adjusted RR. CONCLUSIONS: There is a significant increasing trend in prevalence of depression among diabetic population in recent years in Taiwan. Diabetic patients from urban areas not only had the greatest prevalence of depression but also showed the largest increase in prevalence during the study period, which highlights a need for managing depression in urban diabetes.

Effects of prolonged intensive training on the resting levels of salivary immunoglobulin A and cortisol in adolescent volleyball players.

AIM: Concerns have been raised regarding the effects of prolonged intensive training on adolescent athletes. This study investigated the differences in mucosal immune functions and stress responses between intensively trained male adolescent volleyball players and age-matched sedentary controls. METHODS: Twelve male volleyball players (16.5 [0.7] years of age) and sixteen healthy sedentary male volunteers (17.1 [0.6] years of age) participated in this study. Volleyball players were engaged in regular and year-round training. Unstimulated saliva samples were collected from volleyball players during the high-intensity training period and from the counterparts at the same timepoints after at least 18 hours of rest. Concentrations of salivary total protein, secretory immunoglobulin A (SIgA), cortisol, and lactoferrin were measured. RESULTS: Results of this study revealed that the SIgA concentrations and the ratio of SIgA/total protein in volleyball players were significantly lower compared with those in sedentary controls. However, the salivary cortisol concentrations and the ratio of cortisol/total protein in volleyball players were markedly higher compared with those in sedentary controls. No significant difference was observed in lactoferrin levels between volleyball players and sedentary controls. CONCLUSION: The findings of this study suggest that the prolonged intensive training may elicit a sustained stress and induce a suppressive effect on mucosal immunity in regularly and intensively trained adolescent athletes.

[Efficacy of surgical treatment of medullary thyroid carcinoma in patients with regional and distant metastases].

Results of surgical treatment of 93 primary patients with medullary thyroid carcinoma within 1995-2009 years, including 26 (28%) - with hereditary disease (MEN2 syndrome) were analyzed. The best long-term results were observed in group of noninvasive tumor without metastases at the time of operation (39% - clinical and biochemical recovery, 32% - clinical remission). No one patient with extrathyroid tumor invasion and regional/distant metastases has completely recovered. Hereditary forms of disease are more aggressiveness in comparison with sporadic carcinomas with higher rate of distant metastases (31 and 21%) and worse survival. In sporadic group 3 (6%) patients and in hereditary group - 4 (12%) died from progression of distant metastases within 8-15 years after primary operation. Complete recovery was seen only after radical primary operations. Repeated surgery was palliative. Implementation of calcitonine screening and genetic testing for Ret-protooncogene mutation is an important task for Ukraine medicine to improve results of medullary carcinoma treatment.