Diagnosis and management of a ruptured 20-week anencephalic cornual ectopic pregnancy undergoing termination: implications of interstate travel due to restrictive abortion law.

In the changing legal environment of obstetric care in the USA, with laws in many states banning termination at all stages of pregnancy with narrow exemptions, healthcare providers are encountering cases in which risk to maternal safety is increased. This report presents a case of a 28-year-old primigravida with an anencephalic fetus who was legally unable to pursue termination in her home state. She traveled to another state in order to pursue safe and legal abortion of a non-viable fetus. Due to an unrecognized cornual ectopic gestation, the delivery resulted in uterine rupture, the need for hysterectomy, and significant morbidity in a patient with a strong desire for future fertility.

Description of Micellar Radii for Phase Behavior and Viscosity Modeling of Aqueous Surfactant Solutions and Microemulsions.

The study of surfactant solutions and microemulsions is relevant for many industrial applications that include oil recovery, environmental remediation, and detergency. Understanding the coupled nature of microstructure, phase behavior, and rheology can help in the design of these applications. The microstructure of surfactant solutions and microemulsions determines their equilibrium properties, including phase composition and viscosity. Modeling microemulsion phase behavior by explicitly defining the shape and size of micelles allows for the consistent estimation of phase viscosity. We define a coupled microstructure-phase behavior-viscosity model by considering a two-dimensional lattice, where micelles are assumed to be elliptical. We also define equivalent three-dimensional models, where micelles are assumed to be oblate and prolate spheroids. The compositional dependence of the micellar radii is defined such that the oil-internal-bicontinuous-water-internal structural transitions are consistent with experimental observations. The model offers physical insights by modeling the transition between oil-internal-bicontinuous-water-internal regions in ternary diagrams as critical events, which are then tied to the unusual behavior observed in viscosity and scattering.

Coupled Interfacial Tension and Phase Behavior Model Based on Micellar Curvatures.

This article introduces a consistent and robust model that predicts interfacial tensions for all microemulsion Winsor types and overall compositions. The model incorporates film bending arguments and Huh's equation and is coupled to phase behavior so that simultaneous tuning of both interfacial tension (IFT) and phase behavior is possible. The oil-water interfacial tension and characteristic length are shown to be related to each other through the hydrophilic-lipophilic deviation (HLD). The phase behavior is tied to the micelle curvatures, without the need for using the net average curvature (NAC). The interfacial tension model is related to solubilization ratios in order to introduce a coupled interfacial tension-phase behavior model for all phase environments. The approach predicts two- and three-phase interfacial tensions and phase behavior (i.e., tie lines and tie triangles) for changes in composition and HLD input parameters, such as temperature, pressure, surfactant structure, and oil equivalent alkane carbon number. Comparisons to experimental data show excellent fits and predictive capability.

Renal donors with prostate cancer, no longer a reason to decline.

OBJECTIVE: To fully assess the true risk of prostate cancer transmission in during renal transplantation. METHODS: A full review of all existing literature relevant to the topic. RESULTS: There has not been a single documented case of transmission of prostate cancer during renal transplant. Prostate cancer in deceased organ donors has an incidence estimated between 3% and 18.5% and over 100 transplants have been performed using organs from donor with proven prostate cancer without issue. CONCLUSION: Transmission of prostate cancer through kidney transplantation seems very unlikely. The risks of remaining on the waiting list are outweighed by a transmission risk and the potential benefit makes the case to have clear guidelines about donor prostate malignancy when accepting potential organs.

Sources of occupational stress in NSW and ACT dentists.

BACKGROUND: This study aimed to identify and understand the chronic sources of work stress in the NSW and ACT dentistry context. Further, the study examines whether Australian dentists are exposed to similar sources of work stress as dentists internationally. METHODS: A purposive sample of registered members of the NSW Branch of the Australian Dental Association (ADA) were interviewed. Participants were selected because they represented the key characteristics of the broader ADA population. Interviews were recorded and fully transcribed. Themes were identified, developed, refined and clarified using established and rigorous methods of interview investigation and analysis. RESULTS: A total of 18 dentists participated in the study. Inductive content analysis was used to develop six main categories of chronic sources of stress. These groupings were time and scheduling pressures, professional concerns, patient/public perceptions of dentists, staffing problems, pressures associated with treating patients and business process stressors. CONCLUSIONS: Like their international counterparts, Australian dentists are subject to a variety of job-specific stressors. However, the most notable difference between Australian and international dentists relates to the business side of dentistry. It would appear that the Australian statutory, regulatory and industrial relations environment place unique and profound pressures on Australian dentists.

Ontogeny and stand condition influence the dispersal behavior of a defoliating specialist caterpillar.

