Solitary jejunal diverticulum: a rare unexpected cause of chronic pneumoperitoneum.

Jejunal diverticula are a rare acquired herniation of the mucosa and submucosa through the muscularis propria. They are asymptomatic in the majority of cases; however, they can present with non-specific abdominal symptoms and rarely complicate leading to acute abdomen. Perforation usually results in symptoms and signs of acute peritonitis and it is not an identifiable aetiology of chronic pneumoperitoneum. Computed tomography scanning may identify intestinal wall oedema, air bubbles travelling through the mesentery, free intra-abdominal air and/or fluid. Radiological diagnosis requires a high index of suspicion of such pathology. We report a case of an isolated jejunal diverticulum as a cause for aseptic chronic pneumoperitoneum.

Erratum to: Oxytocin enhances the appropriate use of human social cues by the domestic dog (Canis familiaris) in an object choice task.

Erratum to: Anim Cogn (2015) 18:767­775 DOI 10.1007/s10071-015-0843-7. Unfortunately, in the original publication the word 'receptor' under the sub-heading 'The effect of gender on the efficacy of oxytocin' has been incorrectly published as 'peptide'. The correct text should read as below. Oestrogen is known to enhance the production of oxytocin and its receptor (Rissman 2008), and this may explain why the female dogs in this study did not perform as well as human female subjects in other tests of social cognition, as the majority (88 %) had been spayed, thereby reducing the volume of oestrogen their bodies would be producing. The online version of the original article can be found under doi:10.1007/s10071-015-0843-7.

Oxytocin enhances the appropriate use of human social cues by the domestic dog (Canis familiaris) in an object choice task.

It has been postulated that the neuropeptide, oxytocin, is involved in human-dog bonding. This may explain why dogs, compared to wolves, are such good performers on object choice tasks, which test their ability to attend to, and use, human social cues in order to find hidden food treats. The objective of this study was to investigate the effect of intranasal oxytocin administration, which is known to increase social cognition in humans, on domestic dogs' ability to perform such a task. We hypothesised that dogs would perform better on the task after an intranasal treatment of oxytocin. Sixty-two (31 males and 31 females) pet dogs completed the experiment over two different testing sessions, 5-15 days apart. Intranasal oxytocin or a saline control was administered 45 min before each session. All dogs received both treatments in a pseudo-randomised, counterbalanced order. Data were collected as scores out of ten for each of the four blocks of trials in each session. Two blocks of trials were conducted using a momentary distal pointing cue and two using a gazing cue, given by the experimenter. Oxytocin enhanced performance using momentary distal pointing cues, and this enhanced level of performance was maintained over 5-15 days time in the absence of oxytocin. Oxytocin also decreased aversion to gazing cues, in that performance was below chance levels after saline administration but at chance levels after oxytocin administration.

Prone extralevator abdominoperineal excision of the rectum with porcine collagen perineal reconstruction (Permacol™): high primary perineal wound healing rates.

PURPOSE: Extralevator abdominoperineal excision of the rectum (elAPER) is arguably the modern surgical approach to low rectal cancer and yet results in large defects that may necessitate plastic surgical reconstruction. This study aims to evaluate the quality of prone elAPER surgery with Permacol™ repair of the perineum. The primary end point studied was the rate of primary perineal wound healing. METHODS: Data were prospectively collected for consecutive patients having prone elAPER at a single institution to assess surgical morbidity together with pathological and cancer-specific outcomes. RESULTS: Between 2006 and 2012, 48 patients had prone elAPER with median age of 63 (40-86). Thirty-four patients (72.3%) received neoadjuvant treatment. Median length of stay was 9 days (6-66). With a prone approach, three patients had specimen perforation (6.4%) and seven patients had circumferential margin involvement (14.9%). Complete perineal wound healing was achieved in 34 patients (73.9%) at 4 weeks. Four patients (8.3%) were unhealed at 6 months; one patient required a perineal sinus to be laid open, and another patient required plastic surgical reconstruction. No perineal wound herniae have been identified during follow-up. CONCLUSIONS: Acceptable oncological outcomes are achieved with the prone extralevator approach. The technique achieves high rates of primary healing, making it an attractive option in centres without access to plastic reconstructive expertise.