A 4-yr field study was carried out to study the dispersal behavior of young larvae of the eastern spruce budworm (Choristoneura fumiferana Clemens) (Lepidoptera: Tortricidae) within and between crowns of balsam fir (Abies balsamea (L.) Miller), through the peak to decline of an outbreak. Newly hatched neonates, searching for overwintering sites in the fall, were frequently captured in sticky traps as they dispersed via "ballooning" (on silken threads) between and within tree crowns. A relatively small proportion of neonates were also captured on sticky tapes as they walked down the trunk toward the lower crown, where most larvae overwinter. In the spring, second-instar larvae (L2) searching for feeding sites also ballooned within and between trees, but were also frequently captured on traps on all crown levels as they walked up trunks. Over the course of our study, defoliation in our study trees increased, and current-year shoot availability decreased significantly, perhaps influencing L2 in search of food to disperse more frequently among hosts via ballooning. Results of our study suggest that the foraging priorities of neonates and L2 significantly influence larval dispersal behaviors and that spruce budworm larvae may vary behaviors in response to changing host condition during an outbreak.

Temporal and spatial variations in microclimate influence the larval foraging behaviors and performance of a conifer-feeding sawfly.

Herbivorous insects are often exposed to broad temporal and spatial variations in microclimate conditions within their host plants and have adapted a variety of behaviors, such as avoidance or basking, to either offset or benefit from such variation. Field experiments were carried out to investigate the influence of daily and intratree variations in microclimate on the behaviors (feeding, resting, dispersal, and hiding) and associated performance of late-instar larvae of the yellowheaded spruce sawfly, Pikonema alaskensis (Rohwer) (Hymenoptera: Tenthredinidae) within crowns of 1.25-1.5 m tall black spruce (Picea mariana [Miller] Britton Sterns Poggenburg); late instars feed on developing shoots of young spruce and are often exposed to microclimatic extremes with unknown effects on performance. Larvae fed diurnally from just after dawn (0800 h) until dusk (2000 h) and rested throughout the night, with brief periods of dispersal occurring in the morning and evening. Neither larval behavior nor abiotic conditions differed significantly between the upper and lower crowns of trees. Temperature, humidity, and solar insolation all explained >90% of variation in feeding; however, sunrise and sunset were the most likely cues influencing diurnal behavior. Most larvae (94%) fed on the bottom, shaded side of shoots, and field experiments indicated that this behavior is adaptive with respect to microclimate, probably reducing hygrothermal stress. Thus, behavioral adaptations by P. alaskensis to daily and within-shoot microclimatic variation may reduce the risk of hygrothermal stress during dispersal or feeding, while still allowing larvae to feed on the preferred and highly nutritious upper crown foliage of young spruce.

A case of pseudo-xanthoma elasticum presenting with ischaemic claudication.

A 37-year-old man presented with symptoms of intermittent claudication. Investigations revealed atypical calf vessel disease but no obvious aetiology. Ten years later he re-presented with worsening symptoms. CT angiography confirmed the atypical pattern of lower limb arterial disease but also noted calcification of the renal parenchyma, myocardium and scrotum. A diagnosis of pseudo-xanthoma elasticum was confirmed by skin biopsy. Pseudo-xanthoma elasticum is a rare condition that presents infrequently to vascular surgeons. Early recognition should prompt aggressive risk factor management to slow accelerated atherosclerosis. Clinicians should be aware of the clinical features of this condition to allow early diagnosis.

Journeying with Alice: some things I don't know for certain.

In this narrative I reflect on those things I do not know for certain. The narrative is constructed around my experience of giving Alice, a patient at the hospice where I worked as a complementary therapist, a foot massage. The narrative reveals the possibility of caring in the context of hospice, notably the significance of paying attention to little things such as a foot massage, that made such a difference to Alice's care. The narrative further reveals factors that resist caring, in particular the impact of labelling people as difficult for whatever reason. The narrative stands as an exemplar of reflective practice as an opportunity to reveal and challenge those things I might claim to know but which in the mystery of the human-human encounter can never be known for certain. Only by being non-attached to knowing can the practitioner truly realise her or his caring potential.

Post-synaptic density-93 mediates tyrosine-phosphorylation of the N-methyl-D-aspartate receptors.

Src family protein kinases (SFKs) -mediated tyrosine-phosphorylation regulates N-methyl-D-aspartate (NMDA) receptor synaptic function. Some members of the membrane-associated guanylate kinase (MAGUK) family of proteins bind to both SFKs and NMDA receptors, but it is unclear whether the MAGUK family of proteins is required for SFKs-mediated tyrosine-phosphorylation of the NMDA receptors. Here, we showed by co-immunoprecipitation that post-synaptic density (PSD) -93, a member of the MAGUK family of proteins, interacts with the NMDA receptor subunits NR2A and NR2B as well as with Fyn, a member of the SFKs, in mouse cerebral cortex. Using a biochemical fractionation approach to isolate subcellular compartments revealed that the expression of Fyn, but not of other members of the SFKs (Lyn, Src, and Yes), was significantly decreased in synaptosomal membrane fractions derived from the cerebral cortex of PSD-93 knockout mice. Interestingly, we found that PSD-93 disruption causes reduction of tyrosine-phosphorylated NR2A and NR2B in the same fraction. Moreover, PSD-93 deletion markedly blocked the SFKs-mediated increase in tyrosine-phosphorylated NR2A and NR2B through the protein kinase C pathway after induction with 4-phorbol 12-myristate 13-acetate in cultured cortical neurons. Our findings indicate that PSD-93 appears to mediate tyrosine-phosphorylation of the NMDA receptors and synaptic localization of Fyn.

Youth of West Cameroon are at High Risk of Developing IDD due to Low Dietary Iodine and High Dietary Thiocyanate

Objectives: Hypothyroidism in utero leading to mental retardation is highly prevalent and recurrent in developing countries where iodine deficiency and thiocyanate overload are combined. So; to explore and identify human population's risks for developing iodine deficiency disorders and their endemicity in Western Cameroon; with the aim to prevent this deficiency and to fight again it; urinary iodine and thiocyanate levels were determined. Methods: The district of Bamougoum in Western Cameroon was selected for closer study due to its geographic location predisposing for iodine deficiency disorders (IDD). A comprehensive sampling strategy included 24-h urine samples collected over three days from 120 school-aged children. Urinary iodine and thiocyanate levels were measured by colorimetric methods. Results: Twenty one percent of boys between the ages 3 and 19 were classified as iodine deficient. The prevalence of thiocyanate overload in the same population was found to be 20. Conclusion: Presence of endemic iodine deficiency and excessive thiocyanate in the population indicates that the region is at risk of iodine deficiency disorder. A multifactorial approach that includes improvement of diet; increasing iodine and minimizing goitrogen substances intake; soil and crop improvement and an iodine supplementation program may help alleviate IDD in the affected area studied

A comparison of cyclizine and granisetron alone and in combination for the prevention of postoperative nausea and vomiting.

We conducted a randomised double-blinded study of 960 women undergoing day-case surgery to determine whether combination anti-emetic therapy of granisetron and cyclizine was more effective at decreasing the incidence of postoperative nausea and vomiting than these agents used alone. The women were randomly allocated to three groups to receive intravenous granisetron 1 mg, cyclizine 50 mg or both before induction of general anaesthesia. The incidence of postoperative nausea and vomiting was 77/322 (24%) in the granisetron group, 73/316 (23%) in the cyclizine group and 53/322 (17%) in those women given both drugs (p = 0.04). There was no difference in the requirement for rescue anti-emetic drugs. There were no differences in the anaesthetic techniques used in the three groups. We conclude that the risk of postoperative nausea and vomiting is less with cyclizine and granisetron given together than with either given alone.

Differential roles of neuronal and endothelial nitric oxide synthases during carrageenan-induced inflammatory hyperalgesia.

The present study investigated the role of neuronal nitric oxide synthase (nNOS) in carrageenan-induced inflammatory pain by combining genomic and pharmacological strategies. Intrathecal injection of the nNOS inhibitor 7-nitroindazole dose-dependently inhibited carrageenan-induced thermal hyperalgesia in both early and late phases in wild-type mice. However in nNOS knockout mice, carrageenan-induced thermal hyperalgesia remained intact in the early phase but was reduced in the late phase. Spinal Ca2+ -dependent nitric oxide synthase (NOS) activity in nNOS knockout mice was significantly lower than that in wild-type mice. Following carrageenan injection, although the spinal Ca2+ -dependent NOS activity in both wild-type and knockout mice increased, the enzyme activity in nNOS knockout mice reached a level similar to that in wild-type mice. On the other hand, no significant difference in spinal Ca2+ -independent NOS activity was noted between wild-type and nNOS knockout mice before and after carrageenan injection. Furthermore, intrathecal administration of the endothelial NOS (eNOS) inhibitor L-N5-(1-iminoethyl)-ornithinein nNOS knockout mice inhibited the thermal hyperalgesia in both early and late phases, though this inhibitor had no effect in wild-type mice. Meanwhile, Western blot showed that eNOS expression in the spinal cord of nNOS knockout mice was up-regulated compared with wild-type mice; immunohistochemical staining showed that the spinal eNOS was mainly distributed in superficial laminae of the dorsal horn. Finally, double staining with confocal analysis showed that the enhanced spinal eNOS was expressed in astrocytes, but not in neurons. Our current results indicate that nNOS plays different roles in the two phases of carrageenan-induced inflammatory pain. In this model, enhanced spinal eNOS appears to compensate for the role of nNOS in nNOS knockout mice.