Antitropical distributions and species delimitation in a group of ophiocomid brittle stars (Echinodermata: Ophiuroidea: Ophiocomidae).

In this paper we examine the phylogeny and biogeography of the temperate genera of the Ophiocomidae (Echinodermata: Ophiuroidea) which have an interesting asymmetrical anti-tropical distribution, with two genera (Ophiocomina and Ophiopteris) previously considered to have a separate species in both the North and South hemispheres, and the third (Clarkcoma) diversifying in the southern Australian/New Zealand region. Our phylogeny, generated from one mitochondrial and two nuclear markers, revealed that Ophiopteris is sister to a mixed Ophiocomina/Clarkcoma clade. Ophiocomina was polyphyletic, with O. nigra and an undescribed species from the South Atlantic Ocean sister to a clade including Clarkcoma species and O. australis. The phylogeny also revealed a number of recently diverged lineages occurring within Clarkcoma, some of which are considered to be cryptic species due to the similarity in morphology combined with the apparent absence of interbreeding in a sympatric distribution, while the status of others is less certain. The phylogeny provides support for two transequatorial events in the group under study. A molecular clock analysis places both events in the middle to late Miocene. The analysis excludes a tectonic vicariance hypothesis for the antitropical distribution associated with the breakup of Pangaea and also excludes the hypothesis of more recent gene flow associated with Plio/Pleistocene glacial cycling.

Sympatric cryptic species in the crinoid genus Cenolia (Echinodermata: Crinoidea: Comasteridae) delineated by sequence and microsatellite markers.

The marine species of the southern coast of Australia have not been well studied with regard to molecular connectivity. Cryptic species are expected to be prevalent on this coastline. Here, we investigate the crinoid genus Cenolia (Echinodermata: Crinoidea: Comasteridae) using molecular methods to elucidate cryptic species and phylogenetic relationships. The genus Cenolia dominates the southern Australian crinoid fauna in shallow waters. Few studies have examined crinoids for cryptic species at a molecular level and these have been predominantly based on mitochondrial data. We employ the nuclear markers 28S rRNA and ITS-2 in addition to the mitochondrial COI. Six divergent mitochondrial clades were identified. Gene flow between confirmed clades was subsequently examined by the use of six novel microsatellite markers, showing that sympatric taxa with low mtDNA divergences (1.7% K2P) were not interbreeding in the wild. The type specimens of Cenolia benhami and C. spanoschistum were examined, as well as all six divergent clades. Morphological characters dividing taxa were refined. Due to comb pinnule morphology, the New Zealand species benhami was determined to belong to the genus Oxycomanthus (nov. comb.). Three new species of Cenolia (including the Australian "benhami") require description.

Current transport across the pentacene/CVD-grown graphene interface for diode applications.

We investigate the electronic transport properties across the pentacene/graphene interface. Current transport across the pentacene/graphene interface is found to be strikingly different from transport across pentacene/HOPG and pentacene/Cu interfaces. At low voltages, diodes using graphene as a bottom electrode display Poole­Frenkel emission, while diodes with HOPG and Cu electrodes are dominated by thermionic emission. At high voltages conduction is dominated by Poole­Frenkel emission for all three junctions. We propose that current across these interfaces can be accurately modeled by a combination of thermionic and Poole­Frenkel emission. Results presented not only suggest that graphene provides low resistive contacts to pentacene where a flat-laying orientation of pentacene and transparent metal electrodes are desired but also provides further understanding of the physics at the organic semiconductor/graphene interface.

Stable hole doping of graphene for low electrical resistance and high optical transparency.

We report on the p doping of graphene with the polymer TFSA ((CF(3)SO(2))(2)NH). Modification of graphene with TFSA decreases the graphene sheet resistance by 70%. Through such modification, we report sheet resistance values as low as 129 Ω, thus attaining values comparable to those of indium-tin oxide (ITO), while displaying superior environmental stability and preserving electrical properties over extended time scales. Electrical transport measurements reveal that, after doping, the carrier density of holes increases, consistent with the acceptor nature of TFSA, and the mobility decreases due to enhanced short-range scattering. The Drude formula predicts that competition between these two effects yields an overall increase in conductivity. We confirm changes in the carrier density and Fermi level of graphene through changes in the Raman G and 2D peak positions. Doped graphene samples display high transmittance in the visible and near-infrared spectrum, preserving graphene's optical properties without any significant reduction in transparency, and are therefore superior to ITO films in the near infrared. The presented results allow integration of doped graphene sheets into optoelectronics, solar cells, and thermoelectric solar cells as well as engineering of the electrical characteristics of various devices by tuning the Fermi level of graphene.

De novo SCN1A mutations in migrating partial seizures of infancy.

OBJECTIVE: To determine the genetic etiology of the severe early infantile onset syndrome of malignant migrating partial seizures of infancy (MPSI). METHODS: Fifteen unrelated children with MPSI were screened for mutations in genes associated with infantile epileptic encephalopathies: SCN1A, CDKL5, STXBP1, PCDH19, and POLG. Microarray studies were performed to identify copy number variations. RESULTS: One patient had a de novo SCN1A missense mutation p.R862G that affects the voltage sensor segment of SCN1A. A second patient had a de novo 11.06 Mb deletion of chromosome 2q24.2q31.1 encompassing more than 40 genes that included SCN1A. Screening of CDKL5 (13/15 patients), STXBP1 (13/15), PCDH19 (9/11 females), and the 3 common European mutations of POLG (11/15) was negative. Pathogenic copy number variations were not detected in 11/12 cases. CONCLUSION: Epilepsies associated with SCN1A mutations range in severity from febrile seizures to severe epileptic encephalopathies including Dravet syndrome and severe infantile multifocal epilepsy. MPSI is now the most severe SCN1A phenotype described to date. While not a common cause of MPSI, SCN1A screening should now be considered in patients with this devastating epileptic encephalopathy.

Wings or winds: inferring bat migration in a stepping-stone archipelago.

Eocene ocean currents and prevailing winds correlate with over-water dispersals of terrestrial mammals from Africa to Madagascar. Since the Early Miocene (about 23 Ma), these currents flowed in the reverse direction, from the Indian Ocean towards Africa. The Comoro Islands are equidistant between Africa and Madagascar and support an endemic land vertebrate fauna that shares recent ancestry predominantly with Madagascar. We examined whether gene flow in two Miniopterus bat species endemic to the Comoros and Madagascar correlates with the direction of current winds, using uni- and bi-parentally inherited markers with different evolutionary rates. Coalescence-based analyses of mitochondrial matrilines support a Pleistocene (approximately 180,000 years ago) colonization event from Madagascar west to the Comoros (distance: 300 km) in the predicted direction. However, nuclear microsatellites show that more recent gene flow is restricted to a few individuals flying against the wind, from Grande Comore to Anjouan (distance: 80 km).

Intraarticular injection of anakinra in osteoarthritis of the knee: a multicenter, randomized, double-blind, placebo-controlled study.

OBJECTIVE: To evaluate the clinical response, safety, and tolerability of a single intraarticular injection of anakinra in patients with symptomatic osteoarthritis (OA) of the knee. METHODS: Patients with OA of the knee were enrolled in a multicenter, double-blind, placebo-controlled study and randomized 2:1:2 to receive a single intraarticular injection of placebo, anakinra 50 mg, or anakinra 150 mg in their symptomatic knee. Patients were evaluated for 12 weeks postinjection. The primary end point was the change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score from baseline to week 4. Safety assessments included the evaluation of adverse events (AEs), laboratory tests, and vital signs. Pharmacokinetic parameters were assessed in a subset of patients. RESULTS: Of 170 patients who enrolled, 160 (94%) completed the study. The mean improvements from baseline to week 4 in the WOMAC score were not statistically different between the placebo group and the patients who received 50 mg of anakinra (P = 0.67) or 150 mg of anakinra (P = 0.77). Anakinra was well tolerated. No withdrawals due to AEs or serious AEs, and no serious infections or deaths were reported. No clinically significant trends were noted in laboratory values or vital signs. Pharmacokinetic parameters demonstrated that the mean terminal half-life of anakinra in serum after intraarticular injection was approximately 4 hours. CONCLUSION: Anakinra was well tolerated as a single 50-mg or 150-mg intraarticular injection in patients with OA of the knee. However, anakinra was not associated with improvements in OA symptoms compared with placebo.