Evidence of neuronal excitatory amino acid carrier 1 expression in rat dorsal root ganglion neurons and their central terminals.

The expression and distribution of the neuronal glutamate transporter, excitatory amino acid carrier-1 (EAAC1), are demonstrated in the dorsal root ganglion neurons and their central terminals. Reverse transcriptase-polymerase chain reaction shows expression of EAAC1 mRNA in the dorsal root ganglion. Immunoblotting analysis further confirms existence of EAAC1 protein in this region. Immunocytochemistry reveals that approximately 46.6% of the dorsal root ganglion neurons are EAAC1-positive. Most EAAC1-positive neurons are small and around 250-750 microm2 in surface area, and some co-label with calcitonin gene-related peptide (CGRP) or isolectin IB4. In the spinal cord, EAAC-1 immunoreactive small dot- or patch-like structures are mainly localized in the superficial dorsal horn, and some are positive for CGRP or labeled by isolectin IB4. Unilateral dorsal rhizotomy experiments further show that EAAC1 immunoreactivity is less intense in superficial dorsal horn on the side ipsilateral to the dorsal rhizotomy than on the contralateral side. The results indicate the presence of EAAC1 in the dorsal root ganglion neurons and their central terminals. Our findings suggest that EAAC1 might play an important role in transmission and modulation of nociceptive information via the regulation of pre-synaptically released glutamate.

Knockdown of spinal cord postsynaptic density protein-95 prevents the development of morphine tolerance in rats.

The activation of spinal cord N-methyl-D-aspartate (NMDA) receptors and subsequent intracellular cascades play a pivotal role in the development of opioid tolerance. Postsynaptic density protein-95 (PSD-95), a molecular scaffolding protein, assembles a specific set of signaling proteins around NMDA receptors at neuronal synapses. The current study investigated the possible involvement of PSD-95 in the development of opioid tolerance. Opioid tolerance was induced by intrathecal injection of morphine sulfate (20 microg/10 microl) twice a day for 4 consecutive days. Co-administration of morphine twice daily and PSD-95 antisense oligodeoxynucleotide (50 microg/10 microl) once daily for 4 days not only markedly reduced the PSD-95 expression and its binding to NMDA receptors in spinal cord but also significantly prevented the development of morphine tolerance. In contrast, co-administration of morphine twice daily and PSD-95 missense oligodeoxynucleotide (50 microg/10 microl) once daily for 4 days did not produce these effects. The PSD-95 antisense oligodeoxynucleotide at the doses we used did not affect baseline response to noxious thermal stimulation or locomotor function. The present study indicates that the deficiency of spinal cord PSD-95 attenuates the development of opioid tolerance. These results suggest that PSD-95 might be involved in the central mechanisms of opioid tolerance and provide a possible new target for prevention of development of opioid tolerance.

Intact carrageenan-induced thermal hyperalgesia in mice lacking inducible nitric oxide synthase.

To date, the exact role of inducible nitric oxide synthase (iNOS) in inflammatory pain remains controversial. In the present study, we combined a pharmacological strategy (using a selective iNOS inhibitor) with a genomic strategy (using mice lacking the iNOS gene) to address the function of iNOS in the central mechanism of carrageenan-induced persistent inflammatory pain. In the wild type mice, intrathecal administration of L-N(6)-(1-iminoethyl)-lysine, a selective iNOS inhibitor, significantly inhibited thermal hyperalgesia in the late phase but not in the early phase of carrageenan inflammation. Moreover, iNOS mRNA expression in the lumbar enlargement segments of the spinal cord was dramatically induced at 24 h (late phase) after injection of carrageenan into a hind paw. Interestingly, targeted disruption of iNOS gene did not affect carrageenan-induced thermal hyperalgesia in either the early (2-6 h) or late phase. In the lumbar enlargement segments of iNOS knockout mice, nitric oxide synthase (NOS) enzyme activity remained at a similar level to that of the wild type mice at 24 h after carrageenan injection. We found that intrathecal administration of 7-nitroindazole (a selective neuronal NOS inhibitor), but not L-N(5)-(1-iminoethyl)-ornithine (a selective endothelial NOS inhibitor), significantly reduced carrageenan-induced thermal hyperalgesia in both the early phase and the late phase in iNOS knockout mice. We also found that expression of neuronal NOS but not endothelial NOS in the lumbar enlargement segments was significantly increased in iNOS knockout mice compared with wild type mice at 24 h after carrageenan injection. Our results indicate that neuronal NOS might compensate for the function of iNOS in the late phase of carrageenan-induced inflammatory pain in iNOS knockout mice. This suggests that iNOS may be sufficient, but not essential, for the late phase of the carrageenan-induced thermal hyperalgesia.