Safety of extended treatment with anakinra in patients with rheumatoid arthritis.

OBJECTIVE: To determine the safety profile of anakinra after extended exposure in a diverse clinical trial population of patients with rheumatoid arthritis. METHODS: A six month, randomised, double blind phase comparing anakinra (100 mg/day) with placebo was followed by open label anakinra treatment for up to three years in patients with rheumatoid arthritis. Concomitant non-steroidal anti-inflammatory drugs, corticosteroids, and other disease modifying antirheumatic drugs were permitted. RESULTS: In all 1346 patients with rheumatoid arthritis received anakinra for up to three years. Patients had varying levels of disease severity, concomitant drug use, and comorbid conditions. Cumulative, exposure adjusted event (EAE) rates for all adverse events (AEs), serious AEs, and deaths were similar during each year of anakinra treatment; the overall rate (0 to 3 years) was similar to that observed for controls during the blinded phase. The most frequent AEs were injection site reactions (122.26 events/100 patient-years), rheumatoid arthritis progression (67.80 events/100 patient-years), and upper respiratory infections (26.09 events/100 patient-years). The EAE rate of serious infections was higher for patients treated with anakinra for 0 to 3 years (5.37 events/100 patient-years) than for controls during the blinded phase (1.65 events/100 patient-years). However, if the patient was not receiving corticosteroid treatment at baseline, the serious infection rate was substantially lower (2.87 event/100 patient-years). The overall incidence of malignancies was consistent with expected rates reported by SEER. Neutralising antibodies developed in 25 patients, but appeared to be transient in 12; neutralising antibody status did not appear related to occurrence of malignancies or serious infections. There were no clinically significant trends in laboratory data related to anakinra. CONCLUSION: Anakinra is safe and well tolerated for up to three years of continuous use in a diverse population of patients with rheumatoid arthritis.

Comparison of disease progression and mortality of connective tissue disease-related interstitial lung disease and idiopathic interstitial pneumonia.

OBJECTIVE: To compare disease progression and mortality between idiopathic interstitial pneumonia (IIP) and interstitial lung disease (ILD) due to connective tissue diseases (CTD) including scleroderma, rheumatoid arthritis, systemic lupus, polymyositis, dermatomyositis, Sjögren's syndrome, and mixed CTD. METHODS: A case-control study of patients with CTD-ILD (n = 46) and IIP controls (n = 51), seen at the University of Michigan between July 1,1998 and June 30,1999 and followed until March 30, 2002, was conducted. Survival analysis and Cox regression were performed to estimate survival, accounting for demographic and clinical parameters, including pulmonary function tests and high resolution computed tomography (HRCT) diagnosis and scoring. RESULTS: Median followup time was 4.4 person-years. Five-year survival in the IIP group was 51.9% (95% confidence interval [95% CI] 30.8-69.4) versus 43.4% (95% CI 21.1-63.9) in the CTD-ILD group. There were no significant differences among HRCT diagnostic categories between IIP and CTD-ILD. A fibrotic score > or = 2 was associated with decreased survival among the entire group. Age at diagnosis and most recent forced vital capacity were significant predictors of mortality when adjusted for IIP versus CTD-ILD diagnosis, sex, and interstitial score. CONCLUSION: Contrary to expectation, CTD-ILD compared with IIP appears to be associated with a worse prognosis when adjusted for age. A higher fibrotic score is suggestive of decreased survival.

Molecular systematics and biogeography of the bent-wing bat complex Miniopterus schreibersii (Kuhl, 1817) (Chiroptera: Vespertilionidae).

The complete mitochondrial ND2 gene (1037 bp) was sequenced to examine relationships within the bent-wing bat complex, Miniopterus schreibersii (Family Vespertilionidae). It was found that M. schreibersii is a paraphyletic assemblage comprising several species. Two major lineages were identified, one of which was restricted to the Palearctic-Ethiopian regions and the other to the Oriental-Australasian regions. This pattern of differentiation was mirrored by the genus as a whole. Speciation and differentiation within the genus Miniopterus appears to have a hierarchical geographical pattern. The earliest divergence corresponds to the Ethiopian-Palearctic and the Oriental-Australasian biogeographical zones. This early divergence is then followed by radiations within each of the Ethiopian, Oriental and Australasian regions. The study also revealed that the number of species currently recognized (11 or 13) is a gross underestimate of the number of actual species. The emerging picture is one of a relatively speciose genus with most species having relatively restricted distributions; few, if any, occur in more than one biogeographical region.

Illumination of x-rays: the usual lights exposed.

AIMS: Faced with pressure of work and limited resource, doctors frequently use the nearest available light to examine x-ray films. The aim of this study was to examine the relative intensities of hospital light sources, and to compare these with the light intensity guidelines (1500 to 3000 candelas) of the British Institute of Radiology. METHODS: The relative intensities of seven hospital light sources were examined using a standard light meter at a constant 30 cm from the source. A control group of 10 individual consultant's x-ray viewing boxes were compared with six other ward based light sources. RESULTS: Only two light sources approached the British Institute of Radiology light intensity x-ray viewing criteria: the x-ray viewing boxes of consultant radiologists with a median light intensity of 3503 candelas (chi(2)=13.3, df 1; p=0.0001), and daylight from north facing windows with a median of 1464 candelas when overcast (chi(2)=8.571, df 1; p=0.003) and 4669 candelas in sunshine (chi(2)= 6.364, df 1; p=0.0001). CONCLUSION: Few hospital light sources met the British Institute of Radiology guidelines. The long held high regard of artists for northern light appears justified even in the environment of a British district general hospital.

Complementary and alternative therapies for fibromyalgia.

Fibromyalgia (FM) is a syndrome of chronic widespread musculoskeletal pain that is accompanied by sleep disturbance and fatigue. Clinical treatment usually includes lifestyle modifications and pharmacologic interventions meant to relieve pain, improve sleep quality, and treat mood disorders. These therapies are often ineffective or have been shown in clinical studies to have only short-term effectiveness. Pharmacologic treatments have considerable side effects. Patients may have difficulty complying with exercise-based treatments. Thus, patients seek alternative therapeutic approaches and physicians are routinely asked for advice about these treatments. This article reviews nontraditional treatment alternatives, from use of nutritional and herbal supplements to acupuncture and mind-body therapy. Little is known about efficacy and tolerance of complementary and alternative therapies in FM and other chronic musculoskeletal pain syndromes. Most studies on these treatments have been performed for osteoarthritis, rheumatoid arthritis, or focal musculoskeletal conditions. Clinical trials are scarce; the quality of these trials is often criticized because of small study population size, lack of appropriate control interventions, poor compliance, or short duration of follow-up. However, because of widespread and growing use of alternative medicine, especially by persons with chronic illnesses, it is essential to review efficacy and adverse effects of complementary and alternative therapies.

Knowledge and attitudes about vaginal birth after Caesarean section in Australian hospitals. VBAC Study Group. Vaginal Birth After Caesarean.

A survey of staff attitudes and knowledge about vaginal birth after Caesarean section (VBAC) was undertaken in Australian hospitals. There was a high response rate (67%), and over 900 responses were analysed. Generally, there was a high level of awareness about outcomes and the relative importance of many issues in considering VBAC. Registrars, consultants and midwives differed significantly in some aspects of their knowledge and attitudes to VBAC. There was also a wide range of opinion within each group. Approximately half (53%) of respondents believed patients should be actively encouraged to consider VBAC, whereas 47% felt it should be simply presented as an option.